Older, but not wiser: how men get information about AIDS and sexually transmitted diseases after high school

CONTEXT: As they reach adulthood, young men are less likely to use condoms and are at increased risk for exposure to AIDS and other sexually transmitted diseases (STDs). Little is known about which prevention efforts reach men in their 20s. METHODS: Longitudinal data from the 1988, 1990-1991 and 1995 waves of the National Survey of Adolescent Males are used to identify sources of information about AIDS and STDs among 1,290 young men aged 22-26. Information receipt from four main sources, the topics covered by each source and the personal characteristics associated with getting more information are all explored. RESULTS: Twenty-two percent of men surveyed discussed disease prevention topics with a health provider in the last year, 48% attended a lecture or read a brochure, 51% spoke to a partner, friend or family member, and 96% heard about AIDS or STDs from the media (e.g., television advertisements, radio or magazine). Excluding media sources, 30% of young men reported getting no STD or AIDS prevention messages in the last year. Being black or Hispanic, having had a physical exam or an AIDS test in the last year, and having discussions about AIDS or STDs with parents or a health care provider in the past were associated with receiving more information. CONCLUSIONS: Although young men who are at higher risk for STD or HIV infection are more likely than other young men to get information about disease prevention, young adult men are much less likely than adolescents to receive AIDS or STD prevention education. More prevention efforts need to be aimed at young adults.     

青少年与成年人艾滋病知、信、行对照研究及干预措施探讨

为比较青少年与成年人对艾滋病问题的看法、认识以及某些行为方面的问题,对２６３名中学生和２３３名成年人进行了调查。结果明显：两组人群对艾滋病知识掌握情况并不乐观,于少年优于成年人;高中生与成年人认为艾滋病威胁到本人的比例分别为２５．１０％、３７．８０％,不赞同婚前性行为的分别为３８．８０％、５７．５０％;两组人群知识来源前３位均为报刊书籍杂志、电视广播和宣传展览。提示动员全社会力量深入开展艾滋病健康     

Risk factors for HIV and other sexually transmitted diseases among adolescents in St. Petersburg, Russia.

CONTEXT: Over the past several years, there have been sharp increases in the prevalence of HIV and other sexually transmitted diseases (STDs) among young people in Russia. Very little is known about Russian adolescents' behaviors and attitudes that might influence their risk of acquiring these infections. METHODS: A 1995 survey of 533 students aged 15-17 attending eight St Petersburg high schools assessed their sexual risk practices, AIDS-specific attitudes and beliefs, sexual relationship patterns and preferences, and social characteristics. RESULTS: Overall, 39% of students were sexually experienced, and these young people had had, on average, 3.4 sexual partners. Only 29% of sexually experienced students said they consistently used condoms, and 29% said they never did. Unprotected vaginal intercourse was the predominant and preferred sexual practice; it also was the practice that most often occurred with students' last sexual partner. In all, 28% of students defined "safer sex" as condom use. Many young people believed that AIDS is a threat only to members of particular "risk groups"; relatively few believed that they could get AIDS (17%) or said that AIDS information had influenced their sexual behavior (29% of those who were sexually experienced). Females were more likely than males to prefer having an exclusive partner, and males were more likely to prefer having casual partners. CONCLUSIONS: Educational and behavioral interventions are urgently needed to help young people in Russia avoid HIV and other STDs. Risk and social characteristics identified in this study can help to guide the development and tailoring of risk reduction interventions.     

Gender and class differences in young people's sexuality and HIV/AIDS risk‐taking behaviours in Thailand

This study examines gender and class differences in young people's beliefs about sexuality and HIV/AIDS risk‐taking behaviours in Thailand. Sixty young people aged 15–19, divided equally by gender and socioeconomic background, participated in focus groups and in‐depth interviews. Four topics were explored: the differences between ‘good’ and ‘bad’ girls/boys; young people's perceptions of sexuality; social class variations in young people's knowledge of HIV/AIDS and perceptions of risk; and the most influential institutions shaping young people's sexual attitudes. Results showed that young people screened potential sexual partners utilizing an image of ‘good girls/boys' as potential HIV/AIDS‐free partners; young people defined sexuality in terms of love/sexual relationships, premarital sex, promiscuity, and virginity; and HIV/AIDS awareness varied according to class. Young people of all classes failed to demonstrate an in‐depth understanding of how they can contract AIDS. They neither viewed themselves as being in an at‐risk group, nor considered their sexual behaviours to be at‐risk behaviours. Finally, family, friends, and mass media were reported to be among the most influential institutions shaping young people's sexual attitudes. In the struggle against HIV/AIDS, these institutions together with health education not only protect but also can empower young people in Thailand.     

AIDS and Muslim communities: opening up

In October 1995, the Pakistan AIDS Prevention Society held an international meeting to explore the relationship of Muslim religious and political concepts with HIV transmission, medical care, and human rights. Participants noted that interpretations of the Koran are often inaccurately used to deny women equality and that marriage practices increase women's vulnerability to gender inequalities. It was recommended that all men and women study the Koran to combat inaccurate teachings, including justifications for such practices as female genital mutilation. Participants also expressed concern about the lack of information people living in Muslim societies have about reproduction, sexuality, HIV/AIDS, and sexually transmitted diseases. Exploration of the culturally-sensitive issues surrounding AIDS requires cooperation and understanding between leaders and educators and the formation of "safe" channels of information such as free, confidential telephone lines. Participants supported efforts to endorse the right of people with HIV/AIDS to receive compassionate treatment in an atmosphere of confidentiality. An increased number of counselors was called for to help individuals and families and to refer people to the new forms of self-help organizations which will become necessary. Finally, the need to train program managers, policy-makers, staff, and volunteers in appropriate skills was identified. Networking was seen as a means to reduce the sense of isolation which pervades the operating climate for many nongovernmental organizations.     

Experiences and Perceptions of Sexuality and HIV/AIDS among Young People with Physical Disabilities in a South African Township: a Case Study

This study explored the experiences and perceptions of sexuality and HIV/AIDS among 15–24 year-old young people with physical disabilities in a South African Township characterised by high unemployment rates and lack of social services. Ten young people and ten parents participated in multiple individual interviews as well as in focus group discussions. The analysis of audio taped and transcribed responses identified common experiences and perceptions among participants. The results indicate that disabled young people have limited factual knowledge about sexuality and HIV/AIDS. The decisions and choices they make about sexual behaviour are not informed by what they know; rather, they are part of the whole life situation in Nyanga. Their need to be loved and accepted, need for job security and family life, were more important than practicing ‘safe sex’. Therefore, there is need for HIV/AIDS programme developers to take into account the experiences and perceptions of the target population.In this paper the phrases ‘young people with physical disabilities’ and disabled young people’ are used interchangeably.     

The AIDS pandemic: changes in the believability and use of information sources

Over 20,000 Americans under 25 years old are infected with HIV every year. In 1994, AIDS was the number one killer of adults between the ages of 25 and 44 years old. Education concerning HIV is critical to the prevention of AIDS. Both the public and private sectors, including government agencies, cause-related organizations, medical professionals, and promotion specialists must determine the best information sources to educate young people. However, with many television shows that appeal to young adults condoning casual sex, it is increasingly difficult to generate motivation to act responsibly. This paper examines the effectiveness of information sources, sponsored by both the government and private organizations, about HIV. Given the impact of media publicity regarding the AIDS virus and the "hard-hitting" messages and public service announcements about AIDS, implications about ethical issues, public policy issues, and media strategies to educate the public about AIDS are discussed. While publicity and specific types of television programming were found to be the most believable and most often used information sources for health issues, there are many strategic implications concerning promotion strategies, targeting, and positioning for both the public and private sectors.     

Individual‐ and School‐Level Correlates of HIV Testing among Secondary School Students in Kenya

The policy framework guiding Kenya's response to the AIDS epidemic identifies voluntary counseling and testing as crucial to risk reduction and HIV‐preventive activities. Yet in Kenya, as in most sub‐Saharan countries, voluntary testing rates are low, especially among young people. Using hierarchical linear models, we identify both individual‐ and teacher/school‐level factors that affect voluntary HIV testing among secondary school students in Kenya. Results indicate that adolescents are more likely to test for HIV serostatus when they are knowledgeable about testing, have been involved in HIV/AIDS activities in primary school, have been provided with HIV information in secondary school, perceive themselves as at high risk of contracting HIV or know of someone infected with or who has died from HIV/AIDS, and have ever engaged in sexual intercourse. Barriers include fear of going to testing centers and being perceived as HIV‐positive. Teacher/school‐level characteristics are relevant for explaining rates of HIV testing, especially among girls. To encourage testing, policymakers should attend to teacher/school‐level factors as well as individual characteristics of students.     

HIV/AIDS and sexual behaviour among youth in Zambia

This study was carried out in selected urban areas in Zambia; its objective was to examine the sexual networking and activities of urban youth in Zambia: specifically to determine how sexual behaviour among young people might influence the course of the AIDS epidemic and also to suggest policy interventions. Sexual behaviour among young people both in-school and out-of-school, aged between 12 and 25, may be vital in influencing the spread of AIDS in Zambia. The results indicate that sexual matters are discussed with close friends of the same sex and peer group, or with cousins who are of the same age. Sometimes grandmothers are consulted for advice by co-resident grand-daughters. Girls and boys engaged in sex or thought about engaging in sex at quite an early age. Girls discussed their intentions about sex with their close friends, many of whom appeared poorly informed about sex themselves. The general views of both sexes about STDs should be a source of concern. The youth do not seem to take STDs seriously basically because most of them, aside from AIDS, are curable. Many young people do not regard AIDS as a threat to their lives and do not even consider it as a hindrance to sexual relationships. A number of recommendations are made for information and education of young people, parents and teachers.     

Evolution of mortality amongst the youth of Navarra: 1985-1995

Recent publications show that mortality rates amongst young people and adolescents in some industrialised countries have increased in recent years. The addition of new diseases such as AIDS, which principally affect the young population, to those inevitable deaths brought about through causes such as traffic accidents has increased interest in this public health problem. The number of deaths and the adjusted global mortality rates amongst men and women of 15-34 years did not increase in Navarra in the 1985-1995 period. These are situated around 70 per 100,000. Changes have taken place in the pattern of causes, similar to those observed in other industrialised areas, with an increase of deaths through overdose and AIDS, and a decline in mortality due to traffic accidents in recent years. Traffic accidents were the first cause of death amongst youths until 1993. From this year onwards deaths from AIDS became the first cause amongst women, while amongst men the number of deaths from AIDS is equal to those caused by traffic accidents.     

Preventing HIV transmission: the perspective of inner-city Puerto Rican adolescents.

PURPOSE: To examine the development of HIV prevention strategies that address the concerns and needs of urban Puerto Rican adolescents. METHODS: The study included 542 Puerto-Rican adolescents, divided into age sets of 12 to 14 years and 15 to 19 years. Participants were recruited from community work programs, recreation centers, schools, drug rehabilitation programs, and directly from neighborhood streets in North Philadelphia. A hierarchical series of peer-facilitated group techniques and interviews allowed adolescents to generate, prioritize and explain strategies. The study question was developed in focus groups. Ideas were generated and prioritized in Nominal Technique Groups. The ideas with the highest priority were used to develop a survey that allowed participants to rank those they believed would be most effective. Participants then clarified the top-ranked ideas in open focus groups. RESULTS: In both age sets, the strategy perceived as the most effective in preventing HIV-risk behaviors was "Have people who are HIV-infected talk to teens." Similar ideas addressing this theme varied in perceived effectiveness. The second and third rated ideas among participants aged 12 to 14 years were "Teach teens how HIV infects them, " and "Show teens how people die from AIDS." The second and third rated ideas among participants aged 15 to 19 years were "Show teens what AIDS does to people " and "Have parents be more supportive of teens, so if they are having sex, they can encourage them to use condoms." Other top-ranked ideas included the development of community programs, increased efficacy and availability of condoms, and assessing partners for the risk of HIV infection. Three items revealed significant gender differences. Males were more likely to rate "Give out more free condoms" and "Educate teens in schools about AIDS." Females aged 15 to 19 years were more likely to rate "Teens should know their partner's background before having sex." CONCLUSIONS: To develop effective prevention strategies for youth, their views of the problems and interpretations of proposed solutions must be understood.     

Confidentiality With Adolescents in the Medical Setting: What Do Parents Think?

Purpose

When confidential health care is provided to adolescents they are more likely to seek care, disclose sensitive information, and return for future visits. Guidelines for health professionals recommend seeing young people alone to facilitate confidential care. We sought to document parental views regarding confidentiality with adolescents, aiming to identify topics that parents believe they should be informed about despite an assurance of confidentiality between their child and the doctor. We also aimed to document harms and benefits that parents associate with adolescents seeing doctors alone.

Methods

A sample of 86 parents attending an adolescent medicine clinic with their son/daughter was surveyed using a brief, anonymous questionnaire.

Results

Parents identified several benefits associated with confidential care, yet also believed they should be informed about a wide range of topics, even if their children did not want them to know. Parents' primary concern about confidentiality was a fear of not being informed about important information.

Conclusions

Parental views concerning confidentiality are complex and conflicting and differ from current guidance provided to health professionals. Ensuring that parents accurately understand the limits to confidentiality and support the notion of confidential care for their children is a challenging yet vital task for health professionals.     

Preventing the sexual transmission of AIDS during adolescence

In order to be effective, the national effort to contain the spread of Acquired Immuno deficiency Syndrome (AIDS) must include a youth focus. Knowledge of adolescent sexual behavior, drug use, sexually transmitted diseases suggests that many adolescents are in jeopardy of acquiring Human Immuno deficiency Virus (HIV) infections; and they are among those most likely to benefit from preventative efforts as they explore adult roles and lifestyles. Preventative education should particularly target gay and other homosexually active young men. Effective teaching uses a variety of media, both inside and outside the classroom. Learning about AIDS is most likely to effect behavioral change when accompanied by other programs to build social supports, self-esteem, and positive identity. The ethical and rational use of HIV antibody testing may be a helpful adjunct to education for certain adolescents. Ultimately, our society's ability to address complex, associated social issues will determine our ability to control AIDS.     

Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC).

There is concern about the high prevalence of adolescent sexual health problems, such as sexually transmitted diseases (STDs) and unwanted pregnancies, that currently exist in the UK. If young people are to reduce their risk from HIV/AIDS and other STDs it is imperative, in the first instance, they know what the risks are and how they can avoid them. However, effective school-based sex education can only be delivered if there are accurate data on young people's current levels of knowledge and existing sex education needs. This paper details findings from the WHO: Health Behaviours of School-aged Children Study on the changes that have occurred between 1990 and 1994 in Scottish school-children's knowledge, attitudes and perceived educational needs in relation to HIV/AIDS. There have been significant changes in knowledge and attitudes that may affect their sexual behaviour, e.g. in their attitudes to condom use, risk of HIV/AIDS and other STDs, and also other sexual health problems, such as the risk of unwanted pregnancies and abortions. Finally, areas that require future research and recommendations for future sexual health education interventions are highlighted.     

AIDS and sex education for young people in China

Although China has had a rich sexual culture for thousands of years, Chinese people are usually unwilling to openly discuss issues of sex. Some parents are quite ignorant of the change in their children's sexual attitude and behaviour. In China today, adolescents are becoming much more sexually liberated. Premarital sex and unplanned pregnancies among teenagers are increasing. Sexually transmitted diseases (STD) including HIV/AIDS are also spreading rapidly. However, young people lack basic information on AIDS/STD and do not know how to protect themselves from these diseases or how to avoid unintended pregnancies. Several major youth peer education programmes in China are mentioned in this paper. Among them, a four-year programme entitled the Australian-Chinese AIDS/STD/Safer Sex Peer Education Programme for Youth, is discussed in some detail. The programme has so far reached over 40000 university and school students. Evaluation results show that the programme is effective in both significantly increasing students' knowledge about AIDS/STDs and changing their attitude towards AIDS patients. In addition, the programme is highly praised by the students.     

Somebody Else’s Job: Experiences of Sex Education among Health Professionals,Parents and Adolescents with Physical Disabilities in Southwestern Ontario

Sexuality is an aspect of health and development that is often overlooked among people with physical disabilities, particularly adolescents. Studies have demonstrated that youth with physical disabilities show considerably lower levels of sexual knowledge and receive inadequate sex education compared to their peers without such disabilities. The data for this paper are part of a qualitative study that explored the experiences, barriers and challenges associated with sex education for youth with physical disabilities from the perspectives of young people themselves, their parents and the health professionals who work with them. The findings from this study highlight the tendency for parents, educators and health professionals to place the responsibility of delivering sex education to young people with physical disabilities on someone else who they believe to be more appropriately qualified to handle these types of situations. As a result, the findings illustrate that adolescents with physical disabilities do not always receive the necessary combination of comprehensive sex education within school environments, specialized information from health professionals, and informal sex education from family and peers that they require in order to gain the knowledge and skills needed to understand their own sexual capabilities and make informed decisions about their sexual health and intimate relationships.     

Gender and class differences in young people's sexuality and HIV/AIDS risk-taking behaviours in Thailand

This study examines gender and class differences in young people's beliefs about sexuality and HIV/AIDS risk-taking behaviours in Thailand. Sixty young people aged 15-19, divided equally by gender and socioeconomic background, participated in focus groups and in-depth interviews. Four topics were explored: the differences between 'good' and 'bad' girls/boys; young people's perceptions of sexuality; social class variations in young people's knowledge of HIV/AIDS and perceptions of risk; and the most influential institutions shaping young people's sexual attitudes. Results showed that young people screened potential sexual partners utilizing an image of 'good girls/boys' as potential HIV/AIDS-free partners; young people defined sexuality in terms of love/sexual relationships, premarital sex, promiscuity, and virginity; and HIV/AIDS awareness varied according to class. Young people of all classes failed to demonstrate an in-depth understanding of how they can contract AIDS. They neither viewed themselves as being in an at-risk group, nor considered their sexual behaviours to be at-risk behaviours. Finally, family, friends, and mass media were reported to be among the most influential institutions shaping young people's sexual attitudes. In the struggle against HIV/AIDS, these institutions together with health education not only protect but also can empower young people in Thailand.     

城市社区居民艾滋病知识问卷调查结果分析

目的探讨在城市社区中开展艾滋病健康教育的有效方式。方法在石家庄市选择庄窠小区、石纺小区的常住居民，采用分层整群抽样的方法选取500例居民进行艾滋病相关知信行面对面问卷调查。结果城市居民喜欢获得艾滋病信息的途径主要是电视、广播、报纸等新闻媒体，其次是宣传橱窗、宣传折页、开展宣传活动等。他们对艾滋病的传播途径全部答对率为15．11％，对国家“四免一关怀”政策知晓率为47．83％。在对艾滋病病毒感染者的态度上，有10．97％的人采取歧视或回避的态度，在与艾滋病相关的行为问题方面，有24．02％的人去过娱乐场所消费。结论社区居民对艾滋病的认识较肤浅，应在社区中开展针对性强、形式多样的艾滋病健康教育，是控制艾滋病传播的有效措施。