Original Research: Knowledge, attitudes and behaviours of adolescents in relation to STIs

Transcription

1 Knowledge, ttitudes nd behviours of dolescents in reltion to STIs, pregnncy, contrceptive utiliztion nd substnce buse in the Mhlkulo region, Estern Cpe Bn A, MBChB student b Bht VG, MD Godlwn X, MBChB student Libzi S, MBChB student Mholwn Y, MBChB student Mrfungn N, MBChB student Mon K, MBChB student Mbonisweni AM, MBChB student Mbulw N, MBChB student Mofuk J, MBChB student Mohljo NA, MBChB student Nondul NN, MBChB student Qubekile Y, MBChB student Rmnrn B, MBChB student Yer-3 COBES Group, Wlter Sisulu University, Mthth, Estern Cpe province b Deprtment of Medicl Microbiology, Wlter Sisulu University, Mthth, Estern Cpe province Correspondence to: Dr VG Bht, e-mil: vivekbht25@yhoo.com Keywords: STIs (sexully trnsmitted infections); youth; teenge pregnncy; contrception; substnce buse Abstrct ;52(2): Bckground: Sexully trnsmitted infections (STIs) nd HIV/AIDS re mjor problem in South Afric. This, coupled with high incidence of teenge pregnncy, lcohol nd drug buse, is of grve concern, especilly its impct mong the young (15 24 yers) nd in economiclly poor, rurl popultions. This study imed to ssess the youths knowledge, ttitudes nd behviours regrding STIs, teenge pregnncy, contrception nd substnce buse. Methodology: This is n interview-bsed, descriptive study. The smple design employed strtified smple (using schools s strt) of young people ged 15 to 24 yers in three schools in the Mhlkulo region, Estern Cpe province. From ech school, smple of lerners from grdes 1 to 12 ws selected rndomly. Questionnires covering relevnt prmeters were used to interview the lerners, fter which the dt were ssimilted nd nlysed. Results: A totl of 15 lerners were surveyed (8 femles nd 4 mles). In totl, 5% of them knew bout STIs. About 88% of the prticipnts lerned bout STIs from helth cre workers/nurses/doctors/clinics, the medi, eductors, the school nd friends. Most preferred to communicte to friends (38.7%) nd siblings (28%); only 15% communicted with prents. Among the sexully ctive, 54% reported the use of condoms; of these only 2% used them consistently. Of the prticipnts, 7.33% hd more thn five sexul prtners. Of the young women, 12.8% reported to hve fllen pregnnt with one-sixth of them wnting to become pregnnt. Thirty per cent of those pregnnt hd to quit school, but did return subsequently. Common contrceptives used were condoms (54%) nd pills (58%). Twenty-two per cent of the youths dmitted to the use of recretionl drugs t some time; most of these were relted to lcohol (19.33%). A smll frction (1.33%) used dgg (cnnbis). Conclusion: There is lck of knowledge of STIs nd their prevention nd condom nd contrceptive use mong young people of this community. Sexul promiscuity nd teenge pregnncy in the group is cuse for concern. Substnce buse is nother importnt problem tht requires urgent ttention.. Peer reviewed. (Submitted: , Accepted: ). SAAFP Introduction Sexully trnsmitted infections (STIs) re mjor public helth concern in South Afric, with 11 million STI cses occurring nnully. 1 They not only present huge disese burden on the society, but lso fcilitte the spred of HIV. 2 The prevlence of STIs in South Afric is high, lthough STI prevlence vries substntilly between sentinel popultions. 3 A study in rurl South Afric estimtes tht t lest 9% of men nd 9% of women contrct STIs every yer with dischrge (49% with equl numbers of men nd women); ulcer only (3% men & 14% women) nd pelvic inflmmtory disese (18% women). 4 Another study in rurl re showed tht pproximtely 25% of ll women in the reproductive ge group hve t lest one STI on ny given dy, of which hlf re symptomtic. 1 Eqully disturbing is the high incidence of teenge pregnncy. The proportion of dolescents who hve ever been pregnnt rises rpidly with ge; from 2% t ge 15 to 35% t ge This ws shown to be relted to lcohol use in nother study, in which women who reported n unwnted pregnncy binged more hevily thn those with n intended pregnncy. Alcohol consumption hs incresed in South Afric becuse of decresed controls over the production, sle nd redy vilbility of lcohol nd other locl culturl fctors, ffecting both mles nd femles. 7 It is probble tht this my led to n increse in episodes of unprotected sex, which in turn my contribute to n increse in STIs nd unwnted pregnncies. Teenge pregnncy mkes the young mother susceptible to socil ostrcism, interrupted eduction, lck of socil security, poverty nd repet pregnncies. 8 Youths ged 15 to 24 yers form bout 18.3% of the popultion in 154 Vol 52 No 2

2 South Afric nd school ttendnce mong 1 to 2-yer nd 21 to 24-yer ge groups in South Afric is 71.4% nd 27.3% respectively. 5 This study ws crried out in Mhlkulo which is rurl community re (3 km from Mthth) in the Estern Cpe with popultion of bout 3. Lerners of the 15 to 24-yer ge group who would form representtive smple were included in this study, with the following objectives: To determine the levels of STI-relted knowledge nd perceptions mong lerners of this ge group. To identify their sexul ttitudes nd behviour. To determine their sources of informtion bout STIs nd their preferences relted to communiction regrding the topic. To determine their knowledge nd use of contrceptives in reltion to teenge pregnncy. To determine their knowledge nd use of lcohol nd recretionl drugs. About 3% lived with their mothers lone nd bout 28% of prticipnts lived with both prents (Figure 1). A totl of 58.7% of the prticipnts prents were unemployed nd 1% were receiving socil grnts (government pension funds). The verge number of people stying in onebedroom house ws six, nd there were n equl number of mud houses nd brick nd cement houses. In bout 58% of the households, the wter supply ws from nerby river, with only 38% hving wter from tp (municiplity) nd 4% using tnks. Methodology This interview-bsed, descriptive study ws crried out s component of the Wlter Sisulu University s Communitybsed Eduction nd Service (COBES) progrmme, which seeks to fmilirise MBChB third-yer students with community-specific helth issues nd initite them into relted reserch. Questionnires were used in this study nd were designed to cover demogrphics, sexul behviours (condom use, prtner number, ge of sexul debut, trnsctionl sex), teenge pregnncy nd contrceptive use, lcohol nd drug buse, sexul coercion nd violence, condom use, ttitudes, norms nd key communiction prctices bout STIs. The smple design employed strtified (using schools s strt) smple of young people ged 15 to 24 yers in three schools in the Mhlkulo region, Estern Cpe province. From ech school smple of lerners (5 in number) from grdes 1 to 12 were rndomly selected, from totl of 3 lerners in the three schools. The study ws performed during the period of My to September 28. Lerners t the prticipting schools were interviewed fce to fce in clssroom setting nd the pre-structured questionnires were filled out. The study ws lso verblly explined to the prticipnts by members of the reserch tem. The primry nlysis in this study involved responses from 15 prticipnts. Results Demogrphics The men ge of the smple ws 18.2 yers. Overll, 8 of the prticipnts were femle while 4 were mle. Figure 1: People living with the respondents STI knowledge, communiction nd perceived risk Fifty-six per cent of the youths responded tht they knew STIs re diseses tht re contrcted during unsfe sex. There were 15.33% who did not know wht STIs were nd 2.1% who believed it to be femle diseses. About 5% of the prticipnts hd herd bout HIV/AIDS specificlly; nd up to 37% hd some vgue ide bout other STI syndromes like dischrge nd ulcers. Knowledge tht STIs could be prevented ws present in 5% of the prticipnts though mny of the prticipnts were not cler on the differences between methods of contrception nd STI prevention. Most of the prticipnts preferred to communicte with friends (38.7%) nd siblings (28%) bout sex (Figure 2). Only 15% tlked to either prent. A totl of 45.71% of the prticipnts believed tht their prents did not know bout their sexul ctivity. However, 92% of them were concerned bout wht their prents might think nd sy bout their sexul lives nd 54% of the prticipnts felt tht prentl dispprovl of their sexul behviour would cuse them to chnge. About 88% of the prticipnts lerned bout STIs from helth cre workers/nurses/doctors/clinics, the medi, eductors, school (techers, clssmtes or in the clssroom) nd friends (Tble I). Only smll proportion reported hving lerned bout these issues from their prents/gurdin. 155 Vol 52 No 2

3 No one Reltion Others Friend Sibling Fther to 5 to 1 more thn 1 Mother 1 Number of prtners Figure 2: Preference of communiction bout mtters relted to sex Tble I: Source of informtion bout STIs Min source of informtion Frequency Prents Helth professionl nd clinic 54 3 Medi 3 24 Eductors Friends Never herd of them Levels nd chrcteristics of sexul experience nd ctivity The definition of sex vried mong the prticipnts. Sixty per cent thought tht sexul intercourse ws essentil wheres the remining thought tht kissing, fondling, orl nd nl sex ws lso included in the ct. Overll, pproximtely 75% of the respondents reported to hve hd sex.. The medin ge of first sex mong those who reported to being sexully ctive ws 1 yers. Of those who were sexully ctive, only 54% reported the use of condoms. Among those who reported condom use, 2% used condoms consistently. Seventy-five per cent of the sexully ctive girls reported relly wnting their first sexul experience compred to 72% of sexully ctive boys. Regrding the number of sexul prtners they hd, it ws found tht 4.7% hd single longstnding prtner; 28% hd hd two prtners; 24% hd three to five prtners nd the remining hd more thn five prtners (Figure 3). Twelve per cent hd sex in the lst week; 38% in the lst month nd 3% in the lst yer. Among those who hd sexul intercourse in the pst 12 months, 3% reported tht they hd more thn one sexul prtner in the pst 12 months. Pregnncy nd contrceptive use Of the femles, 12.8% reported to hve been pregnnt in this study. Only one-sixth of these young women 35 4 Figure 3: Number of sexul prtners wnted to be pregnnt; hence most of the pregnncies were unwnted. Nevertheless, two-thirds of the femles who becme pregnnt eventully wnted to keep their bbies. Most of the pregnnt femles fmilies (85%) showed strong dispprovl of the pregnncy; nd lmost 3% of these girls ended up quitting school, lthough they returned subsequently. Regrding the prticipnts understnding of contrceptives, 8% connected contrceptives to the prevention of pregnncy nd only 4% of them believed they could prevent STIs, including HIV; the remining were not sure bout the role of contrceptives. Types of contrceptive mesures tken by prticipnts minly included brrier methods such s condoms (54%) nd pills (58%) (Figure 4). There ws low number of girls using injectbles (%), nd 1% reported not using ny contrception. Some of the girls were using combintions (e.g. pills nd condoms) Condoms Substnce buse 58 Pills Injectbles Figure 4: Methods of contrception used: When sked bout wht drug buse ment to the prticipnts, 3% reported it to be the buse of ny substnce. In ddition, 2.8% believed tht drugs ffect the brin nd bout 23% believed tht drugs led to violent behviour. The common substnces of buse known to them were lcohol (5.7%), dgg (54.7%), tobcco (48%) nd cocine (2.7%) (Figure 5). 1 Not using 15 Vol 52 No 2

4 Alcohol Dgg Tobcco Cocine Glue 'Pills' Do not know reflect the fct tht more thn one-qurter of those surveyed did not live with ny prent. It could, however, lso point to lck of knowledge on the prt of the prents themselves. This lck of knowledge could probbly be ddressed by greter helth eduction for the prents s well. None of the prticipnts believed tht STIs were cused by witchcrft or evil spirits. Prticipnts in one study considered STIs to be n gent of contmintion or pollution. 1 The medin ge of sexul debut in this group ws 1 yers. This ws slightly more thn the South Africn (23) figures in the dolescent group (7% of girls nd 12% of boys) who hd sex for the first time before they were 14 yers old. 11 Figure 5: Knowledge of drugs Tble II: Use of recretionl drugs Substnce Nil Alcohol Dgg Tobcco Benzene Twenty-two per cent of the youths dmitted to the use of recretionl drugs t some time; most of these were relted to drinking lcohol (19.33%). Two of them dmitted to the use of dgg (Tble II). Of the prticipnts, 34.5% felt tht they indulged in sexul ctivity nd 2.7% dmitted to engging in violent behviour following the use of drugs. Discussion Number of prticipnts 117 (78%) 29 (19.33%) 2 (1.33%) 1 (.7%) 1 (.7%) This study sought to understnd STI knowledge, communiction nd perceived risk long with the levels of sexul ctivity, pregnncy, contrception nd substnce buse in 15 to 24-yer-old youths in the light of demogrphic fctors such s socioeconomic sttus nd eduction levels in smll rurl community re of South Afric. The mjority of subjects in this study cme from reltively disdvntged socioeconomic bckground. More thn hlf of the subjects in our study knew bout STIs nd HIV, with the mjor sources of informtion being helth cre workers/nurses/ doctors/clinics, the medi, eductors, the school (techers, clssmtes or in the clssroom) nd friends; only smll proportion reported hving lerned the most bout these issues from their prents. This ws less thn the findings in nother study, in which 39% of prticipnts greed tht prents hd tlked bout wht is right nd wht is wrong with regrd to sexul behviour, 5% tlked bout delying sexul ctivity, nd 58 nd 2% tlked bout birth control nd preventing STIs respectively. 9 Open communiction bout these issues my led to incresed wreness nd knowledge bout STIs nd my serve to reduce high-risk behviour. Tht prents were poor source of informtion s compred to clinics nd the medi in this study could The chnces of cquiring STIs increse with the number of sexul prtners. Wht ws lrming in our study ws tht nd 1.33% of the lerners hd hd six to ten nd more thn ten sexul prtners respectively in their lifetimes. Overll condom usge in this study ws found to be 54%; however, only 4% of these users reported consistent use. In comprison, in study conducted in KwZulu-Ntl, South Afric, the figures for condom usge regulrly, occsionlly nd never were 1, 58 nd 41 mong men nd 9, 27 nd 4 mong women respectively. 12 Regulr use of condoms with csul prtners vried from 41.5 to 42% in Durbn study 13 to 59% in nother study. 14 Resons described for not using condoms include lck of wreness, decresed sexul plesure, shifting responsibility to the other prtner, non-vilbility of condoms nd too shy to buy them, mong others. 15 This could be ddressed by greter emphsis on helth eduction with regrd to sfe sex nd lso by mking condoms more esily nd freely vilble. Other thn the risk of contrcting HIV nd STIs, unprotected sex cn lso result in unwnted pregnncies. The percentge of femles ged 15 to 19 who were mothers or who hd ever been pregnnt hd risen from 11.9% in 23 to 39% (2) in South Afric, nd the percentge of women of reproductive ge (15 49) who were using modern contrceptive method ws 4.7% for South Afric nd 2.4% for the Estern Cpe province. 11 In our study, the commonest methods of contrception included condoms nd pills lthough 1% of the femles did not use ny form of contrception. Of the femles, 12.8% reported pregnncy, most of which were unwnted. The femles who wnted the pregnncy were ged between 21 nd 24 yers nd dmitted tht they hd been influenced by the fct tht some other femles in the community of similr ge hd hd bbies. Another South Africn study showed tht by ge 24 yers, over two-thirds of young South Africn women reported being sexully experienced nd 5% hd been pregnnt (mny unwnted), yet only hlf reported using contrception. 1 Teenge pregnncy compromises eduction nd future socil nd finncil security. 17 In fct, studies in South Afric hve shown tht fter finncil 157 Vol 52 No 2

5 concerns, teen pregnncy is one of the min resons for high school dropout rtes. This is supported by the results obtined from our study, which indicted tht lmost 3% of the prticipnts tht becme pregnnt hd quit school temporrily, resulting in disruption in their eduction, lthough they returned to school subsequently. Young people re more likely to engge in high-risk behviour when under the influence of lcohol nd drugs. According to the first South Africn Ntionl Youth Risk Behviour Survey 22, in the Estern Cpe province, 1.7% greed tht they bought or were given illegl drugs on school premises, 9% used lcohol on school premises nd 4% used dgg on school premises. 18 In our study too, lcohol nd dgg were the leding types of substnces used by the youths nd they hd different ides bout the effects of drugs on the humn body. They dmitted tht the use of drugs ws more prevlent during holidy or ceremonil occsions (trditionl nd others). Alcohol consumption might directly cuse n incresed risk of STIs due to its effects on behviour nd sexul rousl or by dverse effects on the immune system. 19 In one study, substnce buse ws significntly ssocited with hving multiple sexul prtners. 2 In this study, some of the youths who used recretionl drugs dmitted to incresed sexul ctivity nd violent behviour following their use. Therefore, substnce buse lso puts these youths t greter risk of contrcting STIs, including HIV. There exists problem of drug buse in the youth, s evident from the results obtined in our study, nd if no remedil intervention is brought bout, they re t serious risk of jeoprdising their helth nd future life. Conclusion There is lck of knowledge of STIs nd their prevention nd condom nd contrceptive use mong lerners of this community. Sexul promiscuity nd teenge pregnncy re lso issues of concern. Substnce buse is nother importnt problem tht requires urgent ttention. These cn be ddressed by trgeted helth eduction for this group in the community. Acknowledgements The uthors wish to thnk Wlter Sisulu University, Fculty of Helth Sciences, the Deprtment of Community Medicine (Prof A Del Rio), Mhlkulu Helth Centre stff, community representtives, principls, stff nd lerners of the school where the study ws done. Finncil support: No finncil support ws required for this study. Conflict of interest: None. Authors contribution: All uthors contributed eqully to this work nd nmes re in lphbeticl order References 1) Sonko R, McCoy D, Gos E, et l. Sexully trnsmitted infections. Durbn: Helth Systems Trust; 23. Avilble from pdf (Accessed 24//29). 2) Wsserheit JN. Epidemiologicl synergy. Interreltionships between humn immunodeficiency virus infection nd other sexully trnsmitted diseses. Sex Trnsm Dis 1992;19: ) Johnson LF, Coetzee DJ, Dorrington RE. Sentinel surveillnce of sexully trnsmitted infections in South Afric: A review. Sex Trnsm Inf 25;81; ) Wilkinson D, Connolly AM, Hrrison A, Lurie M, Abdool Krim SS. Sexully trnsmitted disese syndromes in rurl South Afric: Results from helth fcility surveillnce. Sex Trnsm Dis 1998;25:2 3. 5) Deprtment of Helth, South Afric. South Africn Demogrphic nd Helth Survey Pretori: Ntionl Deprtment of Helth; 22. Avilble from (Accessed 28/3/29). Also vilble from ) Stnderwick K, Dvies C, Tucker L, Sheron N. Binge drinking, sexul behviour nd sexully trnsmitted infections in the UK. Int J STD AIDS 27;18: ) Pithey AL, Morojele NK. Literture review on lcohol use nd sexul risk behviour in South Afric. Alcohol nd Drug Abuse Reserch Unit, Medicl Reserch Council; Mr 22. Avilble from dmodule/review.pdf (Accessed 24//29). 8) Consequences of teenge pregnncy. Avilble from (Accessed 28//29). 9) Aspy CB, Vesely SK, Omn RF, et l. Youth-prent communiction nd youth sexul behvior: Implictions for physicins. Fm Med 2;38(7):5 4. 1) Green EC. The prticiption of Africn trditionl helers in AIDS/STD prevention progrmmes. Trop Doc 1997;27 Suppl: ) Helth Sttistics Indictor Dt - Helth Systems Trust, South Afric. Avilble from (Accessed 21/2/29). 12) Moodley P, Sturm PDJ, Connolly C, Sturm AW. Identifiction of women t high STD risk mong STD clinic ttendees: Implictions for STD progrmmes. Int J STD AIDS 23;14: ) O Frrell N, Morison L, Moodley P, et l. High-risk sexul behviour in men ttending sexully trnsmitted infection clinic in Durbn, South Afric. Sex Trnsm Inf 27;83: ) Ford K, Sohn W, Lepkowski J. Chrcteristics of dolescent s sexul prtners nd their ssocition with use of condoms nd other contrceptive methods. Fm Plnn Perspect 21;33(3): ) Abrhm L. Risk behviour nd misperceptions mong low-income college students of Mumbi: Towrds dulthood. Avilble from reproductive-helth/publictions//towrds_dulthood/9.pdf (Accessed 12/3/29). 1) McPhil C, Pettifor AE, Pscoe S, Rees HV. Contrception use nd pregnncy mong yer old South Africn women: A ntionlly representtive cross-sectionl survey. BMC Med. 27;5:31. 17) Cunninghm PW, Boult BE. Blck teenge pregnncy in South Afric: Some considertions. Adolescence 199;31: ) Reddy SP, Pndy S, Swrt D, et l. Umthenthe Uhlb Usmil The South Africn Youth Risk Behviour Survey 22. Cpe Town: South Africn Medicl Reserch Council; 23. Avilble from helthpromotion/helthpromotion.htm (Accessed 24//29). 19) Cook RL, Clrk DB. Is there n ssocition between lcohol consumption nd sexully trnsmitted diseses? A systemtic review. Sex Trnsm Dis Mr 25;32(3): ) Yn AF, Chiu YW, Stoesen CA, MQ Wng. STD/HIV-relted sexul risk behviors nd substnce use mong US rurl dolescents. J Ntl Med Assoc Dec 27;99(12): Vol 52 No 2