CHAPTER I INTRODUCTION
By Richelle Greganda and Vher Sison
Background of the Study The health concern that has gripped the world in recent years is the spread of the human immunodeficiency virus (HIV), the main cause of AIDS. In 2014, the UNAIDS estimated that AIDS had claimed about one million lives and an increasing number of people continue to contract the disease. An estimated two million people were infected with HIV in 2014, bringing the total infected population at 42 million (as cited in WHO Global Summary of HIV/AIDS, 2014). In the Philippines, the first AIDS case was diagnosed in 1984, although it was only in 1986 that AIDS was declared a notifiable disease. The number of HIV cases continues its upward trend, with the latest figure from the Department of Health AIDS Registry showing an accumulated 28,428 HIV Ab seropositive cases since 1984. Of this number, 2413 had developed to full blown AIDS. Overall, official death toll for AIDS related cases had already reach 1309 (Department of Health, 2015). The face of growing threats of HIV/AIDS infection is particularly among young people. Worldwide, they are considered one of the more vulnerable segments of the population insofar as HIV/AIDS infection is concerned. The population within the age range 15-24 continues to comprise the major bulk of HIV infections. Based on estimates by the UNAIDS, more than half of new infections belong to this age group (UN, 2014). The vulnerability of young people to sexually transmitted infection is associated with their growing involvement in risk behaviors such as ear ly and unprotected sex, having multiple partners, drug use and alcohol abuse. Recent statistics on adolescent sexuality in the
Philippines point to an increasing number of young people engaged in premarital sexual intercourse and other risky sexual practices (Kisses Jabson, DZRH, 2014) (Natividad, DRDF, 2013) Based on the recent adolescent survey, premarital sex (PMS) prevalence among young adult aged 15-24 rose from 6.3 per cent in 2002 to 13.6 per cent in 2013. Majority of the sexual experiences are spontaneous in nature, and in most instances, unprotected. There is also liberalizing views on sex among the young. In 2013, 35 percent of Filipino youth approved of men having PMS while 29 percent approved of the same behavior for women. Approval of PMS for women almost doubled in 2013 from the 13 per cent approval posted in 2002 (Young Adult Fertility and Sexuality Study, 2013). However, as more people are engaging in sex at earlier ages, they do so bereft of sufficient information on reproductive health, notably, the consequences of early sex (Ohio State University, 2011). Theoretical Framework
By Richelle Greganda and Vher Sison
The study is supported by theory of Pender which is Health Promotion Model. This theory defines health as a positive dynamic state rather than simply the absence of disease. Health promotion is directed at increasing a patient's level of well-being including knowledge. The health promotion model describes the multidimensional nature of persons as they interact within their environment to pursue health. Pender's model focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. The theory notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavior specific knowledge and affect have important motivational significance. The variables can be modified through nursing
Philippines point to an increasing number of young people engaged in premarital sexual intercourse and other risky sexual practices (Kisses Jabson, DZRH, 2014) (Natividad, DRDF, 2013) Based on the recent adolescent survey, premarital sex (PMS) prevalence among young adult aged 15-24 rose from 6.3 per cent in 2002 to 13.6 per cent in 2013. Majority of the sexual experiences are spontaneous in nature, and in most instances, unprotected. There is also liberalizing views on sex among the young. In 2013, 35 percent of Filipino youth approved of men having PMS while 29 percent approved of the same behavior for women. Approval of PMS for women almost doubled in 2013 from the 13 per cent approval posted in 2002 (Young Adult Fertility and Sexuality Study, 2013). However, as more people are engaging in sex at earlier ages, they do so bereft of sufficient information on reproductive health, notably, the consequences of early sex (Ohio State University, 2011). Theoretical Framework
By Richelle Greganda and Vher Sison
The study is supported by theory of Pender which is Health Promotion Model. This theory defines health as a positive dynamic state rather than simply the absence of disease. Health promotion is directed at increasing a patient's level of well-being including knowledge. The health promotion model describes the multidimensional nature of persons as they interact within their environment to pursue health. Pender's model focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. The theory notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavior specific knowledge and affect have important motivational significance. The variables can be modified through nursing
actions. Health promoting behavior is the desired behavioral outcome, which makes it the end point in the Health Promotion Model. These behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail intended actions for promoting health. The Health Belief Model is a framework for motivating people to take positive health actions that uses the desire to avoid a negative health consequence as the prime motivation. Having knowledge per se on negative consequences of HIV the desire to avoid HIV can be used to motivate adolescent into practicing safe sex or abstaining from it at all. This research looks at the knowledge of Filipino adolescents on HIV/AIDS and how this relates on their decision to engage in premarital sex and adopt safe sex practices and preventive practices on HIV/AIDS. This paper takes the premise that correct information on reproductive health empowers one in decision making. Thus, given sufficient information on HIV/AIDS, young people will be m ore cautious of their sexual practices, particularly the use of condom during premarital sexual episodes. In the AIDS Risk Reduction Model developed b y Catania, et. al., (as cited UCLA 2015), an
adequate knowledge of AIDS was identified as necessary in recognizing one’s behavior as high risk, which in turn, could lead to action towards modification of behavior (Brusk, 2013). The exploration of HIV/AIDS knowledge and its possible link to sexual practices provides important windows from which to frame adolescent sexual behaviors and the risk of infection among young people in the country. This provides important bases for program and policy interventions that will address adolescent reproductive health.
Conceptual Paradigm
By Richelle Greganda and Vher Sison
Knowledge
Preventive Practices
-Nature and Mode of Transmission of HIV
-Abstaining from Sex
-Consequences of having HIV
-Safe Sex (Contraceptive)
-Sexual Awareness
-HIV Testing for High risk individuals
-Contraceptive Awareness
Decreased HIV Infection among
Adolescents
Figure1. Conceptual Paradigm Showing the Effect of Increase HIV Knowledge leads to Increase Preventive Practices that results to Lower HIV infection among adolescents Conceptual Framework
By Richelle Greganda and Vher Sison
The study determined the effect of increase HIV awareness and the increase preventive practices associated with it among adolescents. The first box in the illustration showed the awareness or knowledge about HIV on Level I to IV college students. This knowledge denotes knowing the nature and mode of transmission, consequences of having HIV, and having sexual and contraceptives awareness and that an increase of this will lead to preventive practices.
The second box represented the pr eventive practices associated with HIV such as abstaining form Sex, being faithful to an uninfected partner, having safe sex (contraceptives) and HIV testing for high risk individuals. The arr ow represents represent the relationship between the variables. The outcome that the researchers hoped to achieved is that when knowledge is increased mutually preventive practices is also increased thus lowering the HIV infection among adolescents. Statement of the Problem
By Zyra Bruzo and Vher Sison
This study will determine the relationship between knowledge and preventive practices about HIV among adolescents. The study will answer the following questions: 1. What is the level of knowledge of adolescents in terms of: 1.1 Nature and Mode of Transmission of Infection, 1.2 Consequences of having Infection, 1.3 Sexual Awareness, and 1.4 Contraceptive Aware ness? 2. What is the level of preventive practices among adolescents in terms of: 1.1 Sex Abstinence, 1.2 Use of Contraceptives 1.3 Health Practices of HIV 1.4 HIV Teaching 1.5 Health Values & Beliefs
3. Is there a significant relationship between the levels of knowledge and level of preventive practices of HIV among adolescents?
Hypothesis
By Zyra Bruzo
The hypothesis will be tested at 0.05 level of significance. There is no significant relationship between l evel of knowledge and level of preventive practices among adolescents Significance of the Study
By Zyra Bruzo
The result of the study benefits the following persons: Adolescents. The findings of the study will give awareness as well as further information about HIV, alarm them about its increasing cases, how would it be prevented and their knowledge in all aspects. These adolescents will be enlightened about the hot issue as of today. Parents. The results of the study will urge them to counsel their children on H IV. This will show them how important they are as the first educator of their children about this sensitive topic. The study will provide them the information that they need to be able to
satisfy their children’s curiosity about HIV Members of the Health Care System. The outcome will be a basis in planning a comprehensive health education about HIV to adolescents at school and at the community.
School And Community . They will be more knowledgeable and will be aware on how they can prevent the disease specified in this study. Further Researchers. They can widen their consciousness and concern regarding this sensitive topic. They will be helped in case they intend to dig deeper or replicate this study. This study can serve as their review of literature and help them improve and satisfy their research. Scope and Limitation This study established the idea of acknowledging the outraging cases of HIV nowadays at preventing it as possible as every individual can. The respondents of this
study were 100 adolescent students (50 males and 50 females), of Calamba Doctors’ College enrolled in academic year of 2016-2017. This study includes all college students and Senior High School students since the questionnaire were more relevant for their age group.
Definition of terms
By Christian Sison
The following terms used in the study are operationally defined as follows:
Commented [ER1]: ITO LANG ANG MGA TERMS NA IDEDEFINE NYO AT DEFINE IT ACCORDING TO HOW YOU USE IT OR MEASURE IT. MAY QUESTIONNAIRE NA BA KYO?
Knowledge – refers to the awareness of adolescent in terms Consequences of Having HIV Contraceptive Awareness – be knowledgeable about conception, its methods, the uses, and proper application of it. Sexual Awareness – being
aware of one’s own sexual identity
Preventive Practices – methods to avoid the occurrence of the disease like. HIV testing - is an antibody screening test (immunoassay), which tests for the antibodies that your body makes against HIV. The immunoassay may be conducted in a lab or as a rapid test at the testing site. It may be performed on blood or oral fluid (not saliva). Safe sex or use of contraceptives – use various devices, drugs, agents, sexual practices, or surgical procedures to prevent hiv infection or passing of the infection to the fetus under its development Low immune system – when immune system is low, HIV will take advantage of the current state of the body wher e in all of the defences are low, then there occurs other opportunistic diseases such as tuberculosis, pneumoni a, liver failure, Cryptococcal meningitis, etc. Sexual intercourse - sexual contact between individuals involving penetration, especially the insertion of a man's erect penis into a woman's vagina, typically culminating in orgasm and the ejaculation of semen.
Commented [ER2]: HOW WILL YOU MEASURE THIS AWARENESS? IN TERMS OF: FOLLOWED BY THE SUBVARIABLES USED IN THE STUDY
Transmission - the action or process of transmitting something or t he state of being passes or transmitted. Pregnancy - The state of carrying a developing em bryo or fetus within the female body.
Chapter II Review of Related Literature Variables Associated with HIV/AIDS Behavior Quantitative and qualitative studies over the past decade a nd a half have contributed to our understanding of factors that influence HIV/AIDS related behaviour and its importance, for the purpose of this study, to briefly review here some of the varia bles for which strong and persistent links have been found. The results of these studies clearly highlight how behavior is an outcome of a complex interaction of a variety of factors including knowledge, perceived threat, perceived self-efficacy, proximity to people who h ave been affected by HIV/AIDS, among other factors. A first important aspect is the strong and consistent link that has been found in a number of studies between the level of knowledge of HIV/AIDS and sexual activity (Magnani, 2012). People with a higher level of knowledge appear to be more likely to abstain from high-risk sexual activity and to consistently use a condom (Magnani, 2012). A second important dimension appears to be the link between level of sexual activity and school attendance as well as knowledge of HIV. Those who attended school to a l ater age are more likely to initiate sex later and to use a condom than those who dropped out (Mangnani, 2012). A further important aspect of the pandemic is the potential implications of the silence that surrounds the disease. Various studies have pointe d out the important relationship between talking about H1V/AIDS and strategies for coping and addressing the consequences of the virus. In a study of the
effectiveness of peer education and sexuality in Germany, Appel and Kleiber (2014) found that communication skills were an important intervening variable in adolescents' capacity to manage personal relations. Communication also extends to people with HIV/AIDS. Disclosure of HIV status is a f urther aspect of communication which may also have a very important influence o n the quality of life in the context of HIV infection (Butler, Williams, Howland & Storm 2009). Related to communication is the aspect of emotional expression and depth of processing which appe ars to have a distinct relationship with overall well-being of people with HIV/AIDS and is also related to their long term survival (Penn, Watermeyer, Evans 2013). There is some support also for a relationship between fatalism and HIV/AIDS attitude and knowledge variables and subsequent behavior. This link has not been very consistently studied, and should be seen as an open area for further research, but the limited studies done in this field do indicate that that fatalism can be strongly associated with negative attitudes towards the disease and with negative perceptions of other groups such as people living with HIV/AIDS (Yi, Sandfort, Shidlo, 2010). Mass media exposure has also been linked to behavioral intent and behavior. (Wakefield, Loken, Hornik, 2010), in their study of condom use among adults in Philadelphia, found that by mass medi a exposure such as television, radio and newspapers were sign ificantly more likely to report behavior change than those who did not listen. Adolescence
Adolescence is a stage of development transition. It bridges between childhood and adulthood and is considered generally to being at about 12 to 13 and to end in the late teens or early twenties. The period of adolescence is characterized by the physical, intellectual, temperamental and emo tional changes in their attitudes and behavior. The World Health Organization defined adolescence as progression from appearance of secondary sex characteristics (Puberty) to sexual and reproductive maturity, development of adult mental process and adult identity and transition from total socioeconomic dependence to relative independence. Knowledge of HIV/AIDS The 2009 Philippines National Demographic and Health Survey showed that general awareness of HIV/AIDS among men and women is almost universal in the country (NSO, 2009). HIV is mainly transmitted through sexual contacts between an infected and a non- infected person. Consequently, the HIV prevention programme has mainly sought to reduce further sexual transmission through three important programmatic ways, namely promotion of abstinence, mutually faithful monogamy among uninfected couples and condom use by those that cannot abstain. These are important ways to avoid the spread of HIV/AIDS. HIV/AIDS -related knowledge among youth Knowledge of how HIV is transmitted is one of several factors that enable youth to protect themselves from the virus. Correct knowledge can also reduce stigma and discrimination against people living with HIV/AIDS. Youth
with comprehensive knowledge are those who agree with prompted questions that individuals can reduce their chances of contracting HIV by having sex with only one faithful, uninfected partner and by using condoms, those who know that a healthy-looking person can have the AIDS virus, and those who know that HIV cannot be transmitted by mosquito bites or sharing food with a person who has HIV. HIV/AIDS knowledge among young people globally constitutes a major challenge to the control of this scourge. Most people become sexually active in adolescence. The need to admit that young people are having sex but lack the proper knowledge to protect themselves is important in the fight against HIV/AIDS. Young people ar e now the epicenter and bear a disproportionate burden of this pandemic (WHO/UNICEF/UNAIDS, 2012). In 2013, national surveys found that 40% of young men and 36% of women had accurate HIV knowledge. Both in Philippines and globally, women had lower levels of HIV knowledge. Most youth were aware that being in monogamous relationship with a person of the same sero status is an effective prevention strategy (YAFS Survey, 2013). Research has shown that women and men who have never married, but who have been sexually active, are most likely to know about the major means of avoiding HIV. Education is strongly correlated with knowledge about AIDS prevention (UNESCO, 2014). Myths and misconceptions In addition to knowing about effective ways to avoid contracting HIV/AIDS, it is also useful to be able to identify incorrect belief s about AIDS to eliminate
misconceptions. Common misconceptions about AIDS include the idea that all HIV-infected people appear ill and the belief that the virus can be transmitted through mosquito or other insect bites, by sharing food with someone who is infected, or by witchcraft or othe r supernatural means. In Philippines, surveys continue to indicate that young people between 15-24 years harbor serious misconceptions about HIV and how it is transmitted (Rehal, 2012). Even though it is now common knowledge that the HIV agent cannot be transmitted through mosquito bites, many people still believe that mosquitoes are a good vehicle for HIV transmission. In Philippines where mosquitoes are endemic, this misconception is significant because it implies a pessimistic attitude that regardless of what one does, one is subject to H IV infection as a resident of a mosquito infested r egion. It also poses a compliance challenge for any educational intervention effort targeted at this group (Regan, Morisky, 2012) Knowledge of condom sources among youth Condom use among young people plays an important role in the prevention of transmission of HIV and other sexually transmitted infections, as well as unwanted pregnancies. Knowing a place to get condoms helps youth to obtain and use condoms. Furthermore, knowing where condoms can be got puts youth in a better position to make informed decisions on issues pertaining their sexuality.
Practices: HIV/AIDS-related behaviour Youth in general indulge in sexual relations for various reasons. The basic reason is self-gratification and enjoyment (Ellis, 2013). A survey done in Atlanta, USA showed that the reasons for sexual activity among youth were; forced by partner; peer pressure; carried away by passion; to prove normality; to prove love for boyfriend; tantalizing movies and films; seeking physical pleasure and desire to be a mother (Eaton et al. 2011). Sexual behavior indicators among youth; abstinence, being faithful, and condom use among
youth. The acronym ‘ABC’ represents a prominent message to youth on behaviors to follow to prevent HIV infection: abstinence, be faithful, use condoms. The approach used in Philippines has been named the ABC approach - firstly, encouraging sexual abstinence until marriage; secondly, advising those who are sexually active to be faithful to a single partner or to reduce their number of partners; a nd finally, especially if you have more than one sexual partner, always use a condom. A number of factors helped to encourage people to take up these strategies (DOH, 2014). Prevalence of HIV among Youth Generally, cases of HIV infection among youth aged 15-24 represent more recent infections and serve as an important indicator f or detecting trends in both prevalence and incidence. An attempt w as made to estimate incidence by subjecting all HIV-positive samples to the BED-assay. However, recent evidence suggests that this test overestimates incidence (UNAIDS, 2005). Research Design
Counseling and Testing Although young people believe that knowing
one’s HIV status is important, a
majority of them have not tested for HIV. A study found that although 90% of respondents believe that men and women who intend to have sex, pregnant women, and engaged couples should test for HIV, only 21% of respondents aged 15 – 19 and 43% of respondents aged 20 – 24 had tested for HIV (BBC, 2009). Qualitative data supports the disparity between knowledge and behavior. Almost all participants in a qualitative study considered VCT as an important way of preventing the spread of HIV. However the majority of males aged 20-
24 said they wouldn’t test for HIV unless it was mandatory because of stigma and discrimination, fear of descending into despair and hopelessness, worrying about eventual death, etc. (Ali, 2010) Other reasons for young people not wanting to test for H IV include not being sick, not wanting to think about self-exposure to HIV and not wanting
to know one’s status (BBC,
2009). Stigma and Discrimination Many young people still hold discriminating attitudes against people living with HIV or AIDS. At the national level, the BBC found that 52.5% of InSchool-Youth and 58.4% of Out-Of-School-Youth had at least one stigmatizing attitude towards people living with HIV or AIDS. The highest
level of stigma was found among In-School-Youth (31%) and Out-Of-SchoolYouth (41.5%) when asked if they would willingly purchase food sold by an HIV infected shopkeeper/food seller (BBC, 2010). However, stigma and discrimination is relatively lower in urban centers than in rural areas. Participants in a rural site in Philippines stated that if a family member had HIV or AIDS, they would be kept separate from the family and their status would be kept hidden from the community (Ali, 20011). Sexual Health Knowledge Young people in Philippines are more often exposed to negative aspects of their own sexual health and sexuality. Perceptions he ld by youth about sexual health are incomplete and tend to be associated with negative aspects of sexual health, i.e. HIV/AIDS, STIs, female circumcision, risks of premarital and marital sex, unwanted p regnancy, sexual harassment, health complications caused by rape, precautions people take before having sex, etc (Ali, 2009). In DOHs conducted in 2008, young men and girls aged 15-19 who practiced abstinence associated various feelings, beliefs and actions with the act of sex. For example, respondents reported that sex was a means to express love, happiness, excitement, and a means to satisfaction and relief from sexual feelings. Respondents also felt that sex occurs as a natural phenomenon; can occur during a loss of self control; can be done at the right
or wrong time; can happen with or without partner consent and can expose a person to disease and unwanted pregnancy. Young girls also assigned value to sex when practiced among married couples and assigned danger to sex
when practiced “accidentally and without planning” ( DOH, 2009). In the same study, randomly picked older young people aged 18 -21 held similar to attitudes to their younger counterparts. They also touched on the importance of sex for procreation (men) and the need to be physically fit for sexual activity (women). Young men also alluded to sex being an activity possible between same sexes and between men and animals (DOH, 2009). Youth in the study regions (and particularly those in urban settings) seemed to have a lot of knowledge about sex and sexual development processes. The source of information is from school, media and reading material on romance and love. Rural youth seemed less informed. Nevertheless, youth expressed that they want more information about sexual development (biological/behavioral) (Ali, 2009). Awareness among young people about STIs and their symptoms is low. A study analyzing DOH data also found that young women were more aware
than young men of both women’s and men’s symptoms, but young men knew more about men’s symptoms (Maria, 2010 ). Risk Perception In Philippines, young people are seen by others as the population group at highest risk for HIV due to their multiple developmental stages and
experimentation with new and risky activities such as early sexual in itiation and drug abuse. However, many young people consider themselves to not
be at risk for HIV because they reported that they didn’t engage in risky behavior or took the “necessary precautions” (BSS, 2012 ). Nevertheless, the association of risk with different types of risky behaviors among young people and the
consistency at which they utilize the “necessary precautions” is
debatable. For example, many young people d o not view certain risky sexual practices as risky. A BBC study found that significantly less respondents believed that sex at an early age (belo w 18) and anal sex were highly risky to one’s health. The proportions of males, youth aged 20 -24, rural respondents and married respondents who believed these sexual practices were highly risky were lower than their counterparts (females, 15 – 19, urban, and single respondents) (BBC, 2008). Yong people are aware of the risks associated with having sex. A quantitative baseline study found that between 80 and 90% of respondents believed that
certain sexual practices were highly risky to one’s health. These p ractices were sex with someone with an ST I, casual sex, sex without knowing
partner’s status, sex after alcohol and drug use, sex without a condom, continuing sex after a condom breaks, or having multiple sexual partners (BBC, 2008). The majority of youth in both urban and rural settings understood the importance of safe sex and linked safe sex with avoidin g sex without a
condom, avoiding casual sex and being faithful to o ne HIV negative partner. Nevertheless, youth also mentioned a disconnect between knowledge and practice (Ali, 2009). A recent study also found that high school students have low HIV risk perception in the short term. Twenty-nine point one percent of high school students reported that their chances of catching the virus were low and 28.2% felt that there was no chance o f infection. However, 81.9% of sexually active respondents reported that there was a chance of being infected if they continued with their current and 87.1% reported that there was a very high likelihood of contracting HIV in their lifetime (G/Mariam, 2012). Sexual debut The mean age of sexual debut in Philippines for men is 21.1 and for women is 16.4 (DOH, 2011). In a study conducted among government and non government high schools, 70% of sexually active respondents began having sex between the ages of 15 – 19 and 28.6% started having sex before the age of 15. The average age of sexual debut among respondents was 15.3 years (G/Mariam, 2012). Social attitudes about the suitable age for sexual debut are different than the actual age. Findings from a qualitative study revealed that although young people believed that the right age for engaging in sexual relationships was 18
– 20 for both sexes, actual practice deviated from these beliefs. For example, the majority reported that young people begin to have sex at 14. In other
regions, participants reported the norm being 15 and 16 for girls and boys respectively (Ali, 2009). Young people gave the following reasons for early sexual debut: exposure to porn films, peer pressure, the degree of family control, financial constraints (especially for girls), alcohol consumption, early marriage (rural areas). Among upper class, youth also rent big houses to hold day parties where they smoke, drink, watch porn films and participate in sexual initiation activities. (Ali, 2009) The majority of young people suggested the right age for marriage for women should be 18 – 22 and for men it should be 25 and above. The latter age was seen as desirable because this is the age where a young person would have finished University and have become economically independent (Ali, 2009). Sexual behavior Many recent studies have shown that young peop le have become more
knowledgeable about ‘ABC’ as methods of HIV prevention; however, safe sexual behavior has not necessarily increased comparatively. Results from the 2008 BBC shows that ISY and OSY participants claimed that among their age group, inconsistent practice of all three prevention methods was the norm (BBC, 2008). Furthermore, a nationally representative study using data from the 2009 DOH concluded that sexually active young people in Philippines exhibit highly risky sexual behavior evidenced by the proportions of multiple sexual partners, low
condom use, and low contraceptive use. For example, the study highlighted that 65.8% of young males and 24.6% of young females who ever had sexual intercourse had two or more sexual partners in the last 12 months (Maria, 2012). Nevertheless, virginity for boys and girls is perceived to b e of benefit both in rural and in urba n areas. In a cross sectional survey of 3,743 young people, a large percentage of rural and urban males and their female counterparts viewed the benefits of virginity to be a pre-condition for marriage and protection from HIV/STIs (for partners) (Berhane, et. al, 2009). Regardless of the perceived benefits of virginity, young people between the ages of 20 – 24 are five times as likely to be sexually active than those aged 15 – 19. A quantitative study conducted in Cav ite, Laguna, Batangas, Rizal and Quezon regions found that 64% of respondents between the ages of 2024 were sexually active versus the 14% of 15 – 19 year olds who reported they were sexually active (BBC, 2009). In a quantitative study of 758 high school students (m ost of whom were aged 15 - 19), 31% stated they wer e sexually active. Ninety percent of these respondents were aged 15 – 19 of which 58.6% were male and 32.2% were female (G/Mariam, 2012). This data is interesting considering that results from the 2009 BBC show th at 9% of ISY stated they were sexually active. Results from a qualitative study showed that high school students perceive that most of their peers are in r elationships and/or having sex. Reasons for
having sex included: peer pressure, hopelessness, inability to control sexual drive, sex for money (particularly females), and rape (G/Mariam, 2012). Types of sexual intercourse practiced among young people are varied. Vaginal sex is still the most commonly practiced type of sex by young peopl e. Sixty-two point five percent of sexually active respondents from the G/Mariam study practiced vaginal sex, followed by 19.1% for oral sex, and 11.6% for anal sex. More anal sex is practiced between male and female high school students, Males reported higher practice of anal and oral sex than females followed by men having anal sex with either gender and then male-to-male anal sex. Interestingly, the same study found that condoms are used only for vaginal sex; and of those had vaginal sex, only 19.7% reported condom use (G/Mariam, 2012). The study also showed that about two -thirds of high school students agree that oral sex is a common practice among their peers and 25% of them see anal sex as a common practice. In a comparison of government high schools to non-government schools, the amount of individuals reporting practicing vaginal sex was practically equal. However, anal and oral sex was more prevalent in government schools. (G/Mariam, 2012) Misconceptions about sexual modes of transmission prevail among young people. High school students engaged in anal and oral sex because of the
following reasons: to keep their virginity, avoid unwanted pregnancy, prevent HIV transmission, to experience extra satisfaction/pleasure, and as foreplay before vaginal sex. (G/Mariam, 2012) Young people use a number of slang words to refer to anal, oral or group
sex, and masturbation. For example oral sex was referred to as ‘ jobo’ (meaning “to get down to my private part for sucking or licking”), “threesome, foursome” referring to group sex; and “tikol,”
to refer to masturbation
(G/Mariam, 2012). Multiple sexual partners Sexually active young people (those who engage in any type of sex – anal, oral or vaginal) in Philippines often have had more than one sexual partner. This trend is more statistically visible among young men then young women. The trend is also more apparent in Manila and certain regions where having multiple partners is socially condoned for some groups. For example, 25% of sexually active ISY in Manila reported having more than one partner in the 12 months preceding the 2009 BBC. Similarly, among sexually active ISY respondents from all regions, 22.7% had had more than one partner in the last 12 months and males were 12 times more likely to have had more th an one sexual partner than females.
More recent data from a qualitative study of government and nongovernment high schools estimates a higher proportion of sexually active young people. The study found that 63.9% of sexually active high school students reported having sex with regular partners, 6% reported having sex with strangers and 2.8% with CSWs (G/Mariam, 2012). Risk perception among high school students is somewhat low; 48.2% of ISY who had had more than one sexual partner in the past year or who had risky sex felt that they were at no or low risk of HIV infection. Eighty-five percent of OSY felt that they were at no or low risk of HIV infection because of low exposure to sexual activity, no exposure to needle use and trust in partner (BBC, 2009). Sexually active young people also seem to h ave different partners for different sexual activities. Fifty percent of sexually active students from the G/Mariam study who reported they had 2+ partners in their lifetime reported that they had 2+ partners for vaginal sex, 64.2% had 2+ partners for oral sex and 53.1% had 2+ partners for anal sex. The study also found that government school students have more vaginal sex partners than non-government school students, however the latter had more anal and oral sex partners (G/Mariam, 2012). Generally, young people agree that their many of their peers are in multiple sexual partnerships. Young people stated that is common f or youth (boys and girls) to have an average of three partners – one for school, one located on the road from school to home and one who resides in their community (G/Mariam, 2012).
Many young people also assert that having multiple partners is considered adventurous among many male youth. Young men in the 20 – 24 age group in Manila also felt that it was becoming m ore common for young girls to have 2 sexual partners - one for love (younger/boyfriend) and the other for money (much older /sugar daddy) (Ali, 2009). Younger youth are having more significantly more sexual partners than older youth. In 2009, a quantitative study showed that respondents aged 15 – 19 had had 2.2 partners over the preceding 12 months versus the 1.2 partners had by 20-24 year olds (BBC 2009). Masturbation As in other societies around the world, discussing and practicing masturbation is a taboo subject in Philippi nes culture. However, similar to other trends around the world, many young men and women do masturbate. Among students surveyed in the G/Mariam study, the average age for first masturbation was 13.9 years. Additionally, the study found that: Among sexually active and non-sexually active high school students, 32.8% had masturbated at least once in their lives; more males (23.4%) than females (8.8%). More sexually active students (59%) were found to have masturbated than non-sexually active respondents (42.2%). 52.4% of respondents said they masturbated more than twice a week and 50.4% reported once a week.
Many high school students participating in FGDs believed that masturbation was practiced mostly by boys but others argued that it was common among females
as well. Others reported that two “close friends” would practice group
masturbation while they were fully clothed (G/Mariam, 2012). These students also maintained that their peers masturbate for the following reasons: because there is a taboo of females asking males for sex; lack of
self confidence to ask one’s partner for sex; it is seen as a performance test for vaginal sex; and it is a way to control sexual urges (G/Mariam, 2012). Marriage A quantitative survey conducted in 2009 found that the average age of first marriage for youth was 16 years. Overall, 43% of respondents were first married at 16 to 18 years of age, 25% were first married between 13 and 15 and 10% before 12 years of age and 21% after 19 years. Both males and females from the rural areas were more likely than urban respondents to get married before 18 years of age (BBC, 2007). Pregnancy and Contraception Among young people, misconceptions about how and when pregnancy occurs are high, both in both urban and rural areas. Approximately 40% of respondents from the above study repor ted that they do not know if or do not believe that pregnancy can occur at first sex intercourse encounter. This percentage increases among the 15 – 19 age group (BBC, 2009).
Findings from the same study showed that 95% of respondents have heard of a family planning method; birth control pills, injectibles and condoms were mentioned in that order by all these respondents. However, a lesser proportion of younger people and rural respondents reported ever or current use of contraceptive methods (BBC, 2009). On average, the majority of participants could mention five types of contraceptive methods, however 15 – 18 year olds did not have comprehensive knowledge of the methods, how to use them or where to access them (Ali, 2009). The majority of female discussants in regional sites noted that a married
woman can’t decide for herself what contraceptives to use. If she does so and her husband finds out, he feel disrespected, he may suspect her of having extra marital affairs and conflict would ensue (Ali, 2009). Sexual equality A qualitative study highlights the dichotomy associated with gender equality with respect to sexual rights and consent. Although the majority of participants felt that women are entitled to the right of making their own choices and making decisions about their sexual life and actions, the majority
also felt that women shouldn’t have the right to refuse sex whenever asked by her sexual partner (Ali, 2009). A quantitative baseline study among respondents Manila supported these findings. Approximately 23% of respondents felt that, even if they are
unwilling, it is acceptable for a man to have sex with a commercial sex worker or his wife (BBC, 2009). (Participants were asked if it wa s completely acceptable, acceptable or acceptable under certain circumstances) The same study found that 6% of respondents believed that, if she is
unwilling, it is acceptable for a man to have sex with a woman he doesn’t know or with a virgin (BBC, 2009). The 2009 qualitative study found that this was the case especially within marriage where participants indicated that women should have special and convincing reasons for not want sex and even then she would need to discuss this with her partner before r efusing outright. Participants also said that those reasons would need to be discussed with her partner before she can refuse outright (Ali, 2009). In the rural context, sexual responsibility seems to be attributed to women only with respect to the issue of sexual rights. Some rural male youth
participants were not in favor of women’s sexual rights and argued that it would contribute to unrestricted sex and therefore an increase in HIV. Many of these male participants also felt that women shoul d not have the right to practice premarital sex (Ali, 2009). Research on current urban attitudes about sexual responsibility is warranted to ascertain the level of societal approval of
women’s sexual rights.
Participants justified these views by stating that refusal of sex by a partner may cause a man to go satisfy his sexual desire elsewhere and this can lead to HIV infection, divorce and conflict (Ali, 2009). Sexual abuse and harassment Sexual abuse and harassment is a sizeable social problem in Philippines. In addition to varying harmful beliefs about sexual consent, young people must contend with sexual abuse and especially har assment from varying arenas. A large percentage (41.1%) of sexually active high school students reported sexual harassment at home (whether verbal or physical). Most of the abuse came from siblings, parents and other family – mainly cousins. Most of the harassment from parents was verbal as opp osed to physical which for some
respondents made them “think about sex and start it at an early age” (G/Mariam, 2012). In the same study, of those who had been sexually abused physically at home, twice as many individuals reported that the a buse had been anal as opposed to vaginal. Abuse happens in school as well; 12.6% of respondents reported that they were harassed and abused at schools by teachers or students (teachers more than students, a .8% difference) (G/Mariam, 2012). Although the majority of sexual abuse and harassment (among youth) is committed against young women, sexual abuse of young boys occurs often. A qualitative study of sexual abuse of young men in Manila found that 22% of sexual abuse cases reported to the police were regarding sexual abuse of
boys. The majority of sexually abused boys are school childr en aged 10 to 18 years Eighty percent of the perpetrators of this abuse are children between 10 and 18 years old and 98% of the perpetrators are male (Hagos, 2011).
Additional research needs to be done on young women and men’s understanding of sexual harassment and th eir self efficacy and skills associated with dealing with sexual abuse and harassment. Forced sex/rape Deep rooted inequitable male and female gender norms fuel harmful attitudes with respect to sexual and gender based violence among many young people in Philippines.
Among a study’s urban sites, rape was considered a despised act and was condemned, however in some of the study’s rural sites, rape is considered shameful and despicable if it involves a child. H owever, if the female victim is above 16, it is considered resolvable between the victim/p erpetrator’s families (Ali, 2009). Women many feel unable to say no to sex due to cultural pressures, potential violence by their partners, economic dependence, fear of losing her partner, rape or forced sex, forced marriage, lack of self confidence, awareness and assertiveness (Ali, 2009). Although many young people were aware of the adverse psychological, physical, and physiological effects of rape and were a ware that it is a
violation of women’s rights and punishable by law; there were reports of
youth, particularly between 15 and 18 who believed that forced sex could only be rape if the victim is a virgin (Ali, 2009). Participants provided a number of major factors that contributed to rape or
forced sex. These included: “len ience of the law and law-enforcement bodies, low reporting of rape cases to police, addiction, girls’ negligence to avoid being in potentially dangerous places at unseemly times, peer pressure, uncontrolled sexual lust of rapists, mental disorder, cultural traits that condone rape of divorcees or girls assumed to be not virgin, lack of knowledge about human r ights, and absence of free discussion about sexual
issues in the community.” Moreover, some male groups argued that women invite rape by dressing indecently (Ali, 2006). Harmful sexual practices In the previous study, the majority of youth from urban areas identified the following as dangerous sexual practices: rape/forced sex, having multiple sexual partners, uncontrolled sex, sex after drug and alcohol use, homosexual activities, anal and oral sex, sex at an ear ly age, sexual incompatibility (men reaching orgasm before women do which could lead to unfaithfulness on the part of either per son), having sex while menstruating, and imitating acts from porn films (Ali, 2009).
Synthesis
Although AIDS has not spread rapidly in the Philippines, an analysis of data from the 2013 Young Adult Fertility and Sexuality Study (Y AFS-II) shows that young men are at considerable risk of infection through sexual routes. Results from the survey of 15 to 24 year olds shows that over one-th ird of young men engage in sex before marriage with a partner other than their future wife. By age 24, 20 percent of young men have had sex with a commercial sex worker. Although only slightly more than 2 percent of young women in the Philippines report premarital sex with a partner other than their future husband, women are at risk of HIV infection through the previous and current sexual activities of their partners. Awareness of HIV/AIDS is nearly universal, but knowledge is rather limited. Most young people (85 percent) can identify at least one sexual mode of transmission, and 25 percent can identify at least one non-sexual transmission mode. Misperceptions about HIV transmission are not common, but 16 pe rcent of young people who kno w about AIDS believe that HIV can be transmitted by having contact with the belongings of an infected person. Education and regular exposure to television, radio, or newspapers increase awareness of and knowledge about AIDS. Nearly all young men have heard of condoms. Most also know that condoms, if used correctly, can protect against AIDS and other sexually transmitted diseases (STDs). Only 23 percent of sexually active young men have ever used a condom, however. Education, regular media exposure, and
urban residence all increase the likelihood of lifetime condom use, and young men with good knowledge of AIDS are more likely than others to ha ve ever used a condom. Even in commercial sex, condom use is low. Only 27 percent of young men who visited a commercial sex worker during the year before the survey report using condoms most or all of the time. Widespread sexual activity combined with low condom use indicates the potential for a serious AIDS epidemic in the Philippines. To prevent such an epidemic from occurring, young people must be educated about the risks of infection, and barriers to condom use must be alleviated.
CHAPTER III METHODOLOGY
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This chapter contains the discussion of the research design the sampling technique used, the description of the participants, the instrument, the data gathering procedures and the statistical treatment of the data collected.
Research Design
By Christine Montenegro
The researchers used the descriptive correlational design, which is defined as a research that describes variables and examines relationships among these variables. Using this design will facilitate the identification of interrelationship in a situation. The study may examine the variables in a situation. The study may examine the variables in situation that has already occurred or is currently occurring. Researchers make no attempt to control or manipulate the situation (Burns and Grove, 2007).
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Research Locale
By Christine Montenegro
This study will be
conducted in Calamba Doctors’ College. The college was
established in 2002 through a vision of community service anchored on the accommodation of the education needs of college students. Depicted as proudly
standing side by side with Calamba Doctors’ Hospital, the school is very accessible to pedestrian vehicular traffic traversing a very short stretch off National H ighway at Brgy. Parian, Calamba City. It is one of the seven colleges of Nursing Calamba with a base hospital of its own.
Since its establishment, growth in enrollment, manpower, facilities and other accommodations has taken on a positive stance. It was granted government recognition by the Commission on Higher Education through Government Recognition no. 094, Series of 2005, allowing it to offer Bachelor of Science in Nursing.
Sample and Sampling Technique
By Christine Montenegro
The researchers will use convenience sampling techni que in selecting the respondents of the study. Convenience sampling means that the researcher chooses the sample that is most conveniently available people as study participants (Polit, 2009). The sample of the study were composed of 100 students both male and female
of Calamba Doctors’ College from different colleges who are enrolled in the first semester of academic year 2015-2016. Research Instrument
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By Christine Montenegro
The researchers used self-made questionnaire as the tool of the study. The questionnaire included statements towards the evaluations of Knowledge and Preventive Practices on HIV among Adolescents.
Data Gathering Procedure
By Christian Sison
The researchers asked the permission of dean of College of Nursing to conduct the study. In order to support the validity of the data, interview has been conducted to gather information. Room to room survey will be conducted. The researchers will personally coordinate with the faculty in charge of the class and class presidents for
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their assistance. Survey conduction will be held for two days. The questionnaire will be given to the respondents and discuss the pur pose of the survey. The retrieval of the questionnaire will be done o ne hour after its distribution with the aid of the class president. A total of 100 questionnaires were given out for the male and female college student and hundred percent of retrieval is attained. The data were tallied, tabulated and analyze. Statistical Treatment
By Christian Sison
The following statistical methods and techniques were used to interpret data: The formula used :
Wm=Σfx/Σf
Where: WM= weighted mean
Σ = summation f = frequency x = assigned weight The Likert scale was used to measure the answer of the repondents. Point scale
Range
Description
Interpretation
4
3.1 – 4
Strongly Agree
High
3
2.1 – 3
Agree
Moderate
2
1.1 – 2
Disagree
Low
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