PSYCHOSOCI AL AND BEHAVI ORAL FACTORS ASSOCI ATED TO STD/ AI DS
RI SK AMONG HEALTH STUDENTS
Elm a Mat hias Dessunt i2 Alber t o Olav o Adv incula Reis3
Dessunt i EM, Reis AOA. Psychosocial and behavioral fact ors associat ed t o STD/ AI DS risk am ong healt h st udent s. Rev Lat ino- am Enfer m agem 2007 m ar ço- abr il; 15( 2) : 267- 74.
This st udy aim ed t o ident ify and com par e psychosocial and behavior al fact or s associat ed t o STD/ AI DS risk am ong st udent s enrolled in t he first and last years of t he Nursing and Medical Undergraduat e Program s at St at e Un iv er sit y of Lon dr in a. A con v en ien ce sam ple w as select ed f r om 2 6 3 en r olled st u den t s, an d t h e 1 8 3 st udent s who were sexually act ive ( 70.4% ) had t heir dat a assessed. The Aids Risk Reduct ion Model fram ework w as used t o design t he quest ionnair e in w hich a 5% st at ist ical significance lev el w as consider ed. Som e r isk f act or s w er e id en t if ied su ch as t h e p er cep t ion of in v u ln er ab ilit y , m u lt ip le sex u al p ar t n er s, con su m p t ion of alcoholic bev er ages befor e int er cour se, and t he discont inuous use or no use of condom . The r isk fact or s ar e com m on bot h t o t he fr eshm an and senior st udent s, w it h no significant differ ences r elat ed t o t he passage of t im e or t o t he st udent s’ higher educat ional level. Senior st udent s t end t o be m onogam ous w hich m akes t hem feel safer and decr ease t he use of condom w it h t heir sex ual par t ner s.
DESCRI PTORS: acq u ir ed im m u n od ef icien cy sy n d r om e; sex u ally t r an sm it t ed d iseases; r isk f act or s; sex u al beh av ior ; pr ev en t ion & con t r ol
FACTORES PSI COSOCI ALES Y COMPORTAMENTALES ASOCI ADOS AL RI ESGO DE
ETS/ SI DA ENTRE ESTUDI ANTES DEL ÁREA DE LA SALUD
Est e est udio t uvo com o obj et ivo ident ificar y com par ar los fact or es psico- sociales y com por t am ent ales asociados al r iesgo de ETS/ sida ent r e est udiant es del pr im er o y del últ im o año de los cur sos de Enfer m er ía y Medicina de la Univ er sidad Est at al de Londr ina. Fue seleccionada una m uest r a por conv eniencia, com puest a por 263 alum nos m at riculados, de los cuales fueron analizadas las inform aciones de 183 est udiant es sexualm ent e act iv os ( 7 0 , 4 % ) . Par a la elabor ación del cu est ion ar io, se u t ilizó la est r u ct u r a del Modelo de Redu cción de Riesgo de Sida, adopt ándose el 5 % com o niv el significat iv o. Algunos fact or es de r iesgo fuer on ident ificados t ales com o, la per cepción por la f alt a de v u ln er abilidad, m ú lt iples com pañ er os sex u ales, el u so de bebidas alcohólicas ant es de las relaciones sexuales y la falt a de uso o uso descont inuado del preservat ivo. Se concluyó que, esos fact ores son com unes a los dos grupos, no generándose cam bios significat ivos al paso del t iem po, ni con el increm ent o en el nivel educat ivo de los m ism os. Los alum nos del últ im o año t ienden a adopt ar un único com p añ er o, lo q u e les g en er a m ay or seg u r id ad , d ism in u y en d o p or t an t o el u so d e p r eser v at iv o con su s p ar ej as sex u ales.
DESCRI PTORES: síndr om e de inm unodeficiencia adquir ida; enfer m edades de t r ansm isión sex ual; fact or es de r iesgo; conduct a sex ual; pr ev ención & cont r ol
FATORES PSI COSSOCI AI S E COMPORTAMENTAI S ASSOCI ADOS AO RI SCO DE
DST/ AI DS ENTRE ESTUDANTES DA ÁREA DE SAÚDE
Est e est u do obj et iv ou iden t ificar e com par ar os fat or es psicossociais e com por t am en t ais associados ao r isco de DST/ aids ent r e est udant es do pr im eir o e do últ im o ano dos cur sos de Enfer m agem e Medicina da Univ er sidade Est adual de Londr ina. Selecionou- se um a am ost r a de conv eniência, com post a pelos 263 alunos m at r iculados, t endo sido analisados os dados dos 183 est udant es sex ualm ent e at iv os ( 70, 4% ) . Ut ilizou- se a est r ut ur a do Modelo de Redução de Risco da Aids par a a elabor ação do quest ionár io, adot ando- se 5% com o n ív e l d e si g n i f i câ n ci a e st a t íst i ca . Al g u n s f a t o r e s d e r i sco f o r a m i d e n t i f i ca d o s co m o a p e r ce p çã o d e inv ulner abilidade, a r efer ência a m últ iplos par ceir os sex uais, o uso de bebidas alcoólicas ant es das r elações sex uais e o uso descont ínuo ou não uso do pr eser v at iv o. Conclui- se que esses fat or es são com uns às duas séries, não havendo m udanças significat ivas com o passar do t em po e com a m aior graduação dos alunos. Os alunos do últ im o ano t endem a adot ar a parceria única e parecem sent ir- se m ais seguros, dim inuindo o uso do pr eser v at iv o com seu s par ceir os sex u ais.
DESCRI TORES: síndr om e de im unodeficiência adquir ida; doenças sex ualm ent e t r ansm issíveis; fat or es de r isco; com por t am en t o sex u al; pr ev en ção & con t r ole
1
St udy ext ract ed from Doct oral Dissert at ion; 2 PhD Professor at St at e Universit y of Londrina, e- m ail: elm a@sercom t el.com .br; 3 PhD Professor Universit y of São Paulo College of Public Healt h
I NTRODUCTI ON
T
his st udy aim ed t o ident ify psychosocial and behavioral fact ors associat ed wit h t he risk of sexually t r ansm it t ed diseases ( STD) and AI DS am ong healt h st udent s. This group of fut ure professionals will direct ly or indir ect ly int er v ene in educat iv e act ions link ed t o t hese diseases. Thus, t he k now ledge of psy chosocial and behavioral fact ors associat ed t o t he risk of STD/ A I D S i s e x t r e m e l y i m p o r t a n t t o i d e n t i f y t h i s populat ion’s current st age of preparat ion t o deal wit h people v ulner able t o t hese diseases.The polit ical, econom ic and social im pact of STD/ AI DS is of gr eat im por t ance in under dev eloped and dev eloping count r ies because it is t he cause of gr eat m or bidit y am on g w om en bet w een 1 5 an d 4 4 y ear s old( 1). I n dev eloped count r ies, t her e has been a decline in STD rat es, despit e an est im at ed 12 m illion cases p er y ear f or t h e Un it ed St at es( 2 ). Th e Wor ld Healt h Or ganizat ion ( WHO) est im at ed t hat 40 m illion adult s and children were living wit h HI V unt il t he end of 2001, one t hird of whom are young people bet ween 15 and 24 years old( 3).
Dur ing t he epidem ic phase of HI V/ AI DS, t he i n c i d e n c e a n d p r e v a l e n c e o f S D T n e e d s t o b e m on it or ed, becau se t h e pr esen ce of gen it al w ou n ds favors t he penet rat ion of HI V, increasing infect ion risks by up t o 18 t im es, w hen one of t he part ners has an unt r eat ed SDT( 4). Anot her r eason t o m onit or STDs is t hat t hey ar e t r ansm it t ed dur ing sex ual int er cour se, pr esum ing negligence r egar ding t he consequences of t he sex ual r elat ionship, such as not using condom s.
Yo u n g a d u l t s a r e e x p o se d t o t h e r i sk o f acquiring HI V because t hey get involved wit h m ult iple par t ner s and m any of t hem do not use a condom in all sex ual int er cour se. I n addit ion, m ost adolescent s is init iat ing sexual act ivit y earlier, exposing t hem selves t o t he risk of STD at a younger age.
I n t his cont ex t , m any STD/ AI DS pr ev ent ion pr ogr am s hav e been im plem ent ed all ov er t he w or ld i n t h e a t t e m p t t o c o n t a i n t h e s e i n f e c t i o n s . Undergraduat e courses, especially in t he healt h area, hav e t ried t o address t he issue. However, a t endency t ow ar ds a biologist ic focus on t he issue is obser v ed, t o t h e d e t r i m e n t o f p r e p a r a t i o n f o r p r e v e n t i v e ed u cat ion .
Th e lack of special edu cat ion in m edical or psychology course curricula com prom ises t he t raining of f u t u r e p r of ession als t o ad d r ess sex u alit y( 5 ). Th e u n i v e r s i t y h a s a f u n d a m e n t a l r o l e i n STD / AI D S
pr ev ent ion st r at egies t hr ough it s t eaching, r esear ch, car e and ex t ension funct ions.
I n h u m an r esou r ce t r ain in g , t h e u n iv er sit y m ust consider t hat it s st udent s const it ut e a group of adolescent s and young adult s wit h a high risk of STD, including HI V, since t hey ar e init iat ing sexual act ivit y at an ear ly st age and fr equent ly change par t ner s( 6).
A st u dy per f or m ed w it h college st u den t s in t h e h ealt h ar ea sh ow ed t h at t h e m aj or it y pr esen t s p r e c a r i o u s k n o w l e d g e , r e i n f o r c i n g t h e n e e d t o im plem ent specific and cont inuous educat iv e act ions for t his group( 7).
Th is p op u lat ion m u st also b e p r ior it ized in r esear ch, since it is com pr ised of y oung people, one of t h e p r ior it y seg m en t s f or p r ev en t iv e act ion s. I n a d d i t i o n , co l l eg e st u d en t s i n t h e h ea l t h a r ea a r e con sider ed capable of assessin g t h eir ow n r isk an d associat ed fact or s, appr oaching ot her t han biological aspect s r elat ed t o AI DS t r ansm ission.
Th e a n a l y si s o f m e d i ca l co u r se cu r r i cu l a r e v e a l e d t h a t S TD / A I D S a r e u n s a t i s f a c t o r i l y addr essed, bot h qualit at iv ely as quant it at ively, since not all subj ect s t hat have an int erface wit h t he t hem e addr ess it , an d t h ose t h at do ar e lim it ed t o clin ical aspect s, t o t he det rim ent of psychosocial, cult ural and beh av ior al aspect s( 8 ).
Th e d i d a c t i c a c t i v i t i e s d e v e l o p e d i n t h e u n d e r g r a d u a t e Nu r si n g co u r se a t Lo n d r i n a St a t e Un i v e r si t y ( UEL) i n v o l v e st u d e n t p a r t i ci p a t i o n i n d i f f er en t car e l ev el s, b en ef i t t i n g co n t act b et w een f a cu l t y a n d st u d e n t s f r o m v a r i o u s co u r se s. Th i s allow ed u s t o ex p er ien ce d iv er se sit u at ion s in t h e relat ionship bet ween st udent s and pat ient s wit h STD/ A I D S , m a n y o f w h i c h i n v o l v e p r e j u d i c e , f e a r, insecur it y, com m unicat ion difficult ies, am ong ot her s. On t h e o t h er h a n d , i t ca n b e p er cei v ed t h a t t h e st u den t s av oid t alk in g abou t t h eir sex u al liv es an d seem t o t r eat pr oblem s r elat ed t o STD/ AI DS as “ t he o t h er s’ p r o b l em s”, w h i ch g i v es t h e i d ea t h ey a r e “ unt ouchable” by t he epidem ic.
psychosocial and behavioral fact ors, t o t he ext ent t hat fift h year st udent s are in a different phase t han first -y ear st u den t s?
Thus, in v iew of t hese quest ions, t his st udy p r o p o s e d t h e f o l l o w i n g o b j e c t i v e s : i d e n t i f y a n d co m p a r e t h e p sy ch o so ci a l a n d b e h a v i o r a l f a ct o r s associat ed t o t h e r isk of in f ect ion b y HI V or ot h er STD am o n g f i r st an d l ast - y ear st u d en t s f r o m t h e Nur sing and Medical under gr aduat e cour ses at UEL.
This st udy is expect ed t o provide support for STD/ AI DS pr ev en t ion w or k am on g h ealt h st u den t s, preparing t hem for professional act ions t hat are m ore adequat e t o r ealit y.
METHOD
An a n a l y t i ca l su r v e y w a s p e r f o r m e d w i t h c o l l e g e s t u d e n t s f r o m t h e N u r s i n g a n d Me d i c a l p r og r am s at Lon d r in a St at e Un iv er sit y ( UEL) . Th is r esear ch w as car r ied out at t he UEL Healt h Science Cent er in Londr ina, Nor t her n Par aná, Br azil.
An int ent ional sam ple was select ed from first -an d l ast - y ear Nu r si n g -an d Med i cal u n d er g r ad u at e st u den t s at UEL ( 2 6 3 r egist er ed st u den t s) in 2 0 0 0 . Th is sam p le is com p osed of 2 6 0 st u d en t s ( 9 8 . 9 % ) w ho answ er ed t he r esear ch inst r um ent . Thr ough t his sa m p l e , w h i ch r e p r e se n t s a l l f i r st - a n d l a st - y e a r s t u d e n t s o f t h e a b o v e m e n t i o n e d c o u r s e s , a n i n f er en t i al an al y si s can b e m ad e f r om t h e r esu l t s obser v ed in t he st udy w it h t he st udent s of t he t w o p r op osed y ear s.
The inst r um ent w as st r uct ur ed on t he basis of t he v ar iables of t he AI DS Risk Reduct ion Model – ARRM. Only dat a fr om sex ually act iv e st udent s w er e c o n s i d e r e d , t h a t i s , 1 8 3 ( 7 0 . 4 % ) o f t h o s e w h o a n s w e r e d t h e q u e s t i o n n a i r e . Th i s c r i t e r i o n w a s ad op t ed as n ecessar y t o u se t h e m od el v ar iab les, since t hey are cent ered on populat ions wit h non- zero r isk of acqu ir in g STD/ AI DS.
The ARRM was proposed by Cat ania, Kegeles a n d Co a t es i n 1 9 9 0 a n d , a m o n g h ea l t h b eh a v i o r m odels, it pr ov ides a st r u ct u r e t h at cov er s sev er al psychosocial and behavior al fact or s associat ed t o t he r i s k o f S TD / A I D S , a p p r o a c h i n g t h e i n d i v i d u a l v u l n e r a b i l i t y a s p e c t s m e n t i o n e d b y M a n n a n d Taran t ola( 9 ). Th e ARRM id en t if ies t h r ee st ag es t h at cou ld in f lu en ce t h e r isk of acq u ir in g STD/ AI DS: 1 ) r ecog n it ion an d id en t if icat ion of on e’s ow n sex u al behav ior s as r isk fact or s; 2 ) com m it m ent t o r educe
h i g h - r i sk se x u a l b e h a v i o r a n d i n cr e a se l o w - r i sk act ivit y; 3) search and adopt ion of st rat egies t o reduce high- r isk sex ual behav ior( 10).
Thus, som e inst rum ent quest ions refer t o dat a t h at ch ar act er ize t h e sam p le ( ag e, g en d er, cou r se, year, m arit al st at us) and dat a t hat charact erize sexual act iv it ies ( age of sex ual init iat ion, num ber of sex ual par t ner s, use of cont r acept iv e m et hods, st able and/ or occasional r elat ionship) , w hile ot her s r efer t o t he ARRM v a r i a b l e s, f r o m w h i ch t h e f o l l o w i n g w e r e s e l e c t e d : k n o w l e d g e a b o u t t r a n s m i s s i o n f o r m s , per ceiv ed v u ln erabilit y, discu ssion abou t STD/ AI DS, st ereot yped healt h beliefs, t ype of sexual relat ionship, condom use, use of alcoholic beverages before sexual int ercourse( 10- 12). A large m aj orit y of t he answers were closed an d t h e v ar iables cou ld be m easu r ed on an or din al scale.
The st r uct ur ed quest ionnair e w as pr ev iously t est ed and dat a w ere collect ed aft er aut horizat ion by t he Research Et hics Com m it t ee and aft er cont act s and c l a r i f i c a t i o n s t o t h e r e s p e c t i v e c o u r s e b o a r d s . St udent s were orient ed about t he research obj ect ives and, aft er t hey had agr eed t o par t icipat e, t hey filled out t he inst r um ent . Par t icipant s w er e inst r uct ed not t o ident ify t hem selves, t hus guarant eeing t he secrecy of t he answ ers. Moreover, t o keep t he privacy of t he an sw er s, t h e q u est ion n air e w as accom p an ied b y a “ t er m o f r esp o n si b i l i t y ” si g n ed b y t h e r esear ch er, assum ing responsibilit y for t he collect ed dat a and for t ot al secrecy about t he individual answers. Aft er being f i l l ed o u t , t h e q u est i o n n a i r e w a s p u t i n a sea l ed envelop, wit h t he researcher’s guarant ee t hat it would o n l y b e o p e n e d a f t e r t h e r e t u r n o f a l l a n sw e r e d quest ionnair es per y ear and cour se.
D a t a w er e t a b u l a t ed t h r o u g h t h e ep i - i n f o p r og r am , v er si on 6 . 0 4 . Ot h er co m p u t er p r o g r am s used were Microsoft Excel for Windows 97, S- Plus 4.5 an d SPSS 8 . 0 . To ch aract er ize t h e g r ou p p r of ile of t he st udent s under st udy, an explorat ory analysis wit h descript ive m easures is present ed ( m ean, m edian and st an dar d dev iat ion ) , an d fr equ en cy t ables an d Box -Plot chart s are const ruct ed. Som e quest ions were also a n a l y z e d d e s c r i p t i v e l y, u s i n g t h e r e s u l t o f t h e f r equ en cy t ables.
RESULTS AND DI SCUSSI ON
I n t ot al, 2 6 0 ( 9 8 . 9 % ) Nu r sin g an d Medical st u d en t s an sw er ed t h e q u est ion n air e. We an aly zed t h e an sw er s of t h ose sex u ally act iv e, t h at is, 1 8 3 ( 70. 4% ) st udent s.
A st udy of t he sexual behavior of t he Brazilian p o p u l a t i o n , p e r f o r m e d i n 1 9 9 8( 1 3 ), s h o w e d t h a t ap p r ox im at ely 6 0 % of p eop le b et w een 1 6 an d 1 9 y e a r s o l d h a d a l r e a d y i n i t i a t e d s e x u a l a c t i v i t y, in cr easin g t o 9 2 . 3 % bet w een 2 0 an d 2 4 y ear s old. Specifically am ong college st udent s from a cit y in t he int erior of São Paulo, it was found t hat 63.2% had an act iv e sex ual life( 14).
The data that characterize the sam ple of sexually active college students are presented in Table 1.
Table 1 - Dist r ibut ion of t he num ber and per cent age of fir st - and last - y ear Nur sing and Medical st udent s accor ding t o age, gender, m ar it al st at us and cour se
s e l b a i r a V l a t o
T CourseYear
e u l a V P ) % ( 3 8 1 =
n n=F8ir3s(t%) n=L1a0s0t(%)
e g A d l o s r a e y 9 1 o t 7
1 46(25,7) 46(56,8) 0(0,0)
* * 0 0 0 , 0 d l o s r a e y 2 2 o t 0
2 69(38,5) 30(37,0) 39(39,8) d l o s r a e y 5 2 o t 3
2 52(29,1) 3(3,7) 49(50,0) d l o s r a e y 5 4 o t 6
2 12(6,7) 2(2,5) 10(10,2) 4 = s tl u s e r g n i s s i M r e d n e G e l a
M 87(47,5) 46(55,4) 41(41,0)
* 2 5 0 , 0 e l a m e
F 96(52,5) 37(44,6) 59(59,0) 0 = s tl u s e r g n i s s i M s u t a t S l a t i r a M e l g n i
S 170(92,9) 82(98,8) 88(88,0)
* * 7 0 0 , 0 l a u s n e s n o C / d e i r r a M n o i n
U 13(7,1) 1(1,2) 12(12,0)
0 = s tl u s e r g n i s s i M e s r u o C g n i s r u
N 78(42,6) 30(36,1) 48(48,0)
* 6 0 1 , 0 e n i c i d e
M 105(57,4) 53(63,9) 52(52,0) 0 = s tl u s e r g n i s s i M
* Pearson’s Chi- Square Test ; * * Fisher ’s Exact Test
Ta b l e 1 s h o w s n o s i g n i f i c a n t d i f f e r e n c e b et w een f i r st - an d l ast - y ear st u d en t s i n t er m s o f course or gender. As expect ed, t here was a significant difference regarding age and m arit al st at us, alt hough on ly 7 . 1 % of t h e st u d en t s w er e m ar r ied or h ad a con sen su al u n ion .
Figur e 1 show s t hat t hese st udent s r epor t ed a st art age of sexual act ivit y bet ween 12 and 28 years old. The younger individuals ( first year) are init iat ing se x u a l a ct i v i t y e a r l i e r t h a n t h e se n i o r st u d e n t s, regardless of gender. First - year st udent s w ere sim ilar
acr oss bot h gender s, w it h 50% of t he cases v ar y ing bet w een 1 6 an d 1 8 y ear s old ( m ean 1 6 . 9 f or m en and 16.6 for wom en) . A great er variabilit y is perceived am ong last - y ear st udent s, w it h m en init iat ing sex ual act ivit y bet ween 16 and 20 ( m ean 17.7) and 50% of wom en init iat ing bet ween 17 and 20 years old ( m ean 1 8 . 4 ) .
* * One blank answer was excluded
Figure 1: St art age of sexual act ivit y of first and last -y e a r Nu r si n g a n d Me d i ca l st u d e n t s, a cco r d i n g t o gender and cour se y ear. ( n= 182* * )
A st udy perform ed wit h t he general Brazilian populat ion found a lower m ean age for t he first sexual in t er cou r se am on g m en t h an in t h e p r esen t st u d y ( 1 5 . 6 y ear s old) . I n t h e case of w om en , t h e m ean age found is sim ilar t o t hat of fir st - y ear st udent s in t his st udy ( 17 years old)( 13). Am ong m edical st udent s at Cear á Fed er al Un iv er sit y, t h e m ean ag e f or t h e fir st sex ual int er cour se w as 1 5 . 8 y ear s old, t hat is, bet ween 9 and 27 years old( 15).
Th e n u m ber of sex u al par t n er s r epor t ed by UEL st udent s varied bet ween one and 15 in t heir life, and t he general m ean is 3.07 ( DP= 2.42) part ners for fir st - year and 3.42 ( DP= 3.26) for last - year st udent s. Th e m a j o r i t y ( 6 8 . 2 % ) r e p o r t e d h a v i n g s e x u a l in t er cou r se w it h t w o or m or e p ar t n er s d u r in g t h e per iod, w it h no significant differ ence bet w een cour se y ea r s. To b et t er ev a l u a t e t h e si g n i f i ca n ce o f t h i s indicat or, t he exist ent proport ion bet ween t he num ber of part ners and age can be est ablished. However, our sam ple has a larger concent rat ion of people bet w een 17 and 25 years old, w hich dispenses w it h t his care. I t is im port ant t o m ent ion t hat t he num ber of sexual p ar t n er s of u n k n ow n ser olog ical st at e an d sev er al ex posit ions incr ease t he r isk of STD/ HI V/ AI DS.
I n t he last 12 m ont hs, t he num ber of sexual part ners am ong UEL st udent s varied from zero t o six
an d t h e g en er al m ean w as 1 . 2 4 ( DP 0 . 9 0 ) sex u al part ners am ong first and 1.45 ( DP= 1.18) am ong last -year st udent s. The m aj orit y of t hem ( 71.9% ) report ed sex w it h on ly on e par t n er in t h e last y ear, w it h n o significant differ ence bet w een cour se y ear s.
I t s h o u l d b e m e n t i o n e d t h a t n e i t h e r 2 3 st udent s who report ed having several part ners during t h eir life w it h ou t det er m in in g h ow m any, n or sev en ot her st udent s w ho did t he sam e r egar ding t he last 1 2 m on t h s w er e in clu ded in t h e m ean est im at ion s. Th i s co u l d i n cr ea se t h e a b o v e m en t i o n ed m ea n s, especially in t he first case. The dat a present ed in t his research are sim ilar t o dat a present ed in t he lit erat ure, showing t hat m any UEL st udent s are get t ing involved w it h m ult iple part ners, regardless of t he course. This can l ead t h em t o acq u i r e STD / AI D S, esp eci al l y i f condom use is not consist ent .
The cont inuous use of a cont racept ive m et hod d u r i n g t h e w h o l e p er i o d o f sex u al act i v e l i f e w as r epor t ed by 67. 6% of t he st udied st udent s, w it h no st at ist ical d if f er en ce b et w een t h e y ear s. Th e m ost cit ed cont r acept iv e m et hods of cont inuous use w er e condom ( 34.1% ) , cont racept ive pill ( 28.6% ) , calendar m et hod ( 6 . 0 % ) and coit us int er r upt us ( w it hdr aw al) , ( 4 . 4 % ) .
We found a significant difference bet ween t he t w o y e a r s ( p = 0 . 0 1 ) r e g a r d i n g t h e u s e o f o r a l co n t r acep t i v es, w i t h a h i g h er p r o p o r t i o n o f u ser s am on g last - y ear st u den t s. How ev er, t h e u se of t h is m e t h o d h a s m a d e m a n y y o u n g a d u l t s a b a n d o n condom use, since t her e is a gr eat concer n t o av oid pregnancy, t o t he det rim ent of STD/ AI DS prevent ion. Alt hough t he differ ence in condom use as a c o n t r a c e p t i v e m e t h o d w a s n o t s i g n i f i c a n t , t h e p r o p o r t i o n o f f i r st - y ear st u d en t s w h o u se i t o n a regular basis is higher t han am ong last - year st udent s ( 4 0 . 2 % an d 2 9 . 0 % r espect iv ely ) . I t is im por t an t t o e m p h a s i z e t h a t 6 5 . 9 % o f a l l s t u d e n t s r e p o r t e d
discont inued use or no use of condom s, which result s in higher risk of exposure t o HI V and ot her STD.
The cont ingent of young people who m aint ain unprot ect ed sexual int ercourse is st ill very large and, ev en u n d er con t r acep t iv e p r ot ect ion , y ou n g p eop le w h o h av e m an y p ar t n er s an d d o n ot u se con d om s syst em at ically are unprot ect ed against STD and AI DS. Th e l e v e l o f k n o w l e d g e a b o u t A I D S t r an sm ission f or m s w as est ab lish ed accor d in g t o a cod i f i cat i on of i t em s t h at r an g ed f r om 1 4 ( h i g h er knowledge) t o 70 point s ( lower knowledge) . The sum of m ean v alu es w as 1 8 . 8 an d 1 8 . 2 poin t s f or f ir st -and last - y ear st udent s, r espect ively, show ing a v er y good level of knowledge, wit h no st at ist ical difference bet w een t he y ear s. I n gener al, t he k now ledge lev el about AI DS found am ong st udent s was high. Alt hough consider ed necessar y, m any r esear cher s hav e show n t hat t his high lev el of k now ledge is not sufficient t o r educe sex ual act iv it ies of r isk( 6,10).
K n o w l e d g e a b o u t H I V t r a n s m i s s i o n co n st i t u t es t h e f i r st st ep i n t h e r ed u ct i o n o f r i sk behaviors, but percept ion or belief in personal risk is necessary and essent ial for a change in behavior wit h a view t o r isk r educt ion.
This r isk per cept ion, one of t he v ar iables of t he ARRM m odel, can be evaluat ed by t he degr ee of con cer n / an x iet y r elat ed t o t h e d an g er of acq u ir in g STD/ AI DS. How ev er, it is im por t ant t o highlight t hat t he per cept ion of r isk should not be consider ed only at t he individual level, but also in t he social and cult ural cont ext , clearly influencing prevent ive act ions. I n our st udy, a low degree of concern or anxiet y about having acquired STD/ AI DS in t he past can be observed, wit h som e degr ee of concer n r egar ding t he possibilit y of acquiring it in t he fut ure, bot h am ong first and last -year st udent s. When t his variable is analyzed in t erm s of pr obabilit y, it is clear ly per ceived in Table 2 t hat t he STD/ AI DS ar e seen as “ ot her people’s disease”.
Table 2 Descr ipt ive st at ist ics of t he per cept ion of per sonal r isk of acquir ing STD/ AI DS am ong fir st and last -y ear Nur sing and Medical st udent s
y t il i b a b o r P
r a e Y e s r u o
C MannWhitney t s e T U
p t
s r i
F Last
n a e
M Median StandardError Mean Median Standarderror
n i s u r i v S D I A e h t g n i r i u q c a f O
s r a e y e v if t x e n e h
t 4,12 4 0,68 4,09 4 0,64 0,71
e g a r u o y e n o e m o s f O
s u r i v S D I A e h t g n i r i u q c
a 1,89 2 0,86 2,04 2 0,87 0,24
e h t n i D T S e m o s g n i r i u q c a f O
s r a e y e v if t x e
n 4,01 4 0,76 4,06 4 0,72 0,68
e g a r u o y e n o e m o s f O
D T S e m o s g n i r i u q c
a 1,87 2 0,84 2,04 2 0,89 0,18
Bo t h f i r st - a n d l a st - y e a r st u d e n t s j u d g e t h em selv es w it h lit t le or n o pr obabilit y of acqu ir in g STD/ AI DS, while individuals of t he sam e age are seen w it h high pr obabilit y of acquir ing t hese diseases.
Th i s l o w p e r c e p t i o n o f r i s k a m o n g U EL st udent s is confir m ed, since 62. 8% of t hem classify t h em sel v es as “ l o w r i sk ” an d 2 3 . 9 % as “ n o r i sk ” r egar ding t he possibilit y of acquir ing STD/ AI DS.
Alt h ou gh t h e per cept ion of per son al r isk is low am ong t he UEL st udent s w ho par t icipat ed in t he st udy, 8.2% of t hem report ed having present ed som e STD in t he past .
Be i n g a cq u a i n t e d w i t h so m e o n e w h o h a s AI DS or k now ing about som eone w ho has AI DS can lead people t o a higher per cept ion of vulner abilit y t o t h e in f ect ion . Hen ce, last - y ear UEL st u den t s sh ou ld h a v e a h i g h e r p e r ce p t i o n o f r i sk t h a n f i r st - y e a r st udent s, since t hey had several cont act s wit h pat ient s w i t h H I V / A I D S d u r i n g t h e c o u r s e . H o w e v e r, n o st at ist ical differ ence w as obser v ed bet w een st udent s of bot h y ear s.
To adopt pr ev en t iv e act ion s, people sh ou ld be conv inced of t heir per sonal r isk of acquir ing HI V/ AI DS, which m any t im es is det erm ined by t heir beliefs. Th u s, h et er osex u al m en w h o do n ot u se dr u gs an d also wom en t end t o underest im at e t heir personal risk, due t o AI DS being popular ly associat ed t o m asculine h o m o sex u a l p r a ct i ces a n d t o t h e co n su m p t i o n o f inj ect ion dr ugs.
St udent s in general do not present st ereot yped b e l i e f s r e g a r d i n g p e o p l e w i t h AI D S, w h i c h w a s d e m o n st r a t e d b y t h e l o w sco r e s o f t h e a n a l y ze d variables, which could t ot alize from 7 t o 35. The general sum of t he m eans was 9.4 for first - year st udent s and 9.8 for last - year st udent s, wit hout difference in t erm s o f b e h a v i o r b e t w e e n t h e t w o g r o u p s . H o w e v e r, alt ernat ives such as “ I am not t he kind of person who could get AI DS” and “ I don’t have a sexual relat ionship wit h t he kind of person who could have AI DS” present ed t he highest m ean scores and highest st andard errors for st udent s of bot h years, confirm ing t he percept ion of invulner abilit y r egar ding infect ion by HI V/ AI DS.
The analysis of dat a in Table 3 indicat es t hat not all st udent s hav e st able sex ual par t ner s, w it h a sig n if ican t d if f er en ce b et w een st u d en t s of t h e t w o y ear s, pr ev ailin g m or e st able r elat ion sh ips bet w een last t han bet ween first - year st udent s, bot h in t he last 12 m ont hs and in r ecent r elat ionships. Lik ew ise, t he du r at ion of t h e st able r elat ion sh ip is lon ger am on g last - y ear st udent s ( p= 0. 002) .
Table 3 - Dist r ibut ion of t he num ber and per cent age of fir st - and last - y ear Nur sing and Medical st udent s, accor din g t o t h e t y pe of r elat ion sh ip in t h e last 1 2 m ont hs, exist ence of st able r elat ionship and dur at ion of t he r elat ionship
s e l b a i r a V l a t o
T CourseYear
e u l a V P ) % ( 3 8 1 =
n First ) % ( 3 8 = n t s a L ) % ( 0 0 1 = n s h t n o m e v l e w t t s a l e h t n i p i h s n o i t a l e r f o e p y T e l b a t
S 88(48,1) 31(37,3) 57(57,0)
* * 4 0 0 , 0 l a u t n e v e d n a e l b a t
S 41(22,4) 18(21,7) 23(23,0) l a u t n e v
E 42(22,9) 29(34,9) 13(13,0)
e n o
N 12(6,6) 5(6,0) 7(7,0) 0 = g n i k c a l s e u l a V p i h s n o i t a l e r e l b a t s t n e r r u c f o y c n e t s i x E s e
Y 114(62,3) 39(47,0) 75(75,0)
* 0 0 0 , 0 o
N 69(37,7) 44(53,0) 25(25,0) 0 = g n i k c a l s e u l a V ) 4 1 1 = n ( p i h s n o i t a l e r e l b a t s f o m r e T r a e y 1
< 23(20,5) 13(34,2) 10(13,5)
* * 2 0 0 , 0 s r a e y 3 -|
1 33(29,5) 12(31,6) 21(28,4) s r a e y 5 -|
3 29(25,9) 11(28,9) 18(24,3) s r a e y e r o m r o
5 27(24,1) 2(5,3) 25(33,8) 2 = g n i k c a l s e u l a V
* Pearson Chi- square t est ; * * Fisher ’s Exact Test
A m o n g t h e 4 2 s t u d e n t s w h o r e p o r t e d in v olv em en t w it h ev en t u al p ar t n er s in t h e last 1 2 m ont hs, 69% ar e fir st and 31% last - y ear st udent s.
Table 4 - Dist r ibu t ion of n u m ber an d per cen t age of f ir st - an d last - y ear Nu r sin g an d Med ical st u d en t s, accor ding t o condom use in t he last 12 m ont hs and som e v ar iables r elat ed t o t heir use
s e l b a i r a V l a t o
T CourseYear
e u l a V P ) % (
n nFi(r%st) nLa(%st)
e h t n i e s r u o c r e t n i l a n a r o l a n i g a v g n i r u d e s u m o d n o C ) 3 8 1 = n ( s h t n o m 2 1 t s a l s e
Y 94(55,6) 49(65,3) 45(47,9)
* 7 6 0 , 0 s e m it e m o
S 46(27,2) 17(22,7) 29(30,8)
o
N 29(17,2) 9(12,0) 20(21,3) 4 1 = s e u l a v g n i s s i M ) 0 4 1 = n ( s h t n o m 2 1 t s a l e h t n i d e p a c s e m o d n o c e h T e c n o t s a e l t
A 37(26,8) 17(26,6) 20(27,0)
* 1 5 9 , 0 o
N 101(73,2) 47(73,4) 54(73,0)
2 = e u l a v g n i s s i M ) 0 4 1 = n ( s h t n o m 2 1 t s a l e h t n i e k o r b m o d n o c e h T e c n o t s a e l t
A 32(22,9) 11(16,9) 21(28,0)
* 0 2 1 , 0 o
N 108(77,1) 54(83,1) 54(72,0)
0 = s e u l a v g n i s s i M
* Pearson Chi- square
quest ions can be posed here, such as not choosing t he condom by it s qualit y, not being accust om ed w it h it s use, not hav ing access t o an adequat e condom size, placing it incorrect ly and using inadequat e lubricant s. When quest ioned about who t ook t he decision t o use t he condom , 71. 9% of t he st udent s r epor t ed t h e co u p l e, p r o b ab l y d u e t o g o o d co m m u n i cat i o n bet w een t he par t ner s.
D e s c r i p t i v e s t a t i s t i c s o f c o n d o m u s e frequency wit h st able and event ual part ners in vaginal and anal sex ual r elat ionships dem onst r at ed a higher t endency of less condom use am ong last - year st udent s in v ag in al in t er cou r se w it h ev en t u al p ar t n er s t h an am ong first - year st udent s. That is, last - year st udent s w it h st able r elat ionships ar e t he ones w ho least use c o n d o m s o n a r e g u l a r b a s i s i n t h e i r s e x u a l r elat ion sh ip s.
Analyzing t he possibilit y of condom use being influenced by t he dur at ion of t he r elat ionship am ong non m arried het erosexual adult s, a st udy showed t hat t h e c o n d o m w a s u s e d a t t h e b e g i n n i n g o f t h e r elat ion sh ip. How ev er, as t h e r elat ion sh ip con t in u ed an d t r u st w as est ablish ed, t h e pr eser v at iv e w as n o longer used( 16).
The use of alcoholic beverages before sexual int ercourse, seen as st rong predict ors of risk behavior, w as r ep or t ed b y 6 8 . 8 % of st u d en t s w h o an sw er ed t he quest ion. This can int erfere negat ively in condom use, leading t o t he r isk of acquir ing STD/ AI DS. The u se o f o t h er d r u g s w a s r ep o r t ed b y 4 . 0 % o f t h e st u den t s.
The use of subst ances t hat disinhibit sex ual r epr ession, such as alcohol for ex am ple, or t he use o f i n j e c t i o n d r u g s i s c o r r e l a t e d w i t h a h i g h e r pr obabilit y of inv olvem ent in sex ual r isk behav ior. I n Brazil, st udy perform ed wit h college st udent s in Ceará found t hat 18.3% of m en and 2.7% of wom en reduce c o n d o m u s e w h e n t h e y c o n s u m e a l c o h o l i c bev er ages( 1 5 ).
I n general, t his st udy showed t he m agnit ude of t he STD/ AI DS risk am ong college st udent s, a group which does not consider it self at risk of acquiring t hese i n f e c t i o n s , w i t h m a n y s t u d e n t s w h o h a v e n o t i n c o r p o r a t e d s a f e s e x p r a c t i c e s i n t h e i r s e x u a l act iv it ies.
CONCLUSI ONS
College st udent s from t he healt h area at UEL ar e w ell in f or m ed abou t AI DS t r an sm ission . Th is is ex pect ed, since it is a differ ent iat ed client ele am ong t h e social- cu lt u ral st r at a. How ev er, som e f act or s of r i s k t o S TD / A I D S a r e h i g h l i g h t e d , s u c h a s t h e percept ion of personal invulnerabilit y am ong freshm en and senior s. This w as v er ified by t he low degr ee of pr eoccupat ion/ anx iet y of acquir ing t hese diseases in t he past and t he lit t le concer n about acquir ing t hem in t he fut ure. St ill, a m aj orit y considers it self wit h lit t le o r n o p r o b a b i l i t y o f a c q u i r i n g S TD / A I D S , w h i l e i n d i v i d u a l s o f t h e sa m e a g e a r e se e n w i t h g r e a t probabilit y of acquiring t hese infect ions. Anot her fact or consider ed of r isk is t he r efer ence t o m ult iple sexual p a r t n e r s d u r i n g l i f e , b o t h b y f i r st - a n d l a st - y e a r st u den t s. Th e lat t er t en d t o adopt a sin gle par t n er, w h i ch p e r h a p s j u st i f i e s t h e h i g h e r p e r ce n t a g e o f event ual or no use of condom s in sexual relat ionships. Th i s r i sk i s e v e n h i g h e r f o r se n i o r s w h o r e p o r t co n t i n u o u s u se o f co n t r a ce p t i v e p i l l s, w h i ch ca n cont r ibut e t o non- use of condom s, w it h a significant difference from first - year st udent s. Regarding condom use as a cont racept ive m et hod, t here was no st at ist ical differ ence bet w een t he t w o cour se y ear s, but it can also be consider a fact or of risk if we analyze t hat t he m aj orit y of t hem report no or discont inued use. Most st udent s also r epor t t he use of alcoholic bev er ages, w h i ch ca n l ea d t o n o n - u se o f co n d o m s i n sex u a l int er cour se. I n gener al, st udent s show ed t hem selv es v er y sim ilar on t he differ ent it em s under st udy, and t h e r e w e r e n o si g n i f i ca n t ch a n g e s o v e r t i m e o r accor ding t o gr aduat ion lev el.
Th e p sy ch o so ci a l a n d b e h a v i o r a l f a ct o r s associat ed t o t h e r isk of STD/ AI DS am on g colleg e st udent s, as well as t he sim ilarit y observed regarding t hese fact or s am ong fir st - and last - y ear Nur sing and Medical st u den t s at UEL in dicat e t h e t h at edu cat iv e p r o g r a m s m u s t b e d i r e c t e d t o a d o l e s c e n t s a n d c o n t i n u e d i n c o l l e g e , p r e p a r i n g t h e s e f u t u r e professionals for educat ive act ivit ies, em phasizing not only biological, but also psy chosocial and behav ior al ones. The differ ent appr oaches t o v ulner abilit y m ust be highlight ed, not only t he indiv idual, but also t he p r og r am m at ic an d t h e social, t h in k in g ab ou t t h ese st udent s as agent s t hat t ransfor m r ealit y.
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