Annals of Tropical Paediatrics International Child Health
ISSN: 0272-4936 (Print) 1465-3281 (Online) Journal homepage: http://www.tandfonline.com/loi/ypch19
Acquired immunodeficiency syndrome: education exposure, knowledge and attitude of Nigerian adolescents in Calabar A. A. Asindi, E. O. Ibia & M. U. Young To cite this article: A. A. Asindi, E. O. Ibia & M. U. Young (1992) Acquired immunodeficiency syndrome: education exposure, knowledge and attitude of Nigerian adolescents in Calabar, Annals of Tropical Paediatrics, 12:4, 397-402, DOI: 10.1080/02724936.1992.11747605 To link to this article: http://dx.doi.org/10.1080/02724936.1992.11747605
Published online: 13 Jul 2016.
Submit your article to this journal
View related articles
Citing articles: 5 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypch19 Download by: [Australian Catholic University]
Date: 26 August 2017, At: 01:29
Annals of Tropical Paediatrics (1992) 12,397-402
Acquired immunodeficiency syndrome: education exposure, knowledge and attitude of Nigerian adolescents inCalabar A. A. ASINDI, E. O. IBIA & M. U. YOUNG
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria (Received 7 January 1992)
Summary The knowledge of and attitude to acquired immunodeficiency syndrome (AIDS) of 738 secondary school youths in Calabar were studied by questionnaire in March 1991. Most (92%) of the adolescents bad beard about AIDS, largely through the mass media (79-85%), with parents and teachers contributing in less than 40%. About 30% did not know that AIDS exists in Nigeria. Most of them knew that promiscuity, blood transfusion and sharing injection needles and syringes are the major modes of transmission, but a number still incriminate toilet seats, eating utensils, hand-shaking and kissing. Only 31 ~o were aware that condoms provide protection. For self-protection the youths prefer abstinence (45°,0 ) and confinement to one sex parmer (19%). Only 3.6% would adopt the use of condoms. To prevent the spread of AIDS, the youths prescribe isolation (37%), treatment (34%), and killing (14° 0 ) of diagnosed cases. Most youths (77%) will stop seeing friends and 63% will reject relatives who develop AIDS. The study reveals that while general awareness of AIDS is fairly good, detailed knowledge is riddled with misconceptions and confusion. It is recommended that physicians in the community should assist in disseminating accurate information, with the support of parents, teachers and the youths themselves.
Introduction Within the past decade, the acquired immunodeficiency syndrome (AIDS) has become a worldwide problem causing great public health concern. The best data on AIDS emanate from the advanced countries of America and Europe, whereas in Africa many cases remain unrecognized and unreported. Under-reporting in African countries, including Nigeria, is largely due to large segments of the population having limited access to health care facilities where AIDS might be diagnosed and reported. The Reprint requests to: Dr A. A. Asindi, Department of Paediatrics, University of Calabar, Calabar, Nigeria.
World Health Organization (WHO) estimates that perhaps only 10-20% of adult cases of AIDS in Africa are being reported. 1•2 The authors have been involved in five confirmed cases of AIDS in children admitted to the University of Calabar Teaching Hospital (UCTH) during the months of February to May 1991. In ali five cases, both the child and its mother were HIV -positive by ELISA and Western blot tests. As at Mar ch 1991, the total figure reported by the Nigeria Federal Ministry of Health was 84 cases of AIDS out of 524 HIV-seropositive children. Given the gross under-reporting in many developing countries, these figures are the tip of the iceberg. AIDS must therefore be regarded as a real problem in Nigeria.
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
398
A. A. Asindi et al.
There is a high prevalence of teenage pregnancy among secondary school girls in Calabar, which suggests that a large proportion of adolescents in the city are sexualiy active. Considering the existence of HIV infection in Calabar, the re are grounds for concern that these young people are at risk of acquiring the disease. In the absence of any effective treatment or immunization, the world at the moment relies on preventive measures which involve abandoning behaviour that can promote spread of the disease. 3 In planning an effective anti-AIDS programme for any population, the background knowledge, beliefs and behaviour of people regarding the disease are essential factors to take into consideration. In Nigeria, concerted efforts have been made to enlighten people, mainly through the press, radio and television. I t was decided to determine how effectively the available AIDS information has reached adolescents who are a vulnerable sector of society. A study was therefore conducted to evaluate the knowledge of adolescents in Calabar about modes of transmission of AIDS, their behavioural patterns related to self protection, and their attitudes to condom use and towards AIDS patients. It is expected that the information derived from this survey will be useful in planning educational programmes and in counselling about AID S. Cala bar is a cosmopolitan city in the southeastern part of Nigeria with an estimated population of 600 000. The people are predominantly Christian. By culture, students in post-primary schools are not supposed to bemarried.
Subjects and methods The survey was conducted in March 1991 on secondary school students in Calabar Municipality. A questionnaire with both closed- and open-ended responses was drawn up and given to this sample population. Respondents were asked particularly about their source of information on AIDS,
modes of transmission and attitude to condoms and AIDS patients. Questions regarding knowledge of the disease were answered by 'yes/no/don't know', while those for eliciting attitude and perspective usualiy required volunteered responses. Adequate guidance on how to answer the questions was given with great care so as not to influence their responses. The 'don't knows' were regarded as evidence of ignorance. Six of the eight post-primary education institutions in Calabar were selected for the study. In three of these the pupils were ali girls, in two ali boys and in one both boys and girls. Informed consent was obtained from the principals of the schools in advance. In order to obtain unbiased answers from each student, the questionnaire was administered in the form of a classroom test so that pupils had no opportunity to compare or copy answers. For the same reason, the pupils were given very short notice of the examination in order to prevent prior group discussion which might have produced biased, uniform answers. Also, to limit possible discussion of the project between schools, ali tests were completed within 2 weeks in ali the institutions. The principals and pupils were assured that the answers were confidential and pupils did not write their names on the forms. One of the au thors (MUY) supervised the test in ali the schools.
Results Of a total of 1000 questionnaires administered, 738 were returned properly completed. The ages of the 738 respondents were: 76 (10.3%) under 15 years, 587 (79.5%) 15-20 years and nine (1.2%) 20-22 years. Sixty-six (9%) of the students did not record their ages. Most (92.4%) of the pupils had heard about AIDS, mainly from newspapers, magazines, radio and television which constituted about 80% of sources. Friends, teachers and parents constituted about 40% each of sources (Table I).
AIDS: attitudes of Nigerian adolescents TABLE 1. Adolescent education about AIDS (n = 738)
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
Information/source
399
TABLE II. Knowledge about modes ofHIV transmission (n=738)
%
Heard about AIDS through: Newspapers and periodicals Radio Television Friends Parents Teachers Doctor Yes
No
92.4 85.0 80.0 79.0 42.0 38.7 37.9 31.0 Don'tknow
Any AIDS in Nigeria? Any cure for AIDS?
1.3 61.1
29.3 27.5
69.4 11.4
In response to the question whether AIDS exists in Nigeria, 69% answered in the affirmative. Sixty-one per cent also were aware that there is not yet a cure for AIDS.
Knowledge of modes of transmission The overwhelming majority of pupils were aware that AIDS is transmitted through sexual intercourse (97%), blood transfusion (82%) and contaminated syringes and needles (74%) (Table Il). Seventy-fi.ve per cent of the respondents disagreed with the statement that only men transmit AIDS while 82% agreed that women can transfer AIDS to men. This may be interpreted as indicating that 75-82% of the respondents know that both men and women transmit AIDS. A considerable proportion considered that toilet seats (31 %), sharing cups and spoons (24%), shaking bands (13%) and kissing (42%) were modes of acquiring the HIV infection.
Yes
No
Don'tknow
Modes of transmission
(%)
(%)
(%)
Blood transfusion Kissing Sexual intercourse Sharingcupsandspoons Shaking bands with AIDS patients Injection with already used syringes and needles Toilet seats Only men transmit AIDS Women transmit AIDS tomen
82.0 42.0 97.0 24.5 13.0
3.0 26.0 0.5 35.0 52.0
15.0 32.0 2.5 40.5 35.0
74.2
3.8
22.0
31.0 5.7
24.5 75.0
44.5 19.3
82.0
4.0
14.0
TABLE III. Knowledge about individuals exposed to HIV(n=738)
Young children School children Prostitutes Priests/reverend sisters Individuals with multiple sexual partners
Yes
No
Don't know
(%)
(%)
(%)
14.0 28.0 92.0 7.4 82.0
53.0 32.0 1.5 48.0 3.4
32.0 40.0 6.5 44.6 14.6
92% and 82% of the respondents, respectively (Table III). Persons such as priests and nuns were mentioned least often (7%).
Use of condoms Knowledge of predisposition to H IV infection The students were asked to choose from a list of categories those whom they thought were most vulnerable to contracting AIDS. Sex workers (prostitutes and others with multiple sex partners) were mentioned by
The majority of the respondents (83%) knew about condoms but only 31% were aware that they provide protection (Table IV). About 9% (boys and girls) admitted they had used condoms and 7% recommended their use for safer sex.
A. A. Asindi et al.
400
IV. Knowledge and attitude regarding condoms (n=738)
TABLE
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
Know about it? Does it protect? Self-reponed use of condoms
TABLE V.
Yes
No
Don'tknow
(%)
(%)
(%)
82.9 31.0 8.9
17.1 18.5 91.1
0.0 50.5 0.0
Attitude about prevention of AIDS
(n=738)
% Abstinence Faithfulness Avoiding AIDS patients Avoiding blood transfusion Using condoms Others Don't know
45.3 19.0 5.5 4.3 3.6 13.8 8.5
Attitude towards protection from AIDS When asked to suggest frankly what should be done by individuals and governments to prevent AIDS, abstinence (45%) foliowed by restriction to one sex partner ( 19%) were the most popular options (Table V). Only a smali number (4%) would use condoms to protect themselves and 6.9% recommended them for others. Other suggestions (14% of respondents) included imprisonment of ali prostitutes and ali who engage in indiscriminate sex; closing ali night clubs; restricting immigration of aliens into Nigeria; and a godly lifestyle which forbids extramarital sex.
Attitudes to AIDS patients (Table VI) To a question 'What in your opinion should government do to those who have AIDS?', isolation was the most popular suggestion (37%) and sorne (34%) recommended treat-
TABLE VI.
Adolescent attitude towards AIDS patients (n = 738)
% Isolation Should be treated Should be killed Should be taken overseas Don'tknow Others
36.7 34.1 14.2 1.4 7.6 6.0
mentofthevictims. Sadly,killingofaliAIDS patients was advocated by 14% as a method of limiting spread. Total rejection of friends who develop AIDS was advocated by 77%, and 66% of adolescents would not harbour even a relative in the family household who was found to be seropositive.
Discussion Most secondary schools in Calabar have been famous right from their inception in the early 20th century, when they were established by British missionaries, and they have always attracted admissions from ali parts of Nigeria. Therefore, although the bulk of the student population are those whose parents live in Calabar, the responses obtained from the sample population do not represent only the views of the residents of the city but are partiy national in fl.avour. To our knowledge, this is the first survey of Nigerian youths regarding AIDS-related information and behaviour. Our findings indicate that a majority (92%) of adolescents in Calabar have heard about AIDS. This is close to the 100% knowledge leve} recorded amongst youths in Massachusetts, USA in 1988. 4 The main sources of information for students in Calabar (80%) are the news media-newspapers, magazines, radio and television. Less than 40% of the students derived their information from their parents and teachers, and least from doctors (31 %). In Massachusetts, up to 65% and 80% knew about AIDS through their parents and
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
AIDS: attitudes of Nigerian adolescents
teachers, respectively. 4 Cultural taboos in Nigeria tend to inhibit frank discussion of sexuality between adults and youths. This may explain the low level of interaction of the teachers, parents and even physicians with adolescents on the subject of AIDS demonstrated by our survey. It has become clear from this study that there are severa} misconceptions, beliefs and attitudes which are causes for concem. For instance, 30% of the youths were not aware that AIDS exists in Nigeria and 39% did not know that there is still no cure. This knowledge gap is particularly disturbing because the sexualiy active among them might have been running grave risks. Ali young people in Calabar therefore need to be educated in this regard as a matter of urgency. Knowledge about the modes of transmission was reasonably good. Promiscuity, blood transfusion and sharing injection needles and syringes were identified by the majority of respondents as the most important ways of contracting the disease. However, the idea that AIDS can be transmitted by toilet seats, hand-shaking, sharing eating and drinking utensils and kissing is quite prevalent and needs to be corrected. A similar notion still exists amongst American youths but to a lesser extent. 4 This ignorance probably explains people's instinct to reject friends and relatives who develop the disease, as cited in severa} surveys, including the present one. In Haiti, severa} clinics have reported that staffwould refuse to work with people who are known to have HIV infections or who are simply relatives or friends of victims of AIDS. 5 In Cuba, uniquely, it is govemment policy to confine ali those with AIDS or HIV seropositivity in a sanatorium on the island of Havana in order to limit the spread of the disease. 6 The youths in this study suggested isolating, eliminating by killing and expeliing from the country victims of AIDS as ways of preventing spread. Fortunately, more than one-third (34%) would prescribe treatment for the victims. These unsympathetic reactions highlight the importance of urgently
401
mounting an aggressive health education campaign to allay the unwarranted fears of the community and to protect AIDS sufferers against hostile reactions from feliow citizens and govemment. As a method of self protection, abstinence was the most popular choice (45% ), foliowed by staying with one sexual partner (19%). Only 31% were aware that condoms protect against AIDS and hence only 7% recommended their use for safer sex. It is difficult to know how sincere these young people are in their intentions to remain sexualiy inactive or to sustain their fidelity to one partner. Regarding shielded sex, other surveys have shown that even individuals who constitute the high risk groups for contracting AIDS never or very seldom use condoms. 7 '8 Most of the youths in this study were aware that the disease takes its highest toli in those who trade sex and others who have multiple sex partners. This would indicate that they know whom to avoid but they still need to be made aware that everyone may be a carrier until proven otherwise by a blood test, and that even that may not be foolproof: hence, the importance of adopting safer sex practices at ali times. This study does not daim to have discovered ali there is to know about the knowledge, attitudes and beliefs of Calabar adolescents on the subject of AIDS. For instance, we did not enquire into the sexual and religious practices of the pupils and students were not asked about matemalchild transmission. While there appears to be a considerable amount of knowledge amongst the students questioned, the study has revealed that many of them are misinformed, confused or completely ignorant in many respects. This calis for intervention. The physician seems to be the best and most appropriate agent for disseminating information on AIDS. 4 It is the intention of the authors to visit ali secondary schools in Calabar in order to deliver health talks on AIDS. Teachers, parents and ali health personnel have a
402
A. A. Asindi et al.
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part to play in advancing appropriate information on the epidemiology and pathogenesis of AIDS. The young people themselves should be involved in youth programmes. We hope this paper will trigger more community surveys on the disease. For example, we need to discover in detail the sexual practices and drug habits of teenagers in our community. Finally, it will be important to review from time to time the knowledge of youths about AIDS.
Acknowledgment The authors are indebted to the principals and pupils of the schools involved for their co-operation in this study. The secretarial services of Patience Akpabio and Macaulay Udia are also appreciated.
References 1 Chin J, Mann J M. The global patterns and prevalence of AIDS andHIV infection. AIDS 1988;2 suppl1 :247-52. 2 Chin J, Mann J M. Global surveillance and forecasting of AIDS. Bull WHO 1989; 67:1-7. 3 Mann JM, Chin J. AIDS: a global perspective. N EngiJ Med 1988;319:302-3. 4 Hingson R, Strunin L, Berlin B. Acquired immunodeficiency syndrome transmission: changes in knowledge and behaviors among teenagers, Massachusetts statewide surveys, 1986 to 1988. Pediatries 1990; 85: 24-9. 5 Klous T. The Caribbean: reftecting global contrasts. AIDS Watch 1990; 9:1-4. 6 Bayer R, Healton C. Controlling AIDS in Cuba: the logic of quarantine. N Engl J Med 1989; 320:1022-4. 7 Stiffman AR, Earls F. Behavioral risks for human immunodeficiency virus infection in adolescent medical patients. Pediatries 1990; 85:303-10. 8 Kegeles S, Adler N, Irwin C. Sexually active adolescents and condoms; changes over one year in knowledge, attitude and use. Am J Public Health 1988; 78:460--2.
ISSN: 0272-4936 (Print) 1465-3281 (Online) Journal homepage: http://www.tandfonline.com/loi/ypch19
Acquired immunodeficiency syndrome: education exposure, knowledge and attitude of Nigerian adolescents in Calabar A. A. Asindi, E. O. Ibia & M. U. Young To cite this article: A. A. Asindi, E. O. Ibia & M. U. Young (1992) Acquired immunodeficiency syndrome: education exposure, knowledge and attitude of Nigerian adolescents in Calabar, Annals of Tropical Paediatrics, 12:4, 397-402, DOI: 10.1080/02724936.1992.11747605 To link to this article: http://dx.doi.org/10.1080/02724936.1992.11747605
Published online: 13 Jul 2016.
Submit your article to this journal
View related articles
Citing articles: 5 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypch19 Download by: [Australian Catholic University]
Date: 26 August 2017, At: 01:29
Annals of Tropical Paediatrics (1992) 12,397-402
Acquired immunodeficiency syndrome: education exposure, knowledge and attitude of Nigerian adolescents inCalabar A. A. ASINDI, E. O. IBIA & M. U. YOUNG
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria (Received 7 January 1992)
Summary The knowledge of and attitude to acquired immunodeficiency syndrome (AIDS) of 738 secondary school youths in Calabar were studied by questionnaire in March 1991. Most (92%) of the adolescents bad beard about AIDS, largely through the mass media (79-85%), with parents and teachers contributing in less than 40%. About 30% did not know that AIDS exists in Nigeria. Most of them knew that promiscuity, blood transfusion and sharing injection needles and syringes are the major modes of transmission, but a number still incriminate toilet seats, eating utensils, hand-shaking and kissing. Only 31 ~o were aware that condoms provide protection. For self-protection the youths prefer abstinence (45°,0 ) and confinement to one sex parmer (19%). Only 3.6% would adopt the use of condoms. To prevent the spread of AIDS, the youths prescribe isolation (37%), treatment (34%), and killing (14° 0 ) of diagnosed cases. Most youths (77%) will stop seeing friends and 63% will reject relatives who develop AIDS. The study reveals that while general awareness of AIDS is fairly good, detailed knowledge is riddled with misconceptions and confusion. It is recommended that physicians in the community should assist in disseminating accurate information, with the support of parents, teachers and the youths themselves.
Introduction Within the past decade, the acquired immunodeficiency syndrome (AIDS) has become a worldwide problem causing great public health concern. The best data on AIDS emanate from the advanced countries of America and Europe, whereas in Africa many cases remain unrecognized and unreported. Under-reporting in African countries, including Nigeria, is largely due to large segments of the population having limited access to health care facilities where AIDS might be diagnosed and reported. The Reprint requests to: Dr A. A. Asindi, Department of Paediatrics, University of Calabar, Calabar, Nigeria.
World Health Organization (WHO) estimates that perhaps only 10-20% of adult cases of AIDS in Africa are being reported. 1•2 The authors have been involved in five confirmed cases of AIDS in children admitted to the University of Calabar Teaching Hospital (UCTH) during the months of February to May 1991. In ali five cases, both the child and its mother were HIV -positive by ELISA and Western blot tests. As at Mar ch 1991, the total figure reported by the Nigeria Federal Ministry of Health was 84 cases of AIDS out of 524 HIV-seropositive children. Given the gross under-reporting in many developing countries, these figures are the tip of the iceberg. AIDS must therefore be regarded as a real problem in Nigeria.
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
398
A. A. Asindi et al.
There is a high prevalence of teenage pregnancy among secondary school girls in Calabar, which suggests that a large proportion of adolescents in the city are sexualiy active. Considering the existence of HIV infection in Calabar, the re are grounds for concern that these young people are at risk of acquiring the disease. In the absence of any effective treatment or immunization, the world at the moment relies on preventive measures which involve abandoning behaviour that can promote spread of the disease. 3 In planning an effective anti-AIDS programme for any population, the background knowledge, beliefs and behaviour of people regarding the disease are essential factors to take into consideration. In Nigeria, concerted efforts have been made to enlighten people, mainly through the press, radio and television. I t was decided to determine how effectively the available AIDS information has reached adolescents who are a vulnerable sector of society. A study was therefore conducted to evaluate the knowledge of adolescents in Calabar about modes of transmission of AIDS, their behavioural patterns related to self protection, and their attitudes to condom use and towards AIDS patients. It is expected that the information derived from this survey will be useful in planning educational programmes and in counselling about AID S. Cala bar is a cosmopolitan city in the southeastern part of Nigeria with an estimated population of 600 000. The people are predominantly Christian. By culture, students in post-primary schools are not supposed to bemarried.
Subjects and methods The survey was conducted in March 1991 on secondary school students in Calabar Municipality. A questionnaire with both closed- and open-ended responses was drawn up and given to this sample population. Respondents were asked particularly about their source of information on AIDS,
modes of transmission and attitude to condoms and AIDS patients. Questions regarding knowledge of the disease were answered by 'yes/no/don't know', while those for eliciting attitude and perspective usualiy required volunteered responses. Adequate guidance on how to answer the questions was given with great care so as not to influence their responses. The 'don't knows' were regarded as evidence of ignorance. Six of the eight post-primary education institutions in Calabar were selected for the study. In three of these the pupils were ali girls, in two ali boys and in one both boys and girls. Informed consent was obtained from the principals of the schools in advance. In order to obtain unbiased answers from each student, the questionnaire was administered in the form of a classroom test so that pupils had no opportunity to compare or copy answers. For the same reason, the pupils were given very short notice of the examination in order to prevent prior group discussion which might have produced biased, uniform answers. Also, to limit possible discussion of the project between schools, ali tests were completed within 2 weeks in ali the institutions. The principals and pupils were assured that the answers were confidential and pupils did not write their names on the forms. One of the au thors (MUY) supervised the test in ali the schools.
Results Of a total of 1000 questionnaires administered, 738 were returned properly completed. The ages of the 738 respondents were: 76 (10.3%) under 15 years, 587 (79.5%) 15-20 years and nine (1.2%) 20-22 years. Sixty-six (9%) of the students did not record their ages. Most (92.4%) of the pupils had heard about AIDS, mainly from newspapers, magazines, radio and television which constituted about 80% of sources. Friends, teachers and parents constituted about 40% each of sources (Table I).
AIDS: attitudes of Nigerian adolescents TABLE 1. Adolescent education about AIDS (n = 738)
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
Information/source
399
TABLE II. Knowledge about modes ofHIV transmission (n=738)
%
Heard about AIDS through: Newspapers and periodicals Radio Television Friends Parents Teachers Doctor Yes
No
92.4 85.0 80.0 79.0 42.0 38.7 37.9 31.0 Don'tknow
Any AIDS in Nigeria? Any cure for AIDS?
1.3 61.1
29.3 27.5
69.4 11.4
In response to the question whether AIDS exists in Nigeria, 69% answered in the affirmative. Sixty-one per cent also were aware that there is not yet a cure for AIDS.
Knowledge of modes of transmission The overwhelming majority of pupils were aware that AIDS is transmitted through sexual intercourse (97%), blood transfusion (82%) and contaminated syringes and needles (74%) (Table Il). Seventy-fi.ve per cent of the respondents disagreed with the statement that only men transmit AIDS while 82% agreed that women can transfer AIDS to men. This may be interpreted as indicating that 75-82% of the respondents know that both men and women transmit AIDS. A considerable proportion considered that toilet seats (31 %), sharing cups and spoons (24%), shaking bands (13%) and kissing (42%) were modes of acquiring the HIV infection.
Yes
No
Don'tknow
Modes of transmission
(%)
(%)
(%)
Blood transfusion Kissing Sexual intercourse Sharingcupsandspoons Shaking bands with AIDS patients Injection with already used syringes and needles Toilet seats Only men transmit AIDS Women transmit AIDS tomen
82.0 42.0 97.0 24.5 13.0
3.0 26.0 0.5 35.0 52.0
15.0 32.0 2.5 40.5 35.0
74.2
3.8
22.0
31.0 5.7
24.5 75.0
44.5 19.3
82.0
4.0
14.0
TABLE III. Knowledge about individuals exposed to HIV(n=738)
Young children School children Prostitutes Priests/reverend sisters Individuals with multiple sexual partners
Yes
No
Don't know
(%)
(%)
(%)
14.0 28.0 92.0 7.4 82.0
53.0 32.0 1.5 48.0 3.4
32.0 40.0 6.5 44.6 14.6
92% and 82% of the respondents, respectively (Table III). Persons such as priests and nuns were mentioned least often (7%).
Use of condoms Knowledge of predisposition to H IV infection The students were asked to choose from a list of categories those whom they thought were most vulnerable to contracting AIDS. Sex workers (prostitutes and others with multiple sex partners) were mentioned by
The majority of the respondents (83%) knew about condoms but only 31% were aware that they provide protection (Table IV). About 9% (boys and girls) admitted they had used condoms and 7% recommended their use for safer sex.
A. A. Asindi et al.
400
IV. Knowledge and attitude regarding condoms (n=738)
TABLE
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
Know about it? Does it protect? Self-reponed use of condoms
TABLE V.
Yes
No
Don'tknow
(%)
(%)
(%)
82.9 31.0 8.9
17.1 18.5 91.1
0.0 50.5 0.0
Attitude about prevention of AIDS
(n=738)
% Abstinence Faithfulness Avoiding AIDS patients Avoiding blood transfusion Using condoms Others Don't know
45.3 19.0 5.5 4.3 3.6 13.8 8.5
Attitude towards protection from AIDS When asked to suggest frankly what should be done by individuals and governments to prevent AIDS, abstinence (45%) foliowed by restriction to one sex partner ( 19%) were the most popular options (Table V). Only a smali number (4%) would use condoms to protect themselves and 6.9% recommended them for others. Other suggestions (14% of respondents) included imprisonment of ali prostitutes and ali who engage in indiscriminate sex; closing ali night clubs; restricting immigration of aliens into Nigeria; and a godly lifestyle which forbids extramarital sex.
Attitudes to AIDS patients (Table VI) To a question 'What in your opinion should government do to those who have AIDS?', isolation was the most popular suggestion (37%) and sorne (34%) recommended treat-
TABLE VI.
Adolescent attitude towards AIDS patients (n = 738)
% Isolation Should be treated Should be killed Should be taken overseas Don'tknow Others
36.7 34.1 14.2 1.4 7.6 6.0
mentofthevictims. Sadly,killingofaliAIDS patients was advocated by 14% as a method of limiting spread. Total rejection of friends who develop AIDS was advocated by 77%, and 66% of adolescents would not harbour even a relative in the family household who was found to be seropositive.
Discussion Most secondary schools in Calabar have been famous right from their inception in the early 20th century, when they were established by British missionaries, and they have always attracted admissions from ali parts of Nigeria. Therefore, although the bulk of the student population are those whose parents live in Calabar, the responses obtained from the sample population do not represent only the views of the residents of the city but are partiy national in fl.avour. To our knowledge, this is the first survey of Nigerian youths regarding AIDS-related information and behaviour. Our findings indicate that a majority (92%) of adolescents in Calabar have heard about AIDS. This is close to the 100% knowledge leve} recorded amongst youths in Massachusetts, USA in 1988. 4 The main sources of information for students in Calabar (80%) are the news media-newspapers, magazines, radio and television. Less than 40% of the students derived their information from their parents and teachers, and least from doctors (31 %). In Massachusetts, up to 65% and 80% knew about AIDS through their parents and
Downloaded by [Australian Catholic University] at 01:29 26 August 2017
AIDS: attitudes of Nigerian adolescents
teachers, respectively. 4 Cultural taboos in Nigeria tend to inhibit frank discussion of sexuality between adults and youths. This may explain the low level of interaction of the teachers, parents and even physicians with adolescents on the subject of AIDS demonstrated by our survey. It has become clear from this study that there are severa} misconceptions, beliefs and attitudes which are causes for concem. For instance, 30% of the youths were not aware that AIDS exists in Nigeria and 39% did not know that there is still no cure. This knowledge gap is particularly disturbing because the sexualiy active among them might have been running grave risks. Ali young people in Calabar therefore need to be educated in this regard as a matter of urgency. Knowledge about the modes of transmission was reasonably good. Promiscuity, blood transfusion and sharing injection needles and syringes were identified by the majority of respondents as the most important ways of contracting the disease. However, the idea that AIDS can be transmitted by toilet seats, hand-shaking, sharing eating and drinking utensils and kissing is quite prevalent and needs to be corrected. A similar notion still exists amongst American youths but to a lesser extent. 4 This ignorance probably explains people's instinct to reject friends and relatives who develop the disease, as cited in severa} surveys, including the present one. In Haiti, severa} clinics have reported that staffwould refuse to work with people who are known to have HIV infections or who are simply relatives or friends of victims of AIDS. 5 In Cuba, uniquely, it is govemment policy to confine ali those with AIDS or HIV seropositivity in a sanatorium on the island of Havana in order to limit the spread of the disease. 6 The youths in this study suggested isolating, eliminating by killing and expeliing from the country victims of AIDS as ways of preventing spread. Fortunately, more than one-third (34%) would prescribe treatment for the victims. These unsympathetic reactions highlight the importance of urgently
401
mounting an aggressive health education campaign to allay the unwarranted fears of the community and to protect AIDS sufferers against hostile reactions from feliow citizens and govemment. As a method of self protection, abstinence was the most popular choice (45% ), foliowed by staying with one sexual partner (19%). Only 31% were aware that condoms protect against AIDS and hence only 7% recommended their use for safer sex. It is difficult to know how sincere these young people are in their intentions to remain sexualiy inactive or to sustain their fidelity to one partner. Regarding shielded sex, other surveys have shown that even individuals who constitute the high risk groups for contracting AIDS never or very seldom use condoms. 7 '8 Most of the youths in this study were aware that the disease takes its highest toli in those who trade sex and others who have multiple sex partners. This would indicate that they know whom to avoid but they still need to be made aware that everyone may be a carrier until proven otherwise by a blood test, and that even that may not be foolproof: hence, the importance of adopting safer sex practices at ali times. This study does not daim to have discovered ali there is to know about the knowledge, attitudes and beliefs of Calabar adolescents on the subject of AIDS. For instance, we did not enquire into the sexual and religious practices of the pupils and students were not asked about matemalchild transmission. While there appears to be a considerable amount of knowledge amongst the students questioned, the study has revealed that many of them are misinformed, confused or completely ignorant in many respects. This calis for intervention. The physician seems to be the best and most appropriate agent for disseminating information on AIDS. 4 It is the intention of the authors to visit ali secondary schools in Calabar in order to deliver health talks on AIDS. Teachers, parents and ali health personnel have a
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part to play in advancing appropriate information on the epidemiology and pathogenesis of AIDS. The young people themselves should be involved in youth programmes. We hope this paper will trigger more community surveys on the disease. For example, we need to discover in detail the sexual practices and drug habits of teenagers in our community. Finally, it will be important to review from time to time the knowledge of youths about AIDS.
Acknowledgment The authors are indebted to the principals and pupils of the schools involved for their co-operation in this study. The secretarial services of Patience Akpabio and Macaulay Udia are also appreciated.
References 1 Chin J, Mann J M. The global patterns and prevalence of AIDS andHIV infection. AIDS 1988;2 suppl1 :247-52. 2 Chin J, Mann J M. Global surveillance and forecasting of AIDS. Bull WHO 1989; 67:1-7. 3 Mann JM, Chin J. AIDS: a global perspective. N EngiJ Med 1988;319:302-3. 4 Hingson R, Strunin L, Berlin B. Acquired immunodeficiency syndrome transmission: changes in knowledge and behaviors among teenagers, Massachusetts statewide surveys, 1986 to 1988. Pediatries 1990; 85: 24-9. 5 Klous T. The Caribbean: reftecting global contrasts. AIDS Watch 1990; 9:1-4. 6 Bayer R, Healton C. Controlling AIDS in Cuba: the logic of quarantine. N Engl J Med 1989; 320:1022-4. 7 Stiffman AR, Earls F. Behavioral risks for human immunodeficiency virus infection in adolescent medical patients. Pediatries 1990; 85:303-10. 8 Kegeles S, Adler N, Irwin C. Sexually active adolescents and condoms; changes over one year in knowledge, attitude and use. Am J Public Health 1988; 78:460--2.
