PsychologicalReports, 1990, 66, 11-16. @ Psychological Reports 1990
ATTITUDES O F UNDERGRADUATE COLLEGE STUDENTS TOWARD AIDS ' ISJAAH CRAWFORD Loyo& University of Chicago Summary.-This study examined attitudes about AIDS and the effects of those attitudes on the behavior of 131 undergraduate college students. Participants reported having minimal concern about contracting AIDS from their current or future sexual partners, and their rate of sexual activity had not changed from that of the previous year. Of all participants 69% reported they did not use condoms during their sexual encounters. White students were more knowledgeable about AIDS than their peers from minority groups. Although all participants were aware they could not contract the AIDS virus through common social interaction, 80% reported they would feel very anxious if a classmate who had AIDS continued to attend classes. These findings suggest that these undergraduate students underestimate their risk of HIV infection and so jeopardize their health.
Acquired Immune Deficiency Syndrome (AIDS) is currently one of the most pressing public health concerns facing medical and social scientists. The AIDS epidemic is not abating, and a vaccine or cure is not imminent. For the present, prevention is the only weapon against the spread of the disease. The U.S. Surgeon General (1987), the Institute of Medicine, the National Academy of Sciences (1986), Kegeles, Adler, and Irwin (1988), and Melton (1988) have all recommended that a significant component to the prevention of AIDS should be directed toward adolescents and young adults. Before AIDS prevention programs can be implemented, descriptive studies about sexual practices and other risk-taking behavior of adolescents must be clearly understood. Design of prevention programs requires, at a minimum, information about the populations involved and the situations that appear to elicit risk-taking behavior (Melton, 1988). The intent of this study was to examine the attitudes, behavior, and level of concern of midwestern undergraduate college students toward AIDS.
Participants A total of 131 undergraduate students drawn from psychology classes from two urban universities in Chicago participated in the study in the spring of 1988. The respondents were volunteers, and no identification was requested on the survey other than basic demographic information (i.e., age, sex, marital status, and education of the main provider in their household). 'Address correspondence to Isiaah Crawford, Ph.D., Department of Psychology, Loyola University of Chicago, 6525 N. Sheridan Road, Chicago, IL 60626.
12
I. CRAWFORD
Ninety-one of the participants were black and 26 were white. Seventy-three percent (n = 96) of the subjects were women. Over 89% of the respondents were single. A total of 96% of the sample indicated that their current sexual orientation was heterosexual. Two percent each indicated they were homosexual or bisexual. Participants ranged in age from 18 to 62 yr., with a mean of 22 yr. Eleven percent (n = 14) of the subjects were married (M = 7.1 yr.). Over 66% of the "single" subjects stated they currently had sex partners. The mean duration of these relationships was 1.7 yr. The subjects were asked if they engaged in genital, oral, or anal intercourse. Twenty-eight percent of the sample gave no response to these questions. Of the participants who answered our inquiries concerning sexual practices, a total of 76 (70%) stated they participated in genital intercourse. With regard to oral sex, 44 (41%) acknowledged this practice, and 9 (9%) reported engaging in anal sex. Questionnaires Participants were given an adapted version of a measure used by Simkins and Eberhage (1984), a 7-point rating scale (1 = N o concern at all, 7 =Very concerned about it) in which subjects are asked to rate their concerns about contracting AIDS. In addition, subjects were also asked to rate on a 7-point scale the effect their concerns may have on their current sexual activity compared to the previous year, beliefs regarding mandatory AIDS testing, and concerns over a schoolmate continuing to attend classes if the person were diagnosed with AIDS. Subjects were also asked if they felt their concern about contracting AIDS had influenced their sexual behavior. Subjects also completed the DiClemente AIDS Knowledge Questionnaire, a self-report questionnaire which assessed students' knowledge, attitudes, and beliefs about AIDS (DiClemente, Zorn, & Temoshok, 1986). Test-retest reliability has been reported as 0.70.
RESULTS There were no subjects who responded they had AIDS, although 7% stated they knew someone who was diagnosed with the disease. AIDS Knowledge and Anxiety A t ratio performed on the subjects' scores on the AIDS Knowledge Questionnaire indicated a significant difference between racial groups ( t l j l = 2.98, p < .05). White undergraduate students (M = 27.23, SD = 3.16) were more knowledgeable about AIDS than black undergraduates (M = 24.95, SD = 3.53). There were no significant sex differences in knowledge about AIDS. The mean of the rating scale measuring the concern of "single" subjects about contracting AIDS from a present sexual partner was 3.12 (SD = 2.08), with 47% of the respondents rating 1 on the 7-point scale (no concern at all). There was a significant negative correlation of -0.23 between duration
ATTITUDES TOWARD AIDS
13
of current relationship and concern about contracting AIDS (p = .05). This finding suggests that the longer the duration of the relationship the less the concern about HIV infection. However, there was more concern expressed about contracting AIDS from a future sexual partner (M = 4.50, SD = 2.15); 40% of the respondents indicated they were very concerned about their risk of infection with future sexual partners. The level of AIDS knowledge was not significantly correlated with expressed concerns about contracting AIDS. Although just shy of statistical significance (tljl=1.69), black undergraduates (M = 3.28, SD = 2.12) expressed somewhat more concern about contracting AIDS from their current sexual partners than the white undergraduates (M= 2.35, SD = 1.77). All 131 subjects indicated they were aware they could not contract AIDS by shaking hands with someone who has AIDS or acquire the virus by simply "being around" a person with AIDS. However, when asked to disclose their level of concern if they knew one of their classmates had AIDS and continued to attend classes, 80% stated they would be very concerned about their health and would feel very uncomfortable in their presence. With regard to HIV antibody testing, 43% of black students and 36% of white students were strongly for mandatory testing. O n a more personal level, when asked if they would take a free blood test to determine their own HIV status, 65% of black and 31% of white students reported they would not submit to the test.
Sexual Activity One of the significant concerns of this study was to examine whether AIDS affected undergraduate students' sexual activity. Respondents were asked to indicate on a 7-point scale how their sexual activity compared with that of a year ago. Following Simkins and Eberhage (1984), we also asked if they believed their concerns about AIDS influenced their sexual behavior. Regarding changes in rate of sexual activity, the mean was 3.9 on the 7-point scale, which means that average sexual activity had not changed from that of the previous year. However, 33% of the sample indicated a slight to definite increase in their sexual activity compared to the past year. No significant differences between black (M = 3.73, SD = 2.25) and white (M = 4.40, SD = 2.14) college students were found (t117 = 1.32). When asked if concerns about AIDS influenced their sexual behavior, 24% indicated no, 18% yes, and 58% gave no answer. The high percentage of individuals not responding to this question may have biased this subsample with people who were wiUing to respond. Subsequently, definitive conclusions from this sample should be drawn with caution. Seventy-six percent of the respondents reported that they engaged in genital intercourse; however, only 31% of black students and 51% of white students reported the use of condoms during these sexual encounters (x2= 6.59, p < .05, n = 75).
I. CRAWFORD
DISCUSSION The results of this survey suggest that the impact of the AIDS health crisis on the sexual behavior of this sample of undergraduate students has not been significant. Both black and white students reported having minimal concerns about contracting the virus from their current sexual partners and apparently their level of sexual activity had not been affected. Participants indicated that their level of sexual activity had not changed compared to that of one year ago and less than 50% used condoms during sexual activity. This finding is alarming, given that Finkel and Finkel (1978) found that one-quarter of sexually active young adults used condoms before the AIDS crisis was identified. It could be that this lack of explicit concern regarding infection is based on a feeling of familiarity with their sexual partners and their sexual history so the longer they have been with their partners the less concern they report about HIV infection. Another factor mighc be that some of the participants were recruited from a Catholic-affhated university. I t may be that the lack of the use of condoms by participants in the project is a reflection of their religious beliefs. Greater concern regarding infection is reported about future sexual partners, individuals about whom they have less information and less experience. I t may be that knowledge about one's sexual partners affects the concern felt about contracting AIDS. Kegeles, Catania, and Coates (1989) report that a significant number of individuals indicates they would not disclose a positive H I V testing result to their current partners. Kegeles and her colleagues feel this underscores the need for sexually active individuals to protect their health by following safer sex practices since not all sexual partners can be depended on to be forthright about their antibody status or sexual history. The findings of this survey suggest that some undergraduate students may be underestimating their risk of HIV infection with their current sexual partners, and consequently placing themselves at risk for contracting the H I V virus by not engaging in sexual practices that are believed to reduce the risk of infection. The present study also suggests that black students' knowledge of AIDS is more limited than that of the white students. This suggests that black students may be at greater risk of HIV infection because they lack knowledge and that dissemination of information on AIDS prevention into their communities has not been as effective as in other communities. Because the sample sizes of these two groups were not equal, conclusions drawn from these differences should be done with caution. Although black undergraduates appear to be less knowledgeable about AIDS with regard to risk of contagion than their white peers in this study, all participants were aware that the HIV virus is not airborne and simply being in the presence of a person with AIDS will not give one the disease. However, 80% of the sample reported they would feel very uncomfortable if
ATTITUDES TOWARD AIDS
15
one of their classmates contracted the disease and continued to attend classes. This finding suggests that these respondents have minimal faith in reports regarding the risk of HIV infection from the scientific community when they believe that their personal health may be directly threatened. I t may be that AIDS is perceived to be such a life-threatening medlcal condition that verbal assurances from the public health community do little to reduce fear associated with the disease when it comes to interacting with persons with AIDS. The cognitive dissonance demonstrated by this sample indicates that fear of contagion is well entrenched. Although helpful, current public service announcements and general AIDS prevention messages d o not appear to be enough to alleviate the anxieties of the public. It seems this sample is responding by saying "it is better to be safe than sorry." Concern about contagion can also be perceived in the finding that a significant number of the participants advocate mandatory H I V testing. Interestingly, 65% and 31% of black and whlte students report that they would not undergo the test themselves. One interpretation may be that the individuals participating in this survey d o not feel they have been at risk for contracting the virus so they do not feel the test is indicated or that the results of the test may negatively affect their psychological or social status, and so they do not want to know the results. We did not gather data pertaining to why they would not undergo the testing, so we are limited to the above speculation. The general conclusion of this study is similar to Simkins and Eberhage's (1984) findings, that is, college students are mildly concerned about AIDS, but this concern has had little affect on sexual behavior. I t could be that the relative lack of concern about AIDS is a reflection of what this population believes to be the low incidence of AIDS among their peers. However, their level of concern increases when they perceive a direct threat to their health (i.e., interacting with a person with AIDS). These findings suggest that future AIDS prevention programming directed at college populations may need to emphasize the increasing rate of H I V infection among teenagers and young adults. Elevating and personalizing their awareness of the AIDS epidemic may help this population to place greater emphasis upon protecting their health. Future AIDS prevention efforts must also be tailored to the religious, cultural, and future expectations of the target audience. REFERENCES D I C L ~ E N T R. E , J., ZORN,J., & TEMOSI-IOK, L. (1986) Adolescents and AIDS: a survey of knowledge, attitudes and beliefs about AIDS in San Francisco. American Journal of Ptrblic Heallh, 76, 1143-1145. FINKEL,M. L., & FINKEL,D. J. (1978) Male contraceptive utilization. Adolescence, 13, 443-45 1.
16
I. CRAWFORD
INSTITUTEOF MEDIC~E/NATIONAL ACADEMY OF SCIENCES.(1986) Confronting AIDS: directions for public health, health care and research. Washington, DC: National Academy Press. KEGELES,S. M., ADLER,N. E., & IRWIN, C. E. (1988) Sexually active adolescents and condoms: changes over one year in knowledge, attitudes and use. American Journal of Pt~blicHealth, 78, 460-461. KEGELES,S. M., CATANIA, J. A,, & COATES,T. J. (1988) Intentions to communicate positive HIV-antibody stacus to sex partners. Jotrrnal of American Medical Aaociation, 259, 216-217.
KOOP,E. (1987) The Surgeon General's report on AIDS. Waslungton, DC: U.S. Government Printine.- Office. MELTON,G. B. (1988) Adolescents and prevention of AIDS. Professional Psychology: Research and Practice, 19, 403-408. S ~ K I N SL., , & EBERHAGE, M. (1984) Atdcudes toward AIDS, Herpes 11, and Toxic Shock Syndrome. Psychological Reporh, 55, 779-786.
Accepted Decembo 2 7, 1989
ATTITUDES O F UNDERGRADUATE COLLEGE STUDENTS TOWARD AIDS ' ISJAAH CRAWFORD Loyo& University of Chicago Summary.-This study examined attitudes about AIDS and the effects of those attitudes on the behavior of 131 undergraduate college students. Participants reported having minimal concern about contracting AIDS from their current or future sexual partners, and their rate of sexual activity had not changed from that of the previous year. Of all participants 69% reported they did not use condoms during their sexual encounters. White students were more knowledgeable about AIDS than their peers from minority groups. Although all participants were aware they could not contract the AIDS virus through common social interaction, 80% reported they would feel very anxious if a classmate who had AIDS continued to attend classes. These findings suggest that these undergraduate students underestimate their risk of HIV infection and so jeopardize their health.
Acquired Immune Deficiency Syndrome (AIDS) is currently one of the most pressing public health concerns facing medical and social scientists. The AIDS epidemic is not abating, and a vaccine or cure is not imminent. For the present, prevention is the only weapon against the spread of the disease. The U.S. Surgeon General (1987), the Institute of Medicine, the National Academy of Sciences (1986), Kegeles, Adler, and Irwin (1988), and Melton (1988) have all recommended that a significant component to the prevention of AIDS should be directed toward adolescents and young adults. Before AIDS prevention programs can be implemented, descriptive studies about sexual practices and other risk-taking behavior of adolescents must be clearly understood. Design of prevention programs requires, at a minimum, information about the populations involved and the situations that appear to elicit risk-taking behavior (Melton, 1988). The intent of this study was to examine the attitudes, behavior, and level of concern of midwestern undergraduate college students toward AIDS.
Participants A total of 131 undergraduate students drawn from psychology classes from two urban universities in Chicago participated in the study in the spring of 1988. The respondents were volunteers, and no identification was requested on the survey other than basic demographic information (i.e., age, sex, marital status, and education of the main provider in their household). 'Address correspondence to Isiaah Crawford, Ph.D., Department of Psychology, Loyola University of Chicago, 6525 N. Sheridan Road, Chicago, IL 60626.
12
I. CRAWFORD
Ninety-one of the participants were black and 26 were white. Seventy-three percent (n = 96) of the subjects were women. Over 89% of the respondents were single. A total of 96% of the sample indicated that their current sexual orientation was heterosexual. Two percent each indicated they were homosexual or bisexual. Participants ranged in age from 18 to 62 yr., with a mean of 22 yr. Eleven percent (n = 14) of the subjects were married (M = 7.1 yr.). Over 66% of the "single" subjects stated they currently had sex partners. The mean duration of these relationships was 1.7 yr. The subjects were asked if they engaged in genital, oral, or anal intercourse. Twenty-eight percent of the sample gave no response to these questions. Of the participants who answered our inquiries concerning sexual practices, a total of 76 (70%) stated they participated in genital intercourse. With regard to oral sex, 44 (41%) acknowledged this practice, and 9 (9%) reported engaging in anal sex. Questionnaires Participants were given an adapted version of a measure used by Simkins and Eberhage (1984), a 7-point rating scale (1 = N o concern at all, 7 =Very concerned about it) in which subjects are asked to rate their concerns about contracting AIDS. In addition, subjects were also asked to rate on a 7-point scale the effect their concerns may have on their current sexual activity compared to the previous year, beliefs regarding mandatory AIDS testing, and concerns over a schoolmate continuing to attend classes if the person were diagnosed with AIDS. Subjects were also asked if they felt their concern about contracting AIDS had influenced their sexual behavior. Subjects also completed the DiClemente AIDS Knowledge Questionnaire, a self-report questionnaire which assessed students' knowledge, attitudes, and beliefs about AIDS (DiClemente, Zorn, & Temoshok, 1986). Test-retest reliability has been reported as 0.70.
RESULTS There were no subjects who responded they had AIDS, although 7% stated they knew someone who was diagnosed with the disease. AIDS Knowledge and Anxiety A t ratio performed on the subjects' scores on the AIDS Knowledge Questionnaire indicated a significant difference between racial groups ( t l j l = 2.98, p < .05). White undergraduate students (M = 27.23, SD = 3.16) were more knowledgeable about AIDS than black undergraduates (M = 24.95, SD = 3.53). There were no significant sex differences in knowledge about AIDS. The mean of the rating scale measuring the concern of "single" subjects about contracting AIDS from a present sexual partner was 3.12 (SD = 2.08), with 47% of the respondents rating 1 on the 7-point scale (no concern at all). There was a significant negative correlation of -0.23 between duration
ATTITUDES TOWARD AIDS
13
of current relationship and concern about contracting AIDS (p = .05). This finding suggests that the longer the duration of the relationship the less the concern about HIV infection. However, there was more concern expressed about contracting AIDS from a future sexual partner (M = 4.50, SD = 2.15); 40% of the respondents indicated they were very concerned about their risk of infection with future sexual partners. The level of AIDS knowledge was not significantly correlated with expressed concerns about contracting AIDS. Although just shy of statistical significance (tljl=1.69), black undergraduates (M = 3.28, SD = 2.12) expressed somewhat more concern about contracting AIDS from their current sexual partners than the white undergraduates (M= 2.35, SD = 1.77). All 131 subjects indicated they were aware they could not contract AIDS by shaking hands with someone who has AIDS or acquire the virus by simply "being around" a person with AIDS. However, when asked to disclose their level of concern if they knew one of their classmates had AIDS and continued to attend classes, 80% stated they would be very concerned about their health and would feel very uncomfortable in their presence. With regard to HIV antibody testing, 43% of black students and 36% of white students were strongly for mandatory testing. O n a more personal level, when asked if they would take a free blood test to determine their own HIV status, 65% of black and 31% of white students reported they would not submit to the test.
Sexual Activity One of the significant concerns of this study was to examine whether AIDS affected undergraduate students' sexual activity. Respondents were asked to indicate on a 7-point scale how their sexual activity compared with that of a year ago. Following Simkins and Eberhage (1984), we also asked if they believed their concerns about AIDS influenced their sexual behavior. Regarding changes in rate of sexual activity, the mean was 3.9 on the 7-point scale, which means that average sexual activity had not changed from that of the previous year. However, 33% of the sample indicated a slight to definite increase in their sexual activity compared to the past year. No significant differences between black (M = 3.73, SD = 2.25) and white (M = 4.40, SD = 2.14) college students were found (t117 = 1.32). When asked if concerns about AIDS influenced their sexual behavior, 24% indicated no, 18% yes, and 58% gave no answer. The high percentage of individuals not responding to this question may have biased this subsample with people who were wiUing to respond. Subsequently, definitive conclusions from this sample should be drawn with caution. Seventy-six percent of the respondents reported that they engaged in genital intercourse; however, only 31% of black students and 51% of white students reported the use of condoms during these sexual encounters (x2= 6.59, p < .05, n = 75).
I. CRAWFORD
DISCUSSION The results of this survey suggest that the impact of the AIDS health crisis on the sexual behavior of this sample of undergraduate students has not been significant. Both black and white students reported having minimal concerns about contracting the virus from their current sexual partners and apparently their level of sexual activity had not been affected. Participants indicated that their level of sexual activity had not changed compared to that of one year ago and less than 50% used condoms during sexual activity. This finding is alarming, given that Finkel and Finkel (1978) found that one-quarter of sexually active young adults used condoms before the AIDS crisis was identified. It could be that this lack of explicit concern regarding infection is based on a feeling of familiarity with their sexual partners and their sexual history so the longer they have been with their partners the less concern they report about HIV infection. Another factor mighc be that some of the participants were recruited from a Catholic-affhated university. I t may be that the lack of the use of condoms by participants in the project is a reflection of their religious beliefs. Greater concern regarding infection is reported about future sexual partners, individuals about whom they have less information and less experience. I t may be that knowledge about one's sexual partners affects the concern felt about contracting AIDS. Kegeles, Catania, and Coates (1989) report that a significant number of individuals indicates they would not disclose a positive H I V testing result to their current partners. Kegeles and her colleagues feel this underscores the need for sexually active individuals to protect their health by following safer sex practices since not all sexual partners can be depended on to be forthright about their antibody status or sexual history. The findings of this survey suggest that some undergraduate students may be underestimating their risk of HIV infection with their current sexual partners, and consequently placing themselves at risk for contracting the H I V virus by not engaging in sexual practices that are believed to reduce the risk of infection. The present study also suggests that black students' knowledge of AIDS is more limited than that of the white students. This suggests that black students may be at greater risk of HIV infection because they lack knowledge and that dissemination of information on AIDS prevention into their communities has not been as effective as in other communities. Because the sample sizes of these two groups were not equal, conclusions drawn from these differences should be done with caution. Although black undergraduates appear to be less knowledgeable about AIDS with regard to risk of contagion than their white peers in this study, all participants were aware that the HIV virus is not airborne and simply being in the presence of a person with AIDS will not give one the disease. However, 80% of the sample reported they would feel very uncomfortable if
ATTITUDES TOWARD AIDS
15
one of their classmates contracted the disease and continued to attend classes. This finding suggests that these respondents have minimal faith in reports regarding the risk of HIV infection from the scientific community when they believe that their personal health may be directly threatened. I t may be that AIDS is perceived to be such a life-threatening medlcal condition that verbal assurances from the public health community do little to reduce fear associated with the disease when it comes to interacting with persons with AIDS. The cognitive dissonance demonstrated by this sample indicates that fear of contagion is well entrenched. Although helpful, current public service announcements and general AIDS prevention messages d o not appear to be enough to alleviate the anxieties of the public. It seems this sample is responding by saying "it is better to be safe than sorry." Concern about contagion can also be perceived in the finding that a significant number of the participants advocate mandatory H I V testing. Interestingly, 65% and 31% of black and whlte students report that they would not undergo the test themselves. One interpretation may be that the individuals participating in this survey d o not feel they have been at risk for contracting the virus so they do not feel the test is indicated or that the results of the test may negatively affect their psychological or social status, and so they do not want to know the results. We did not gather data pertaining to why they would not undergo the testing, so we are limited to the above speculation. The general conclusion of this study is similar to Simkins and Eberhage's (1984) findings, that is, college students are mildly concerned about AIDS, but this concern has had little affect on sexual behavior. I t could be that the relative lack of concern about AIDS is a reflection of what this population believes to be the low incidence of AIDS among their peers. However, their level of concern increases when they perceive a direct threat to their health (i.e., interacting with a person with AIDS). These findings suggest that future AIDS prevention programming directed at college populations may need to emphasize the increasing rate of H I V infection among teenagers and young adults. Elevating and personalizing their awareness of the AIDS epidemic may help this population to place greater emphasis upon protecting their health. Future AIDS prevention efforts must also be tailored to the religious, cultural, and future expectations of the target audience. REFERENCES D I C L ~ E N T R. E , J., ZORN,J., & TEMOSI-IOK, L. (1986) Adolescents and AIDS: a survey of knowledge, attitudes and beliefs about AIDS in San Francisco. American Journal of Ptrblic Heallh, 76, 1143-1145. FINKEL,M. L., & FINKEL,D. J. (1978) Male contraceptive utilization. Adolescence, 13, 443-45 1.
16
I. CRAWFORD
INSTITUTEOF MEDIC~E/NATIONAL ACADEMY OF SCIENCES.(1986) Confronting AIDS: directions for public health, health care and research. Washington, DC: National Academy Press. KEGELES,S. M., ADLER,N. E., & IRWIN, C. E. (1988) Sexually active adolescents and condoms: changes over one year in knowledge, attitudes and use. American Journal of Pt~blicHealth, 78, 460-461. KEGELES,S. M., CATANIA, J. A,, & COATES,T. J. (1988) Intentions to communicate positive HIV-antibody stacus to sex partners. Jotrrnal of American Medical Aaociation, 259, 216-217.
KOOP,E. (1987) The Surgeon General's report on AIDS. Waslungton, DC: U.S. Government Printine.- Office. MELTON,G. B. (1988) Adolescents and prevention of AIDS. Professional Psychology: Research and Practice, 19, 403-408. S ~ K I N SL., , & EBERHAGE, M. (1984) Atdcudes toward AIDS, Herpes 11, and Toxic Shock Syndrome. Psychological Reporh, 55, 779-786.
Accepted Decembo 2 7, 1989
