EVALUATION OF EDUCATIONAL PROGRAM ON AIDS IN SECONDARY SCHOOLS IN HONG KONG
Lau J T F, Lee S S*, Centre for Clinical Trials and Epidemiological Research, The Chinese University of Hong Kong, *Department of Health, Hong Kong Government, HONG KONG.
For the Phase I Study, 150 secondary schools were randomly selected from all secondary schools in Hong Kong. 98 out of the 150 principals responded to the Questionnaire for Principals (response rate of about 66%). A subset of 50 schools were then randomly selected, 870 teachers front 46 out of 50 schools responded (a response rate of about 50%). For the Phase II Study, the 150 schools were stratified into 4 groups according to with or without class teaching on AIDS or participation in AIDS-related extra-curricular activities. The students were briefed to ensure confidentiality, the questionnaires were self-administered. 1186 secondary 4 to 6 students from 12 schools participated in the Study.
The opinions were split - 51% of the principals and 41% of teachers thought that infected children should be kept in the same schools that they have been studying; 37% of the principals and 41 % of the teachers thought that they should be kept in special schools; 3% of the principals and 6% of the teachers thought that they should not attend any school. Furthermore, 31% of the principals and 23% of the teachers thought that infected students should be identified. The students seemed to be more supportive, only 13% would mind an infected classmate to study in the same class. Misconception about transmission via casual contact is negatively associated with supportiveness toward HIV-infected person for both teachers and students.
About 50% of the teachers did not feel confident to present accurate information or to answer question about AIDS, condom usage, or to talk about sexual intercourse or condom usage, sexual intercourse. 35% felt inconfident to discuss about high risk sexual behaviours or to help students to develop preventive skills. Among those students who had been taught about AIDS in class, only 10% felt uncomfortable about the teaching. However, only 42% of the students felt that they were interested.
The teachers' knowledge level about AIDS seemed to be quite high, 80 to 90% scored correct on most of the relevant knowledge items; except when body fluid is involved (50%, 50% and 75% believed that mosquito bites, kissing, and coughing can transmit HIV). The students knew quite well that AIDS can be asymptomatic (about 80% "correct"). Knowledge that AIDS can be transmitted via needle sharing and pregnancy of HIV-infected mothers were high (81% and 91%). "Common misconception'' about the transmission via casual contacts however, still exists: 65% believed that AIDS can be transmitted via mosquito bites or kissing. About half thought that it is transmittable via "coughing" or "using toilet seats" that involve HIV-infected persons. Still, one third believed that "dining" or "clothing" can transmit the virus, and 25% believed that it is transmittable by brief body contact.
About half of tile students did not believe that condom is effective to prevent contracting AIDS. 38% of the students believed that abstinence is not the best means to prevent AIDS. About 17% of the students thought that they would not use condom if they were going to have sex. Those with sexual experience were more likely (24%) to reject using condom than those without sexual experience (15%). Furthermore, 22% of the students believed that they would not get AIDS if they had occasional unprotected sex because they saw themselves as being at low risk.
Factors associated with condom avoidance beliefs were : peer's influence, some experience of unprotected sex, knowledge about AIDS transmission, sexually permissiveness and being male students. Those showing some tendency of being at risk tended to believe that preventive measures would not be efficient;
28% of the students stated that they would have sex with their lovers upon their request, 21% thought that they would have multiple partners before their marriage. Students tended to have attitudes associated with risk behaviours : (1) if they were sexually permissive or if they had sex experience; (2) if they were submissive to peer's pressure or if their peers showed high degree of acceptance for risk behaviours.
The practice of premarital sex has widely been accepted by the students. 50% found pre-marital sex acceptable and 23% thought that it is appropriate for youth to have pre-marital sex.
20% of the students reported that they had sexual experience (21% for males, 19% for females). Among those with sexual experience, 27% had unprotected sex for more than once, females were more likely to experience unprotected sex (11% vs. 7%). Sexual permissiveness and peer's influence were shown to be significantly associated with sexual experience.
When the groups of students with or without class teaching and with or without participation in extracurricular programs are compared, while class teaching can bring about better knowledge, it has no impact on the above-mentioned attitudes or behaviours. Extra-curricular programs actually had very little observable effects.
(1) There are still some popular misconception about AIDS among teachers and students; (2) the teaching staff are not well prepared to guide the students in prevention, quite a number of them are not supportive towards HIV-infected students; (3) about 20% of the students are sexually active, a substantial proportion of them were not practising safe sex or were showing attitude inclining towards risk behaviours; (4) class teaching may be able to raise knowledge level, but has not been able to change attitude or behaviours. Extra-curricular programs showed little observable effect; (5) students are strongly subjected to peer’s influence in the AIDS-related attitude and behaviours.