SWAZILAND SECONDARY/HIGH SCHOOL STUDENTS RISKS THAT MAY PROMOTE HIV INFECTION AND THE SPREAD OF AIDS
(Part 1)NOZIPHO EUGENIA MNDEBELE
NATIONAL CURRICULUM CENTRE
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SERA: For being there as a Research Organisation and giving financial support.
SNAP Personnel and Millicent Obaso: For data analysis and the layout of the Report.
Special thanks also go to Mr Rudolph Maziya former Project Manager of SNAP who provided moral support, useful information, skills and comments on the design of the study and for making sure that the study was indeed undertaken.
The study was initiated by the principle investigator Mrs Nozipho Mndebele of Swaziland Educational Research Association (SERA) drawing its members from the University of Swaziland, College Lecturers and Curriculum Developers in Swaziland. The study was part preparation for presentation to the Associations bi-annual symposium which was scheduled to take place in July 1997. The investigator, wrote a project proposal and approached SNAP to work with her to facilitate data gathering from school pupils in the four regions of Swaziland. She involved SNAP in redefining the objectives of the study and to develop questionnaires.
SNAP was interested in the findings and recommendations of the
survey to streamline their youth programme for increased impact.
Secondary and high school students in the four regions were targeted for the study. Forty two schools were randomly selected from 165 schools in all the 4 regions of Swaziland (Manzini, Hhohho, Shiselweni and Lubombo) using school registers. Head teachers from the 42 schools were brought together on 21 January 1995 for briefing and to solicit their support for the study.
The original plan was to involve 6300 pupils but the actual number who were given questionnaires were 3780, but only 2258 were used for analysis. On the 30 of September 1995, representatives from the selected schools were also called for a briefing and orientation on how to collect the data.
Questionnaires were delivered to the trained students in the selected schools between 23 and 27 October 1995 to initiate data collection from their peers.
Data collection took place between 30 October and November 1995. The questionnaire (which was multiple choice style, see appendix) was distributed to 3780 students drawn from forms 1,2 and 4 (form 3 and 5 students were involved in their final exams therefore did not participate in the study). From each school 90 students were randomly selected (30 from each form). The trained student in each school convened a meeting with the 90 sample students and read out one question at a time from the questionnaire. Questionnaires were completed by individual respondents and returned to the principal investigator, between 6 to 10 November 1995, who in turn submitted the completed the questionnaires to SNAP for analysis and report writing.
The fact that the process of completing questionnaires was presided
over by peers, this might have encouraged interviewees to respond freely and in a relaxed
manner to all questions.
LIMITATIONS AND CONSTRAINTS
Several constraints were encountered both by the principle investigating and the consultant who was hired to analyse the data. Highlight of the major constraints is provided below.
1) The data collection instruments did not allow for probing and therefore some of the questions at and some were not answered properly.
And thus although 3780 questionnaires were distributed, only 2258 have been included in the analysis
2) The peer educators who read out the questionnaires to the respondents lacked detailed knowledge in STD, HIV and AIDS as well as experience in facilitating data collection. Since they worked without supervision it led to incomplete responses in some cases which could not be explained later to clarify some issues.
3) The use of multiple choice approach limited the amount of
information that was provided in the questionnaire and this limited qualitative
information which could have been useful in explaining some of the findings.
SECTION ONE KNOWLEDGE AND BELIEF ABOUT AIDS
The objectives of this section were
1) To find out if secondary/high school students know the three basic modes of HIV transmission.
2) To find out if secondary/high school students know the three main basic modes of preventing HIV infection through sexual intercourse.
3) To find out if secondary/high school students know what the acronyms STD, HIV, AIDS, TASC, FLAS, SHAPE, and SNAP stand for.
4) To quantify the knowledge of secondary/high school students on basic facts about HIV/AIDS.
5) To quantify the knowledge of secondary/high school students on HIV prevalence in Swaziland.
6) To find out if secondary/high school students know which age group is most affected by AIDS.
7) To find out if secondary/high school students know the relationship between HIV infection and having an STD.
8) To determine the extent of misconceptions about the transmission of HIV amongst secondary/high school students.
These objectives were addressed by asking thirteen questions analysed in the following sections.
What do the following abbreviations stand for?
STD HIV AIDS TASC FLAS SHAPE SNAP
Correct Answer: n/a
Respondents were requested to write in full what each of the above acronyms stands for. Of the seven acronyms, STD was the best known with 1526 (67.7%). The second best known acronym was FLAS 1502 (66.5%). The third best known was AIDS, known by 1479 (65.5%). SNAP was known by 1254 (55.5%) of the respondents. The least known of the acronyms were TASC (35 people, 1.6%), SHAPE (207 people, 9.2%) and HIV (411 people, 18.2%).
The findings show that over 65% of those interviewed knew what AIDS stands for but less than 20% knew the meaning of HIV. Knowledge of both AIDS and HIV are necessary for the prevention and control of infection. Balanced knowledge of the two should be encouraged.
Taking all of the acronyms as a group, the National Average was 40.6% of respondents giving a correct answer. Hhohho and Manzini regions exceeded this with 45.9% and 41.1% respectively. Shiselweni and Lubombo regions were below average with 38.3% and 31.5% respectively.
All organisations were best known in the regions where they exist. SNAP and SHAPE were best known in Hhohho region and their offices are in Mbabane. TASC was best known in Manzini Region and their office is in Manzini. FLAS was known in all regions and they have branch offices across the country.
The disease AIDS is caused by a(n)? a)Bacteria b)Virus c)Protozoa d)Insect
Correct Answer: Virus
Table K-2 shows respondents knowledge of what causes the disease AIDS. Respondents were requested to select and mark the correct answer out of four choices; bacteria, fungus, protozoa and insect.
Two thousand one hundred and nine youth responded to the question (93.4%). Only 149 (6.6%) did not respond. Over 94% knew the correct answer, that AIDS is caused by a virus. Less than 6% did not know the answer. Those who did not respond to the question are assumed not to know the answer.
Therewas little difference between the regions. In each of the four regions, over 92% had this knowledge. Hhohho region was first with 96.0% of their respondents giving the correct answer. Shiselweni region was low with 92.4% correct.
What is meant by the term "window period"?
Correct Answer: n/a
Table K-3 above shows that a full 97% of those surveyed answered the question (2191 out of 2258). But of those who responded, only 16.4% knew the meaning of Window Period.
More students in Hhohho region knew the meaning of Window Period (20.5% of respondents). In Lubombo region only 9.7% knew what Window Period means. Nineteen and 18% were recorded in Shiselweni and Manzini regions respectively.
After being infected with HIV, how long does it take on average for one to become sick (showing signs and symptoms)?
a) 1-2 years b) 3-4 years c) 5-10 years d) 15-20 years e) None of the above
Correct Answer: 5-10 years
Table K-4 shows the level of understanding is very low in all regions. Only 46.8% of those who responded (1970) gave the correct answer - that it takes 5-10 years to develop full blown AIDS after infection with HIV. Fifty three percent gave incorrect answers.
Manzini and Shiselweni regions had the highest number of correct responses with 50.6% and 50.2% respectively. Lubombo and Hhohho regions had 47.4% and 46.7%.
NOTE: The period of 11-14 years was omitted in the multiple choices provided to the respondents. It is therefore difficult to tell whether some respondents would have chosen this omitted age group.
Thirteen percent (267) of those who responded said all the choices provided did
not apply. Either they thought the correct answer is 11-14 years or possibly they did not
know the answer.
People who get STDs have...
a) a lower risk of getting infected with the AIDS virus than those who do not have
Correct Answer: Higher Risk
Table K-5 shows that while 66.1% of the total sample responded to the question, 33.9% did not respond.
Of those who responded, 73.8% (1102) gave the correct answer - that people with STDs have a higher risk of HIV infection. Of respondents, 14.5% believe that there is no risk of infection, while 11.6% thought the risk was low.
Those who did not respond to the question (33.9%)- which may imply that they did not know the answer- combined with those who gave incorrect answers make up 51.2% (1156) of the total sample.
Manzini and Hhohho regions gave the highest number of correct responses with 81.2% and 79.3% respectively. Lubombo and Shiselweni regions were lower with 70.6% and 65.4%.
People who are sick from being infected with HIV are said to have...
a) AIDS b) HIV Infection c) TB d) Syphilis
Correct Answer: AIDS
62.6% of the youth who responded knew the correct answer - AIDS. However, over one third of the respondents (34.2%) believed people who are sick from HIV infection are said to have HIV infection. Only 3.2% thought they have TB or syphilis. The difference between AIDS and HIV infection was not clear to more than one third of the youth. Responses to a different question about what people who are HIV infected yet still healthy are said to have, showed similar confusion as shown in Table K-5 above.
Lubombo region had the highest number of correct answers with 67.3%. Manzini region was lowest with 56.7%. Hhohho and Shiselweni regions had 63.5% and 63.4% respectively.
People who are infected with HIV yet healthy are said to have...
A) AIDS b) HIV Infection c) TB d) Syphilis
Correct Answer: HIV
A greater number refrained from answering this question. The number of people who knew the correct answer were fewer than who knew the previous question number 6. (62.6% vs. 55.8%) This finding shows that the concepts of HIV Infection and AIDS are confusing to the youth. The findings further show that the term HIV infection is understood less than AIDS. Only 7.5% of the respondents thought those who have HIV infection but are still healthy have either TB or Syphilis.
Manzini and Hhohho regions had the highest number of correct answers with 67.6% and 60.5% respectively. Lubombo and Shiselweni followed with 49.8% and 47.2%.
These two Graphs try to visually display the confusion among respondents
between the meaning of HIV Infection and AIDS.
Name three ways in which the AIDS virus can be spread.
Correct Answer: n/a
This question was open-ended and respondents were to list 3 ways in which HIV is transmitted.
Many respondents gave double responses. It is therefore not possible to express the responses in percentages. (i.e. sharing razor/blood transfusion=blood, Many sexual partners/sex with prostitute=sex) The majority of the responses (2024) were related to blood as a means of transmitting HIV. Sex was ranked as number two with 1902 responses. Mother to child (vertical transmission) was least cited with only 188 responses.
Since percentages cannot be compared and regions had different numbers of possible respondents it is impossible to compare regions. We can say that in general all regions could list blood and sex as transmission routes for HIV. But, Vertical Transmission (Mother to Child) was seldom mentioned in all regions. Respondents were only allowed three answers. Though it cannot be assumed that Vertical Transmission is unknown, we can safely say that respondents do not think of it as a top priority.
Table : K-8B
NOTE: Table K-8 B shows the breakdown of specific answers which were classified as "Blood" in Table K-8.
Table K-8 S
a. Other includes such answers as Polygamy, Prostitution, Oral Sex,
b. Under Multiple Partners respondents were split as to who had multiple partners. Some said, "I was unfaithful" while others said, "My partner was unfaithful".
Name three ways in which the spread of HIV through sexual intercourse can be prevented.
Correct Answer: n/a
Question was open-ended and respondents were to list 3 ways in which HIV transmission can be prevented during sex.
Table K-9 shows that of the 2258 youth who were surveyed 64.1% (1447) listed use of condoms as a means of preventing HIV transmission during sex. 47.8% had listed faithfulness to one partner as a means of prevention, while 41.3% listed abstinence.
A further breakdown of incorrect answers will pinpoint some of the misconceptions.
According to current information, what percentage of sexually active people are estimated to be infected with the AIDS virus in Swaziland?
a) 7.1-10.3% b)15.0-17.5% c) 18.0-23.0% d) 25.9-30.4%
Correct Answer: 18-23%
Table K-10 reveals that a full 23.2% of those surveyed did not respond to the question.
Only 20.8% of those who responded gave the correct answer- 18.0-23.0%.
All regions did poorly on this question. Hhohho region had the greatest percentage of correct answers with 26.9%. Manzini region came second with 21.8%. Lubombo and Shiselweni regions followed with 19.4% and 17.9% respectively.
Among young people age 15 to 19, which gender would you say is more infected?
a) boys b) girls c) both
Correct Answer: Girls
There is significant documentation that girls tend to be more easily infected due to their biological and physiological make-up. As shown in Table K-11, a large number of young boys and girls do not seem to know this, (73.5% of respondents gave incorrect answers) yet they need this information, particularly the girls, in order for them to take maximum precautions to protect themselves from infection with HIV.
The differences between regions was minimal. Hhohho and Manzini regions were on top with 30.5% and 29.8% respectively. Shiselweni and Lubombo regions followed with 24.4% and 22.8%
Name three things which place people at risk of becoming infected with HIV through sexual intercourse.
Correct Answer: n/a
Table K-12 indicates that the majority of respondents did not give three answers to this question. Multiple Partners and Unprotected Sex were the most listed correct answers with 25.2% and 21.6% respectively. Only 1.7% of respondents listed having an STD as something which increases HIV infection chances.
Hhohho and Manzini regions were above the National average of listing any of the three correct responses with 22.6% and 21.8%. Lubombo and Shiselweni followed with 17.2% and 17.1%.
Which ones of the following practices place people at risk of becoming infected with the AIDS virus? (Cross all that apply)
a) kissing b)sexual intercourse c) contact with blood d) sharing of utensils
Correct Answer: n/a
Sex was listed as a means of HIV transmission by 79.8% of the respondents. Blood followed with 56.8% of the respondents listing it. Mosquitos were the top incorrect answer with 16.4%. Kissing was the second incorrect answer with 16.7%.
It should be noted that the areas where mosquitos are more common were more likely to list mosquitos as a factor. And with kissing, more probing would clarify what type of kissing.
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