Original article - Ethiopian Review

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Fisseha Eshetu 1 , David Zakus 1 and Derege Kebede 1Abstract: A cross-sectional descriptive survey through a self-administered, anonymous andstructured questionnaire was conductd from September to December, 1993, in ten high schools inAddis Ababa to determine the sexual behaviour of adolescents, their knowledge about AIDS,attitudes and practices regarding condoms, their attitudes towards the promotion and distribution ofcondoms in schools, and towards the incorporation of health and sex education into the regularteaching curricula and into the teachers’ training curricula.A total of 910 parents, 755 students and 232 teachers participated in the survey. The resultsshowed that, of the 755 students, 39.8% of the boys and 5.6% of the girls have had sexualexperience. Peer pressure (35.2%) and force (21.6%) were the most important factors thatprecipitated the first sexual encounter. Ten percent of the students had coital contact with acommercial sex worker. Only 42.2% of the sexually active students used condoms on their firstsexual encounter, and only 27.7% used condoms continuously on their subsequent sexualencounters.An overwhelming majority in each of the three categories, (92.6% of the students, 98.7% of theparents and 96.1% of the teachers), approved the incorporation of health education into the regularteaching curricula. The idea of sex education in schools was also approved by 80.1% of thestudents, 90.9% of the parents and 96.1% of the teachers.This study, based upon the findings, recommends that education and health policy makers makerelentless effort to commence health and sex education by incorporating them into the regularcurricula; the implementation of subsequent surveys to identify the most effective and acceptableroutes of condom distribution in school; and implementation of similar surveys in the rural settingsto assess the attitudes in a different setting and acquire a more general overview for the wholecountry. [Ethiop. J. Health Dev. 1997;11(1):7-16]IntroductionSince its identification in 1981, AIDS has been spreading over the world at an alarming speed.By 1990, it was estimated that there were 8-10 million people infected with HIV (1). This figurewas expected to reach 15 million, that is 7.4 million males, 5.9 million females and 1.3 millionborn with infection, world wide by 1993 (2). In Africa alone more than 3000 new infections occurevery year, and if uninterrupted, this figure is expected to reach 30-40 million by the year 2000(3). Characteristically 20% of those infected with HIV are expected to be between the ages of20-29 (4). Given the long incubation period, with the mean latency time of the illness (eight years)(5), a substantial number of those infected may have acquired the disease at earlier ages, perhaps intheir adolescence.______________________________________1From Department of Community Health, Faculty of Medicine, Addis Ababa University AddisAbaba, EthiopiaReports on the situation in Ethiopia demonstrate that, from January 1985 to June 1993, 6726AIDS cases were reported from 47 hospitals. Forty one percent of these were residents of AddisAbaba. The largest reported number was in 1992, accounting for 48.41% of the total reportedsince 1986. By 1993 the sex ratio of those reported was 1.6:1, male to female, and the 15-19 agegroup accounted for 5.81% of the reported cases, while those aged 20-24 years constituted 19.81%of the total cases. About four percent of the total reported cases were students (6).The <strong>Ethiopian</strong> National AIDS Control Programme (NACP) estimated that by the end of 1994,536,600 persons will carry the disease, and in the same year 18,315 new cases of AIDS will bediagnosed (7).All the above reports clearly point firstly to the rapid spread of the disease, and secondly thatadolescents, the focus of this study, represent quite a significant number of those being predisposedto and even acquiring this dreadful disease.In many countries (particularly the developing ones), adolescents account for a larger proportion,
around 20-25% of the total population (8). Constituting a large proportion of the population andalso from various behavioural, cognitive and developmental perspectives, adolescents are labelledas a vulnerable group and deserve attention in terms of research and prevention.Many studies have been conducted all over the World to assess the sexual behaviours ofadolescents. All these studies claim that adolscents are in fact sexually active, with figures rangingfrom 17.3% to 83% and that this trend is increasing. Due to all these, adolecent sexuality is not anissue to be ignored (9-20, 22).The very few studies conducted in Ethiopia also demonstrate a similar pattern. Alarmingly, mostof the above studies including those conducted in Ethiopia (8, 23, 24, 25, 26), demonstrate thatthose sexually active adolescents do not practice safe sex.The fact that condoms significantly reduce the risk of HIV infection is beyond discussion (27).With the AIDS crisis and increase in other STDs and the need to develop safer and more effectivebarrier contraceptives, attention has been reoriented to the only available protection, the condom(28). This being the case, we can no longer ignore the association of condoms with adolescents.We cannot also rely only on talking about abstinence (though this should be promoted also). Thefacts will force us to reorient our efforts towards educating them to exercise safe sex, throughmaintaining a single partner, and if this is not possible, to always use condoms. This view has alsobeen supported by many investigatiors (9, 11, 16-21, 24, 25-28).There are two concerns that need to be addressed at this juncture. The first one is, if condomsare to be distributed to students, will this be promoting their sexuality? And secondly, is this reallywhat they want? Perhaps the strongest and most conclusive rejection of speculations such as thiswas provided by the WHO (1993). It critically reviewed 19 studies conducted all over the worldand disproved that sex education and availability of contraception encouraged sexualexperimentation. In fact, sex/AIDS education encouraged adolescents to delay sex initiation and topractise safe sex if sexually active. It also found out that schools that promoted postponement ofsex and use of condoms were more effective than those which promoted abstinence alone (29).The above being the case elsewhere, this study tried to assess the sexual activity pattern of highschool students in Addis Ababa viz-a vis their parents and teachers attitudes towards the issue ofcondom promotion and provision of health education in schools.MethodsA cross-sectional survey on sexual activity patterns, attitudes and knowledge regarding the use ofcondoms, attitudes towards the provision of conodoms at shcools, and attitudes towardsincorporating health and sex education into school curricula was conducted among students,parents and teachers in ten high schools in Addis Ababa over a period of one month (December,1993).The source population consisted of students, parents and teachers of all 38 high schools in AddisAbaba. The study population was obtained from ten high schools that were selected using theprobability proportionate to the size (PPS) method. Students of both sexes attending grades 9-12,parents and foster parents of students in the selected schools, and teachers teaching in the samehigh schools were considered to be eligible for the study.A multistage sampling procedure was used to select subjects to be included in the study.Two structured and pretested questionnaires were developed in such a way that measurement ofthe following variables was attained: The sexual activity patterns of high school students, including(a) the proportion of sexually active students; and (b) the presence of any high risk behaviours,such as multi-partner sexual contact and the use/non-use of condoms; attitudinal variables (a) onthe knowledge and attitudes of students regarding AIDS and condoms; (b) on the attitudes ofstudents, parents and teachers towards the promotion and provision of comdoms in high schools;and (c) on the atitutdes of students, parents and teachers towards the provision of health and sexeducation as a separate course in high schools.Other socio-demographic variables, such as age, sex, parental marital status, monthly income,religion and ethnic grouping were included to allow later determination on how they relate to the
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AnnouncementThe 8 th Annual confere
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