ABSTRACT
This study seeks to determine the effect of School-Based Prevention Programme (SBPP) on sexual behaviour and attitude to HIV/AIDS of in-school adolescents. The study used quasi-experimental design. A purposive sampling technique was used to study SSII intact classes of four coeducational schools in Nnewi education zone of Anambra State. A simple random sampling was used to assign the schools into treatment and control groups. Therefore, 143 SSII students from two public coeducational secondary schools in Nnewi education zone of Anambra State, Nigeria formed the sample for the study. Two questionnaires: Sexual Behaviour Questionnaire for Adolescents (SBQA) and Adolescents Attitude to HIV/AIDS Scale (AAHS) were developed and tested for internal consistency reliability using Cronbach Alpha. The reliability coefficients were 0.84 and 0.82 for SBQA and AAHS respectively. The mean and standard deviation were used to answer the ten research questions, while ANCOVA was used to analyse the ten hypotheses (at 0.05 levels of significance) used for the study. Results showed that School-Based HIV Prevention Programme significantly improved in-school adolescents’ sexual behaviour and attitude to HIV; gender and location did not significantly influence sexual behaviour and attitude to HIV of in-school adolescents. There was no interaction effect of SBPP and gender, as well as SBPP and location, of in-school adolescents on their sexual behaviour and attitude to HIV, respectively. The study further revealed that there was no significant interaction effect between gender and location on sexual behaviour of in-school adolescents, while gender and location has no significant interaction effect on sexual behaviour of in-school adolescents. The study then recommended that SBHPP is necessary for getting in-school adolescents informed about healthy sexual behaviour and risky attitude to HIV/AIDS issues. This information can lead them towards positive sexual behaviour and attitude to HIV. Moreover, the components of SBPP and sex education should be introduced and incorporated into the secondary school course content.
CHAPTER ONE
INTRODUCTION
Background of the Study
Adolescence is the span of years between childhood and adulthood. The word “adolescence” which has its origin in the Latin language: adolescere means “to grow into maturity”. According to Unachukwu and Ebenebe, (2009:97), in the Western society, “it covers from the age of twelve or thirteen till the early twenties”. In Nigeria, there are a number of variations. The period may be long or short but this depends on the tradition or the modern outlook of those involved. According to Eke (1989), the common denominator in all adolescence experiences, irrespective of cultural variations, is the biological change from childhood into mature adult status capable of reproduction. During this period, remarkable physical changes take place. Boys and girls experience a spurt in growth. A sharp increase in height usually takes place in girls between the ages of 11 and 13, and in boys between 13 and 15. For boys and girls, the adolescent growth spurt is comprehensive, affecting practically all skeletal and muscular dimensions. The growth spurt is accompanied by the development of primary and secondary sex characteristics. The development of primary sex characteristics refers to the maturation of the reproductive sex organs. In girls, this means rapid development of the ovaries, uterus, and vagina while in boys it refers to the development of the testes, scrotum and penis (Tanner, 1970).
The secondary sex characteristics include enlargement of breasts, widening of the hips, growth of pubic hairs, deepening of the voice, growth of axillary hairs under the armpits, face and around the nipples and/or between their breasts (Unachukwu and Ebenebe, 2009). All these indicate for boys and girls, sexual maturity and possession of the capability to reproduce their own kind. Sexual maturation leads naturally in time to sexual experimentation. According to Ngwoke and Eze (2004:133), “Sexual experimentation, that is, the physical readiness may be widely distanced from psychological readiness”; in other words, “the ability to copulate may not mean knowledge of sexual functions and reproduction”. This is because sexual behaviour is part of the adolescent growing up experimentation. It follows therefore that sexual behaviour is the totality of normal and abnormal, conscious and unconscious, overt and covert sensations, thoughts, feeling and actions related to sexual organs and other errogenic zones, including masturbation, heterosexual and homosexual relations, sexual deviations, goals and techniques (Wolman:1975). In the context of this work, sexual behaviour is defined as all the activities of in-school adolescent boys and girls, both overt and covert, aimed at attracting a sex partner or aimed at enhancing the performance of sex partners.
Sexual behaviour is prevalent among in-school adolescents who are young boys and girls between the ages of 16 and 18 and at most in their early twenties. They are mostly found at the senior secondary school level of education. The in-school adolescents exhibit high level of risky sexual behaviours and experimentation. This is made worse by peer pressure. Hence Dill (1978: 340) pointed out that “once the child leaves the social setting of the family to enter school, more time is spent outside the family and in the company of peers”. Supporting this observation, Nwoye (1990) indicates that,
it is from the peer culture and group that the adolescent comes to discover and to define herself; for example, ‘believing that menstrual pains and disturbances can often be fairly relieved through involvement in frequent sexual intercourse’, or the belief that good sized breasts and hips are products of constant practice in sexual intercourse with men of healthy built and bearing, (p. 253)
This type of unguided and unfounded misinformation can lead to reckless sexual experimentation with deleterious consequences, such as increasing rate of adolescent pregnancies out-of-wedlock, rise in the rate of school drop-outs, increase in abortions with associated negative consequences, rise in the rate of indiscriminate use of contraceptives which are mainly recommended by the users themselves or their friends, and rise in the incidence of sexually transmitted diseases including HIV/AIDS (Ngwoke & Eze, 2004).
HIV is an acronym for Human Immunodeficiency Virus. According to Marshall and Montagnier (1985), HIV is unique in that it infects those very cells called CD4 or T-helper which co-ordinate the immune system’s fight against infection. AIDS on the other hand, is an infectious disease which is as a result of being infected with HIV. AIDS is an acronym for Acquired Immune Deficiency Syndrome. Acquired means that the disease is caught; immune deficiency means that the body has lost the ability to fight infection, and syndrome means that it consists of several physical signs and symptoms. HIV/AIDS is contracted through three major sources: they include sexual intercourse, transfusion of infected blood, and from mother to child during birth and through breast feeding. It is important to point out that the adolescents including the in-school adolescents exhibit reckless sexual behaviour that usually ends in unprotected sexual intercourse, multiple sex partners, cross generational sex, oral and anal sex. This increases the adolescents’ vulnerability to HIV and the probability of unwanted pregnancy and its ugly consequences.
Adolescents irrespective of gender in recent times tend to show that they place high value on love as a prerequisite for sexual relationship and that is all that matters to them Nwoye (1990). Gender refers to the roles and responsibilities of male and female as assigned by our families, societies and cultures. The concept of gender also includes the expectations held about the characteristics, attitudes and likely behaviours of both males and females. Gender dimensions of sexual behaviour and attitude to HIV/AIDS have been explored. Though every human being is sexual and therefore prone to HIV infection, some people tend to hold the view that risky sexual behaviour is more associated with the male-folk than the female (Reid, 1999). It is believed that gender inequality has placed women in subordinate position as far as sexual behaviour is concerned. The male-folk is said to have stronger sexual drives than the female. Hence, the notion that men cannot do without sex (Cohen and Trusell, 1995; Reid, 1999). Many adolescents do not consider the risk of pregnancy, HIV/AIDS, or even dropping out of school associated with sexual intercourse when involving themselves in sex. Rather, some see it as a way of life or an indication that they ‘belong’ or that they are ‘tough’. In other words, the attitudes of adolescents towards these appear to be that HIV/AIDS are not for in-school adolescents.
Attitude is a relatively enduring way of thinking, feeling and behaving toward an object, person, group or idea. Attitudes almost always involve a certain amount of bias or prejudging on our part. When one applies a label such as “stingy” or “psychotic” to a person, one is both stating an attitude and reveals the way in which one perceives the person. In a sense, attitudes are perceptions that involve emotional feeling or biases and they predispose one to act in a certain way (McConnell, 1974). In the context of this work, attitude is the opinion or general feeling of the in-school adolescent boys and girls towards the opposite sex and focusing of attention on sexual intercourse irrespective of the consequences and the risk of contracting HIV/AIDS.
Since the outbreak of HIV/AIDS in Nigeria, many programmes have been put in place, in an effort to reduce the spread and challenges of the pandemic. These intervention programmes vary according to their objectives: the target groups, resources available and the environments. Some of these programmes are peer education, youth awareness campaigns, general awareness creation and community enlightenment. These programmes provide basic data or information on HIV/AIDS such as the various ways of transmission and prevention, effects of HIV/AIDS on human beings, economy, family, agriculture, and education. The messages of these programmes are centred on the promotion of abstinence, good conduct, mutual fidelity and condom use. According to the Monitoring and Evaluation Cumulative Report of the Nnamdi Azikiwe University Teaching Hospital, Nnewi (2009), the HIV/AIDS level among the hospital users is on the high side and that it has attracted several actors and Donor Agencies such as World Health Organization (WHO), United Nations Joint programme on HIV/AIDS (UNAIDS), Department For International Development (DFID), civil society organizations, faith-based organizations and community leaders. The national family life education curriculum is yet to be implemented in Anambra State; some cultural and religious practices that impede behaviour change are not properly addressed in the intervention programmes. The wide range of intervention programmes targeted at awareness and knowledge have not yet metamorphosed into desired behavioural changes, and a wide range of traditional, religious and socio-economic factors continue to put young people, including in-school adolescents at risk of HIV infection.
Previous attempts at promoting behavioural changes through provision of information only may not work especially when the target population does not perceive the consequences of their actions as a risk. Increased information may be both necessary and sufficient when risk prevention requires a relatively uncomplicated behaviour but may not be sufficient and adequate for the maintenance of such behaviour across time (Fisher and Fisher, 1992). The need according to ILO (2004), to improve intervention programme targeted at adolescents is a very important one, as this group of people exhibit high levels of risky sexual behaviours. It is a truism that HIV is transmitted through risky sexual behaviours, and that no drugs have been invented by medical science for its satisfactory prevention and cure. Therefore, effective intervention programme, such as the School-Based Prevention Programme (SBPP) remains the priority response with special focus on in-school adolescents.
