Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

Original Article Imprimir 

Páginas 37 a 44


Relation between conduct, sexual knowledge and condom use among students and high school teachers

Relación entre conducta, conocimiento sexual y uso de preservativo entre alumnos y profesores de Enseñanza Media

Relação entre conduta, conhecimento sexual e uso de preservativo entre alunos e professores do Ensino Médio

Autores: Thaís Emília de Campos1; Raul Aragão Martins2

1. Doctoral pupil in Education. Master's Degree in Education, Júlio de Mesquita Filho Paulista State University (UNESP). Marília, São Paulo State, Brazil
2. Lecturer. Adjunct Professor III, Júlio de Mesquita Filho Paulista State University (UNESP). São Jose do Rio Preto, São Paulo State, Brazil

Raul Aragão Martins
Universidade Estadual Paulista
Rua Cristovão Colombo, 2265
São José do Rio Preto, SP, Brasil. CEP: 15054-000
raul@ibilce.unesp.br

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How to cite this article

Keywords: Sex education, condoms, knowledge.
Palabra Clave: Educación sexual, preservativos, conocimiento.
Descritores: Educação sexual, preservativos, conhecimento.

Abstract:
OBJECTIVE: Describe data on sexual knowledge, focusing on the relation between HIV/AIDS knowledge and condom use by high school teachers and students from a public school ofaninner city at São Paulo state.
METHODS: Quantitative study using a closed questionnaire with the participation of 31 teachers, seven multipliers students and 189 students, totaling 227 subjects.
RESULTS: The data analysis showed that 59.5% of the interviewed are sexually active; the predominant age of first intercourse among multipliers was15.5 years, among the student group was 14.24 years and among teachers was 19.85 years. The average of sexual relations is 4.7 per month among students, two among multipliers and 3.2 between teachers. Regarding the use of condoms during the first sexual intercourse, the students were the ones who used the most in relation to the other groups.Onthe matter ofthe level of knowledge about STD/AIDS, teachers correctly answered the most questions, which did not occur to student answers.
CONCLUSION: This survey indicated that sexual knowledge is not always related to a preventive practice. Therefore, it's necessary to reflect about the relation of knowledge and sexual conduct, and deepen the study regarding the non-use of condoms.

Resumen:
OBJETIVO: Describir datos sobre el conocimiento sexual, teniendo como foco la relación entre conocimiento sobre EST/Sida y el uso de preservativos por profesores y alumnos de Enseñanza Media de una escuela pública de una ciudad del interior del estado de São Paulo.
MÉTODOS: Estudio cuantitativo con la utilización de cuestionario cerrado en el cual participaron 31 profesores, siete alumnos multiplicadores y 189 alumnos, totalizando 227 sujetos.
RESULTADOS: El análisis de los datos evidenció que 59,5% de los entrevistados tienen vida sexual activa; que la edad predominante de la primera relación entre los multiplicadores fue de 15,5 años, en el grupo de los alumnos fue de 14,24 años y entre los profesores fue de 19,85 años. El promedio de relaciones sexuales es de 4,7 al mes entre alumnos, de 2 entre multiplicadores y 3,2 entre profesores. En cuanto al uso de preservativos en la primera relación sexual, los alumnos fueron los que más tuvieron relaciones con relación a los demás grupos. En las preguntas sobre el nivel de conocimiento sobre EST/Sida, los profesores contestaron correctamente a la mayor parte de las preguntas, lo que no ocurre con relación a las respuestas de los alumnos.
CONCLUSIÓN: Esta pesquisa indicó que no siempre el conocimiento sexual está relacionado a la práctica preventiva. De esta forma, se hace necesario una ponderación sobre la relación de conocimiento y conducta sexual, y profundizar el estudio sobre el no uso del preservativo.

Resumo:
OBJETIVO: Descrever dados sobre o conhecimento sexual, tendo como foco a relação entre conhecimento sobre DST/Aids e o uso de preservativos por professores e alunos de Ensino Médio de uma escola pública de uma cidade do interior do estado de São Paulo.
MÉTODOS: Estudo quantitativo com a utilização de questionário fechado no qual participaram 31 professores, sete alunos multiplicadores e 189 alunos, totalizando 227 sujeitos.
RESULTADOS: A análise dos dados evidenciou que 59,5% dos entrevistados têm vida sexual ativa; que a idade predominante da primeira relação entre os multiplicadores foi de 15,5 anos, no grupo dos alunos foi de 14,24 anos e entre os professores foi de 19,85 anos. A média de relações sexuais é de 4,7 ao mês entre alunos, de 2 entre multiplicadores e 3,2 entre professores. Quanto ao uso de preservativos na primeira relação sexual, os alunos foram os que mais em relação aos demais grupos. Nas questões sobre o nível de conhecimento sobre DST/Aids, os professores responderam corretamente à maior parte das questões, o que não ocorre em relação às respostas dos alunos.
CONCLUSÃO: Esta pesquisa indicou que nem sempre o conhecimento sexual está relacionado à prática preventiva. Dessa forma, faz-se necessária uma reflexão sobre a relação de conhecimento e conduta sexual, e aprofundar o estudo sobre o não uso do preservativo.

INTRODUCTION

Sex is understood as a biological expression that defines a set of anatomical and functional, genital and extra-genital characteristics. In turn, sexuality is related to exchanges of affection and contacts, together with the search for pleasure, which are fundamental needs of human beings. From this standpoint, sexuality may be understood as something far broader than sex, causing this topic to be viewed as taboo in almost all societies, with schools encompassed by this situation. The introduction of Brazil´s National Syllabus Parameters (PCNs) offered indications of how to work on this topic1. These efforts have become urgent, due to the appearance of Human Immunodeficiency Virus (HIV) leading to AIDS.

The earliest government interventions for controlling HIV included campaigns based on terrorist methods, segregation and discrimination of patients. However, this did not prove effective, as people did not identify with this publicity2. As the number of cases rose, it became apparent that a broader approach was needed at earlier stages, in parallel to a new concept of relationships for people with these diseases. For the first point, school is important for the construction and deconstruction of concepts and the reconstruction of an egalitarian society. Youngsters spend most of their days in the classroom, and this is where the first crushes and curiosities appear, with passions and desires prompted by their changing bodies. From the latter standpoint, it became apparent that everyone was susceptible to infection, due to personal, social and environmental factors defined as vulnerabilities3.

Research projects4,5,6.7 show that theoretical knowledge about transmission paths are not always reflected in sexual conduct, meaning that Sex Education must address emotional and social issues as well, including pleasure and desire, in addition to different types of relationships and behaviors. Taking possible vulnerabilities into account, we can add self-care and care for partners, personal hygiene, vaccine and preventive examinations. We are also thinking about subjects with autonomy who are engaged in reciprocal activities with cooperation and mutual respect8. The main barriers to prevention are associated with mistrust: when a partner asks that a condom be worn, this may indicate a lack of belief in fidelity; fear of tests and their outcomes, facing up to the disease and possible transmission through a lack of knowledge about the disease; a girl may be forbidden by her boyfriend to see a male physician, in addition to girls feeling embarrassed about gynecological examinations9.


OBJECTIVES

This research project attempts to discover data on sexual knowledge, emphasizing an analysis of the links among knowledge about STD/AIDS and the use of condoms by secondary school pupils and teachers.


METHODS

A closed questionnaire on social and economic levels was used, based on the Brazil Criteria10, together with sexual profiles, conduct and knowledge about sexuality, based on the Survey of Knowledge, Attitudes and Practices in the Brazilian Population (PCAP)11 for the respondents in this project.

The school where this study was conducted is located in upstate São Paulo, and is part of the government network, with classes from Primary School II and Secondary School, in three shifts: Grades 8 and 9 of Primary School II and Grades 1, 2 and 3 of Secondary School in the morning; Grades 6, 7 and 8 of Primary School II in the afternoon; and Grades 1, 2 and 3 of Secondary School at night. This school was selected for this research project as it is part of a university extension project run by the local campus of a government university, and also because it is one of the schools participating in the Adolescent Sexuality Project being conducted by the Municipal Health Bureau.

Before starting to collect the data, this project was submitted to the Ethics Committee at the School of Philosophy and Sciences at the Marília Campus, Paulista University (UNESP), with a favorable opinion issued on August 21, 2013 under Nº 0803/2013. The respondents were advised that they could drop out at any time, as participation is based on their free consent. Furthermore, the pupils and the school administration were told that individual data will not be disclosed, as this information is confidential.


RESULTS AND DISCUSSION

This research project encompassed a total of 227 respondents who completed the questionnaire, consisting of 196 secondary school pupils and 31 teachers. Among the 196 pupils, seven are multipliers for the university extension project, all studying in the mornings.

Based on the analysis of the data, it was found that most of the respondents were female, heterosexual, and stated that they were Roman Catholic. In terms of the social and economic levels, the teachers are between B and A Classes, with the multiplier pupils between B and C Classes, showing that the former are at higher social and economic levels than their pupils (Table 1).




Regarding sexual behavior and conduct, 57% of the multipliers are sexually active, together with 53% of the pupils and 100% of the teachers. Consequently, among the 227 participants, 132 are sexually active, consisting of just over half the respondents: 59.5% of the total.

The prevailing age of sexual initiation was 15 years old among the multiplicators, 14 years old among the pupils and 19 years old among the teachers. The mean number times they have intercourse each month is 4.70 among the pupils, 2 among the multipliers and 3.2 among the teachers. This shows that pupils engage in sexual intercourse more than their teachers. Levels of satisfaction and pleasure resulting from intercourse were not assessed.

With regard to condom use during intercourse, 60% of the pupils stated that they used them when they had intercourse for the first time, which is a figure higher than the other groups (Table 2). Low condom use among the multipliers for the first time they had intercourse may be related to the large number of female homosexuals in this group, who waive condom use during intercourse. There is some concern among the pupils in this situation, who feel the need to seek guidance on how to protect themselves against diseases, as they have not yet found a safe and pleasurable alternative, with this group thus being more vulnerable. For homo-affective intercourse between women, the use of cling film is recommended for oral intercourse, using condoms on prostheses. This also applies to hetero-affective intercourse where oral sex and prostheses are also used, although this practice is not widely accepted.




Girls going steady were the group who most used condoms during the first time of intercourse, due to the fact that the first time of someone going steady is more carefully planned than a casual hook-up. Condom use drops more sharply among pupils and multipliers going steady, indicating that condom use drops for among boys and girls with stable partners. This drop in condom use among youngsters going steady is due to the fact that they believe that they know their partner over time, trusting them and believing in their faithfulness. Some of them reported that they have taken both STD and HIV tests, and discarded condom use. This places these youngsters in a vulnerable position, as the number of people with HIV among those in stable relationships reached 60% of cases registered during the past few years11. Most girls with casual partners who hook up state that they use condoms and used them during the last time of intercourse (Table 1).

With regard to HIV/hepatitis test, among the 31.8% of 227 participants who had taken these tests, 28.6% were multipliers, 21.1% were pupils and 96.8% were teachers.

The questions analyzing knowledge levels of STD/HIV/AIDS/Hepatitis probed to discover whether a person could be infected by one of the listed diseases through insect bites or stings, using public bathrooms, sharing needles and syringes, not using condoms during intercourse, and which of these diseases have cures. The largest number of correct answers came from the teachers, which is very positive, as teachers are benchmarks for society and their pupils. The multipliers replied wrongly more than the other groups to questions on the use of public bathrooms, condoms and cures for these diseases. These mistakes are related to beliefs that there is a cure for dengue fever, that condom use prevents only HIV, and that gonorrhea can be caught in public bathrooms. We believe that these replies reflect the fact that HIV and hepatitis were strongly emphasized in classrooms during 2013. We did not mention the other STDs nor dengue fever, as this is a public health problem in towns where the study was conducted. Furthermore, two multipliers who spent two years with the project completed their secondary schooling and were replaced by other pupils who had not yet completed the capacity-building classes. Another fact is that malaria is uncommon in Southeast Brazil (Figure 2).


Figure 1. Condom use by respondents in this research project, shown by type of intercourse.


Figure 2. Correct replies from participants in this research project on disease transmission through different pathways.



For questions on conduct and risks of HIV infection, the teachers also scored the highest number of correct replies, followed by the multipliers. We believe that the latter answered these questions more correctly as they did not include other diseases, focusing only on HIV, which is a topic that has been addressed in great depth with this group (Figure 3).


Figure 3. Correct replies from participants in this research project with regard to HIV virus transmission.



DISCUSSION

The teacher group showed the highest level of knowledge and information on STD/HIV, although not posting the highest use of condoms during intercourse. Once again, it was noted that merely having access to information is not enough for this to occur, as sexuality involves affective, cultural, political and religious issues.

Another research project4 corroborates the findings of this study, showing that with regard to knowledge about STD/HIV/AIDS, the level of knowledge is not associated with protective behavior, although low knowledge levels step up vulnerability, indicating a discrepancy between discourse and preventive practices. Consequently, conveying knowledge about STD/HIV/AIDS to real-life behavior does not depend only on information, but is also influenced by gender-related, social, cultural and religious issues. There is thus a clear need to work on affective-sexual education, ensuring that knowledge is internalized and not separated from sex12. Another research project5 showed low levels of safe sex practices adopted by adolescents, despite high knowledge levels.

After completing the closed questionnaire, some pupils provided feedback and raised doubts about sex. We present two situations here that were mentioned by respondent pupils on condom use. One of these boys said that he had been going steady for more than a year, with both of them being 16 years old. They had not yet had intercourse, although eager to do so, but they cannot carry condoms in their wallets and bags as their parents would be angry. This situation raises concern over the issues of vulnerability and sexual rights of adolescents, as the fact that they must deny their desire for intercourse to their parents (who do not allow them to carry condoms around) means that should intercourse occur due to either impulse or opportunity, they will not have a condom to hand. Consequently, denying teen sexuality puts these youngsters at risk. A boy participating in this research project said that he had not yet had intercourse with his girlfriend, as they had nowhere to do so. However, perhaps when they find a suitable place, they will not be a condom to hand. And despite being aware of the importance of using condoms, this does not mean that the information they have on the risks of unprotected intercourse will prevail over desire in the heat of the moment.

Regarding condom use in homo-affective relationships among women, a girl participating in this research project asked questions about never having used a condom, and how she could protect herself during sex with girls. It was clear that research projects prompted by the HIV/AIDS epidemic have led to studies and investigations of the homosexual public. However, academic output addressing vulnerability to STDs for girls identifying as lesbians is insignificant, in the belief that this public is less vulnerable to sexual infection by with HIV/AIDS, and also because this is a small group. This public is largely invisible in terms of studies exploring ways of preventing STD/AIDS, causing concern in the homosexual and bisexual female public. This group is excluded from public prevention policies, with only minor visibility through LGBT movements, magazines and activists with NGOs13.


CONCLUSIONS

Education and sexuality are very broad-ranging topics that are addressed together in the classroom. Through sex education, these topics become even more complex, because they extend beyond biological and reproductive aspects to encompass affective, anthropological, social, cultural, political and legal factors. In general, schools offer a sex education discourse steered by religious and moral tenets or crystalized into precepts that run counter to laws requiring education to be laic and democratic.

Through the closed questionnaire, it was possible to draw up a profile of the sexual behavior of the respondents, together with their conduct and levels of information about STD/AIDS.

Reflection on what would constitute appropriate sexual conduct that takes into account the autonomy of these youngsters is rarely found in the classroom. When it does appear, many barriers and conflicts arise. Consequently, we underscore the demand for such discussions, stressing the need to work formally on moral education and sex education, addressing intellectual and affective dimensions that are vital for moral development.

Another issue that warrants examination in greater depth is the decision taken by adults - such as the teacher group with better knowledge of STD/AIDS - to use condoms less frequently than adolescents who are less well-informed. Even for casual intercourse with no links of affection or trust in a partner´s faithfulness, these adults scorn condom use.

Research is needed into the factors that result in not using condoms, despite knowledge that this is really vital. Perhaps affective aspects require reflection. It is important to work with information on STD/AIDS and conception, but this predominance of intellectual aspects, particularly those related to information, must make way for efforts focused on affective and cultural issues. In order to develop autonomous and vigorous moral conduct, it is known that simultaneous interactions and reflections are required for both the affective and intellectual dimensions.


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