Revista Adolescência e Saúde

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

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 1 - Jan/Mar - 2018

Original Article Imprimir 

Páginas 7 a 17


Knowledge about the sexually transmitted infections by adolescents students of public schools

Conocimiento sobre las infecciones sexualmente transmisibles por estudiantes adolescentes de escuelas públicas

Conhecimento sobre as infecções sexualmente transmissíveis por estudantes adolescentes de escolas públicas

Autores: Oliveira Carvalho1; Raydelane Grailea Silva Pinto2; Márcia Sousa Santos3

1. Graduation in Nursing by the College of Sciences and Technology of Maranhão (FACEMA). Caxias, MA, Brasil
2. Postgraduate in Traumato-Orthopedic and Sports Physiotherapy by Einstein College (FACEI). Post-graduate degree in Health Management by the Federal University of Maranhão (UFMA). Graduation in Physiotherapy by the Faculty of Sciences and Technology of Maranhão (FACEMA). Preceptor at the Multiprofessional Residency in Family Health at the State University of Maranhão (UEMA). Caxias, MA, Brasil
3. Master in Family Health by the University Center UNINOVAFAPI (UNINOVAFAPI). Nurse of the City Health Department of Caxias. Professor at the College of Science and Technology of Maranhão (FACEMA) and Director of the Carmosina Coutinho Maternity. Caxias, MA, Brasil

Correspondência:
Gardenia Raquel de Oliveira Carvalho
Rua Manoel Gonçalves, 1385
Centro. Caxias, MA, Brasil, CEP: 65600-110
(graqueloc@gmail.com)

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Keywords: Sexually transmitted diseases, adolescent, knowledge, health vulnerability.
Palabra Clave: Enfermedades sexualmente transmisibles, adolescente, conocimiento, vulnerabilidad en salud.
Descritores: Doenças sexualmente transmissíveis, adolescente, conhecimento, vulnerabilidade em saúde.

Abstract:
OBJECTIVE: Verify the knowledge about the Sexually Transmitted Infections (STI) and associated factors by adolescents from public schools in the Caxias municipality -MA.
METHODS: Descriptive, exploratory study with a quantitative approach, applied to 195 adolescents from public schools in the Caxias municipality - MA. It was used a structured questionnaire composed by closed questions containing sociodemographic data of the adolescents and the knowledge about transmission and prevention of STI. Data were analyzed using statistical software Stata® version 14.0, considering a significance of 5%.
RESULTS: Of the 195 adolescents who participated of this study, 108 (55.4%) were female. The prevalence of general knowledge about STI among the adolescents was 87.7%, of which 99 (57.9%) were female, with a statistically significant difference in relation to males (P<0,0001).
CONCLUSION: This study showed a significant knowledge of adolescents about STIs, however, 24% of them are opposed to colleagues with STI/AIDS attending school.

Resumen:
OBJETIVO: Verificar el conocimiento sobre las Infecciones Sexualmente Transmisibles (IST) y los factores asociados a ellas por adolescentes estudiantes de escuelas públicas del municipio de Caxias - MA.
MÉTODOS: Estudio descriptivo, exploratorio, con abordaje cuantitativo, realizado con 195 adolescentes de escuelas públicas del municipio de Caxias - MA. Fue utilizado un cuestionario estructurado compuesto por preguntas cerradas, conteniendo informaciones sobre los datos sociodemográficos de los adolescentes y los conocimientos con relación a la transmisión y prevención de IST. Los datos fueron analizados a través del software estadístico Stata® versión 14.0, considerando una significancia del 5%.
RESULTADOS: De los 195 adolescentes que participaron de la pesquisa, 108 (55,4%) pertenecían al sexo femenino. La prevalencia del conocimiento general sobre las IST entre los adolescentes fue del 87,7%, donde 99 (57,9%) eran del sexo femenino, con diferencia estadísticamente significante con relación al sexo masculino (P<0,0001).
CONCLUSIÓN: Este estudio dejó evidente un significante conocimiento de los adolescentes acerca de las IST, mientras, 24% demuestran posiciones contrarias a de que compañeros portadores de IST/SIDA continúen frecuentando la escuela.

Resumo:
OBJETIVO: Verificar o conhecimento sobre as Infecções Sexualmente Transmissíveis (IST) e os fatores associados a elas por adolescentes estudantes de escolas públicas do município de Caxias - MA.
MÉTODOS: Estudo descritivo, exploratório, com abordagem quantitativa, realizado com 195 adolescentes de escolas públicas do município de Caxias - MA. Foi utilizado um questionário estruturado composto por perguntas fechadas, contendo informações sobre os dados sociodemográficos dos adolescentes e os conhecimentos a respeito da transmissão e prevenção de IST. Os dados foram analisados através do software estatístico Stata® versão 14.0, considerando uma significância de 5%.
RESULTADOS: Dos 195 adolescentes que participaram da pesquisa, 108 (55,4%) pertenciam ao sexo feminino. A prevalência do conhecimento geral sobre as IST entre os adolescentes foi de 87,7%, onde 99 (57,9%) eram do sexo feminino, com diferença estatisticamente significante em relação ao sexo masculino (P<0,0001).
CONCLUSÃO: Este estudo evidenciou um significante conhecimento dos adolescentes acerca das IST, entretanto, 24% demonstram posicionamentos contrários à colegas portadores de IST/AIDS continuarem frequentando a escola.

INTRODUCTION

The World Health Organization (WHO) characterizes the adolescence phase as the period between 10 and 19 years, distinguishing also the initial adolescence between 10 and 14 years and the final adolescence between 15 and 25 years. This period of life is defined by the secondary sexual characteristics, the development of psychological processes and identification patterns that evolve from the infancy to the adult stage, through the transition from one state to another of relative autonomy1.

The transformations of puberty are characteristics that arise in social relations, and even biological and physiological transformations, arising from meanings attributed by adults and society. This phase can´t be considered just a simple age group, because it´s the transition to adult life and, therefore, is permeated by biological, social and especially psychological decisions, being a constant search to find its real personality, manifesting behavior neglected with health care, showing itself as a vulnerable group2,3. Vulnerability is characterized by a set of biological, epidemiological, social and cultural factors that increase or reduce the risk and/or protection of a person by circumstance of a particular disease4.

Among these risks, diseases from sexually transmitted infections (STIs) have been a global phenomenon, and it is currently one of the most important public health problems. In adolescence, non-adherence to STI prevention measures associated with early sexual initiation makes this population more susceptible to these infections. The main method of preventing STIs is condoms. This is easy to acquire and available free of charge through the Brazilian health services, however, there is often resistance to adopt it in sexual practices due to aversion to its use, trust in the partner, lack of knowledge about its purpose and benefit, etc5.

In this perspective, the objective of this research was to verify the knowledge about the Sexually Transmitted Infections by adolescent's students of public schools of the city of Caxias - MA.


METHOD

A descriptive study of the exploratory type was carried out, with a quantitative approach. The study population consisted of adolescents from public schools in the city of Caxias - MA. The convenience sample consisted of 195 adolescents who met the inclusion criteria for this study.

We included adolescents of both sexes enrolled in public schools in the city of Caxias - MA, aged between 13 and 19 years. We excluded adolescents enrolled in schools in the rural area of Caxias - MA; students under the age of 18 whose parents or guardians didn´t authorize their participation in the research; students who didn´t agree to participate in the research; students under 13, due to the difficulty in approaching sex in this age group; those who were absent at the time of the application of the questionnaire and the students that presented some deficiency that incapacitated the accomplishment of the research.

Data collection occurred between August and October 2016 during the student's class interval. Initially, an awareness lecture on Sexually Transmissible Infections (STIs) and sex was conducted at four public schools in the city of Caxias - MA and, after this stage, the objectives / justification of the study were clarified and the participate in the research.

Students over 18 who accepted to participate in the study signed a Term of Free and Informed Consent (TCLE), in the case of minors under 18, a Term of Assent for Children and Adolescents was signed and the TCLE was signed by their parents.

Subsequently, they answered a structured questionnaire, composed of closed questions, containing information on adolescents' socio-demographic data (sex, age, race / color, religion and marital status) and knowledge about IST transmission and prevention. The questionnaires were applied in the classroom under the supervision of the researcher.

Data was organized and tabulated using Microsoft Excel version 2016 for Windows and statistical analysis was done using Stata® software version 14.0 for Windows. The univariate analysis was based on the sociodemographic and behavioral characteristics of adolescents, using absolute and relative frequency measures, means, median, minimum and maximum intervals (quartiles) and standard deviation. To compare the means of age on the knowledge of STIs and the beginning of sexual life between boys and girls, the Mann-Whitney test was used.

For the bivariate analysis of the data Fischer's exact test was used to verify associations between sociodemographic characteristics and knowledge about STIs (dependent variables). Statistically significant values of p0.05 were considered statistically significant. Multivariate analysis was performed using multinomial logistic regression (RLM), which was used to obtain estimates of odds ratios (OR) and 95% confidence intervals (95% CI), adjusted for confounding variables: gender, age group, race/color, religion and marital status. The analysis was made by comparing adolescents who had no knowledge of STIs (reference category) and those who knew them. The criterion for the inclusion of variables in the RLM model was the finding of statistically significant associations between the knowledge about STIs and the independent variables in the bivariate analysis. In the multivariate analysis, the null hypothesis was rejected when the value of p <0.05.

The research respected the ethical aspects that involve the studies with human beings supported in the resolution 466/2012 of the National Health Council, which establishes the norms of research in health and approved under opinion nº CAAE: 60173816.4.0000.8007.


RESULTS

Of the 195 adolescents who participated in the study, 108 (55.4%) were female and 107 (54.9%) were 16-19 years of age, with a mean of 15.8 ± 1.8 years and a median of 16 (Q1 14, Q3 17). Regarding color/race, 112 (57.4%) declared themselves brown. Regarding religion, 96 (49.2%) were Catholics and about civil status, 152 (77.9%) were unmarried. The age group presented a statistically significant association with knowledge about STIs (P = 0.001) (Table 1).




Of the general knowledge about STIs, 171 (87.7%) reported knowing them, of which 99 (57.9%) were female, with a statistically significant difference in relation to the male sex (P <0.0001) . In relation to people vulnerable to STIs, 169 (86.7%) adolescents answered that anyone who has sexual intercourse without condom use (with a fixed or casual partner) can contract them.

When questioned about the chances of contracting another STI and the AIDS virus when STIs are already in place, 113 (57.9%) adolescents said that these chances would increase. It can be evidenced that 177 (90.8%) adolescents knew of an STI, and most of them (75.9%) said that the STI / AIDS colleague should continue to attend school. Regarding STI prevention methods, 162 (82.1%) pointed to condoms as the most effective prevention method. Almost all adolescents (91.8%) said that condoms should be used in all sexual relations (Table 2).




The STIs most known by adolescents are shown in Figure 1, where it was observed that most of them (73.3%) are aware of HIV/AIDS.


Figure 1. Sexually Transmitted Infections (STIs) better known by adolescents from public schools of Caxias - MA, 2016.



Most adolescents (51.8%) reported receiving information about STIs at school. The other sources of STI information are described in Figure 2.


Figure 2. Source of information about Sexually Transmitted Infections (STIs) between adolescents from public schools in Caxias - MA, 2016.



Table 3 shows the results of the multinomial analysis, where there was a statistically significant association between knowledge about STIs, age group (P <0.001), knowledge of some STI (P = 0.002), questioning about the duty of the (P <.001) and the questioning of adolescents' duty to use condoms in all sexual relations (P = .047).




DISCUSSION

Adolescents' knowledge about STIs was generally good (87.7%), noting that 81.5% of these had correct knowledge about STIs and forms of transmission. An equivalent result was found by Costa et al.5, where they found that 81% of adolescents interviewed had knowledge about STIs. Other studies verified higher prevalences of knowledge about STIs (96.8%, 94.9% and 91%, respectively)6-8.

The girls showed greater knowledge about STI than boys, with a statistically significant difference (P <0.0001), corroborating the study of Anjos et al.9 conducted in Peruíbe - SP, with 207 students from public schools, where they verified that girls showed more knowledge about STI than boys. However, a study conducted by Sychareun et al.10 with 483 adolescents contradicts the findings of the present study, where it was found that boys (60.2%) had greater knowledge about STIs, with a statistically significant difference in relation to girls. This difference in relation to the present study may be due to the twice-larger sample size used by Asian authors and cultural differences. Regarding the age group, it was observed that adolescents aged 16-19 years had greater knowledge about STIs, which shows that this level of knowledge increases over the years.

Regarding the forms of transmission of STIs, most adolescents (86.7%) said that anyone who has sexual intercourse without using condoms (with a fixed or casual partner) may contract STIs, showing a good level of knowledge. These results are similar to other studies8,9,11, which found that 91%, 93.8% and 94.7% of adolescents, respectively, reported that anyone who has sex without condom use may contract an STI.

According to Oliveira-Campos et al.12, even with media and information dissemination, adolescents and youth still have doubts about the prevention of STI transmission and some resistance to condom use, becoming vulnerable and increasing the incidence of the disease.

Most of the adolescents said that their STI / AIDS colleagues should continue to attend school (75.9%), which shows a good acceptance of colleagues with those who are infected with STIs. Anjos et al.9 also verified that the adolescents agree that the STI / AIDS colleague should continue to attend school, but with a higher prevalence of acceptance (81.6%). Those who have responded negatively to this issue may be fearful of contagion, probably because they have insufficient knowledge about STIs and their forms of transmission. Sychareun et al.10 verified in their study that 40% of adolescents thought they could contract an STI simply by sharing the same glass with an infected colleague.

The majority of adolescents (83.1%) knew that condoms were the best method to prevent STIs, which can be confirmed by previous studies5,9,13,14, which found that 99.3%, 95% 2%, 98.8% and 83.5% of adolescents, respectively, indicated that condoms were the most effective method of prevention against STIs. Almost all adolescents (91.8%) stated that condoms should be used in all sexual relations, being significantly associated with knowledge about STIs (P = 0.024), a result also observed in studies by Costa et al.5 (81% ) and Chaves et al.8 (91.4%). This shows that adolescents are aware of the importance and necessity of using this method as a means of protection against STIs.

Costa et al.5 explain that despite the evident benefit of the condom, adolescents are still resistant to adopting it in sexual practices, because they don´t like to use it, because they trust their partner and because of the occurrence of casual sex with partners. According to Anjos et al.9, for women, vulnerability increases due to the lack of bargaining power and control over the relationship, given the machismo that is still present in society. For the man, the social pressure to always be ready for sex increases his vulnerability, assuming a role of control over his impulses.

The most known STI is adolescents (73.3%), confirming the studies by Theobald et al.6 and Vonk, Bonan and Silva15, who found that HIV/AIDS was the most common STI in 92, 3% and 88.5% of adolescents, respectively. The source most frequently received information about STIs was school (51.8%), which was corroborated by other authors6,11,14,15 whose school was reported by 78.9%, 76.7% , 63.9% and 58.5% of adolescents, respectively, as the place where they obtain more information about STIs. According to Oliveira-Campos et al.12, most adolescents spend most of their time in school, where social contacts and social groups are established and maintained. The authors report that a good involvement with school positively affects health behaviors, since schools contribute to the adolescent health indirectly, through their organization, curriculum development and pedagogical practice, and directly, through educational programs related to health.

The school has a fundamental role in helping to detect practices that make adolescents vulnerable, and participates directly in the elaboration of educational actions aimed at promoting the health of the school. The educational activities in health must be structured according to the socio-cultural context experienced by the adolescent, in order to enhance its success. Such strategies can take the form of lectures, workshops, talk wheels, dialogues, among other activities that allow adolescents to exchange experiences and clarify their doubts5. Rodrigues et al.16 argue that these educational actions can demystify some beliefs and values that have around these themes. But for this, it is necessary to involve health professionals, educators, family and community.

In the analysis of multinomial logistic regression, it was evidenced that adolescents who reported not knowing any STI had significantly lower odds (OR = 0.22, 95% CI: 0.07-0.75, P = 0.002) if they had correct knowledge about STIs than those who claim to know at least one STI. Those who said that the adolescent with STI / HIV should not continue to attend school have a chance of only 0.18 (0.07-0.44) times to know the true meaning of STIs. Chances are even lower (OR = 0.07; 95% CI: 0.01-0.59) when compared to those who said that STI is a disease that catches on to sex workers and homosexuals (P <0.001). Adolescents who stated that condoms should not be used in all sexual relations present minimal odds (OR = 0.23; 95% CI: 0.07-0.75) for knowing about STIs in relation to those who stated that condom should be used in all sexual relations (P = 0.047).

The limitations of this study refer to the fact that the use of alcohol, cigarette and illicit drugs and adolescents' behavior regarding the number of sexual partners, type of sexual practice and type of affective relationship were not investigated, since these factors are described in the literature as factors associated with vulnerability and knowledge of adolescents about STIs.


CONCLUSION

The study showed a good knowledge of adolescents about STIs, and this knowledge is acquired by most of them in school. On the other hand, there are still a number of adolescents who have positions against the acceptance of STI/AIDS colleagues who continue to attend school, showing a dubious or insufficient knowledge about these diseases and, sometimes, a prejudiced behavior.


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2. Macedo EOS, Conceição MIG. Significações sobre adolescência e saúde entre participantes de um grupo educativo de adolescentes. Psicologia: ciência e profissão 2015;35(4):1059-73.

3. Fonseca FF, Sena RKR, Santos RLA, Dias OV, Costa SM. As vulnerabilidades na infância e adolescência e as políticas públicas brasileiras de intervenção. Rev Paul Pediatr 2013;31(2):258-64.

4. Pessalacia JDR, Menezes ES, Massuia DA. Vulnerabilidade do adolescente numa perspectiva das políticas de saúde pública. Rev Bioethikos 2010;4(4):423-30.

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