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 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 7 a 18


Knowledge of teenagers about contraception and sexually transmitted infections

Conocimiento de los adolescentes sobre anticoncepción y infecciones sexualmente transmisibles

Conhecimento dos adolescentes sobre contracepção e infecções sexualmente transmissíveis

Autores: Lorena Zuza Cruz1; Magna Santos Andrade2; Gilvânia Patrícia do Nascimento Paixão3; Rudval Souza da Silva4; Kellyne Mayara do Nascimento Maciel5; Chalana Duarte de Sena Fraga6

1. Graduation in Nursing from the Bahia State University (UNEB). Senhor do Bonfim, BA, Brazil. Resident in Family Health by the Department of Health of the Federal University of Alagoas (UFAL). Lagarto, SE, Brasil
2. Doctor student in Health in the Community by the São Paulo University (USP). Ribeirão Preto, SP, Brasil. Master in Collective Health from the Feira de Santana State University (UEFS). Feira de Santana, BA, Brazil. Assistant Professor at the Bahia State University (UNEB). Senhor do Bonfim, BA, Brazil
3. Doctor in Nursing from the Federal University of Bahia (UFBA). Salvador, BA, Brazil. Assistant Professor of the Department of Education of the Bahia State University (UNEB). Senhor do Bonfim, BA, Brazil
4. Doctor in Nursing from the Federal University of Bahia (UFBA). Salvador, BA, Brazil. Assistant Professor in the Department of Education of the Bahia State University (UNEB). Senhor do Bonfim, BA, Brazil
5. Graduation in Nursing from the Bahia State University (UNEB). Senhor do Bonfim, BA, Brazil. Graduated in Medicine from the University Center of João Pessoa (UNIPÊ). João Pessoa, PB, Brazil
6. Master in Nursing by the Federal University of Bahia (UFBA). Salvador, BA, Brazil. Assistant Professor in the Department of Education of the Bahia State University (UNEB). Senhor do Bonfim, BA, Brazil

Magna Santos Andrade
Universidade do Estado da Bahia, Rodovia Lomanto Junior
Br 407, Km 127. Senhor do Bonfim, BA, Brasil. CEP: 48970-000
(magnaenf@yahoo.com.br)

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Keywords: Education, nursing, adolescent, knowledge, primary prevention, sexuality.
Palabra Clave: Educación en enfermería, adolescente, conocimiento, prevención primaria, sexualidad.
Descritores: Educação em enfermagem, adolescente, conhecimento, prevenção primária, sexualidade.

Abstract:
OBJECTIVE: Describe the knowledge about contraception and sexually transmitted infections among adolescents from public schools in the city of Senhor do Bonfim, Bahia.
METHODS: A descriptive and quantitative study with 185 adolescents. Data were collected through structured self-applied questionnaire.
RESULTS: The parents were the main source of information about sexuality for 34.1% of students; 68.2% said that the condom was the most appropriate method to avoid pregnancy; 98.9% know that the condom is the appropriate method to prevent sexually transmitted infections; 38% said they may be contaminated with sexually transmitted infections by sharing a toilet sit and/or towel.
CONCLUSION: Teenagers know the methods of prevention, however, mistaken and distorted understanding about contamination mechanisms are still evident. Understand the knowledge of adolescents is key for developing strategies that strengthen appropriate information and reduce cases of sexually transmitted infections and unplanned pregnancy.

Resumen:
OBJETIVO: Describir el conocimiento sobre métodos contraceptivos y infecciones sexualmente transmisibles entre adolescentes de escuelas públicas del municipio de Senhor do Bonfim, Bahía.
MÉTODOS: Estudio descriptivo de enfoque cuantitativo, siendo investigados 185 adolescentes. Los datos fueron recogidos a través de un cuestionario estructurado auto aplicado.
RESULTADOS: Los padres fueron la principal fuente de información sobre sexualidad para el 34,1% de los estudiantes; 68,2% afirmaron que el método más adecuado para evitar el embarazo en la adolescencia es el preservativo; 98,9% saben que el preservativo es el método más adecuado para prevenir infecciones sexualmente transmisibles; 38% dijeron que se puede contaminar por infecciones sexualmente transmisibles compartiendo el mismo inodoro sanitario y/o toalla.
CONCLUSIÓN: Los adolescentes conocen los métodos de prevención, sin embargo, todavía es evidente la presencia equivocaciones y comprensión distorsionada sobre algunos mecanismos de contaminación. Comprender los conocimientos de los adolescentes es fundamental para la estructuración de estrategias que consoliden informaciones adecuadas y que posibiliten reducir los casos de infecciones sexualmente transmisibles y embarazo no planificado.

Resumo:
OBJETIVO: Descrever o conhecimento sobre métodos contraceptivos e infecções sexualmente transmissíveis entre adolescentes de escolas públicas do município de Senhor do Bonfim, Bahia.
MÉTODOS: Estudo descritivo de abordagem quantitativa, sendo pesquisados 185 adolescentes. Os dados foram coletados através de questionário estruturado auto aplicado.
RESULTADOS: Os pais foram a principal fonte de informação sobre sexualidade para 34,1% dos estudantes; 68,2% afirmaram que o método mais adequado para evitar gravidez na adolescência é o preservativo; 98,9% sabem que o preservativo é o método mais adequado para prevenir infecções sexualmente transmissíveis; 38% disseram que pode se contaminar por infecções sexualmente transmissíveis compartilhando o mesmo vaso sanitário e/ou toalha.
CONCLUSÃO: Os adolescentes conhecem os métodos de prevenção, todavia, ainda é evidente a presença que há equívoco e compreensão deturpada sobre alguns mecanismos de contaminação. Compreender os conhecimentos dos adolescentes é fundamental para a estruturação de estratégias que consolidem informações adequadas e que possibilitem reduzir os casos de infecções sexualmente transmissíveis e gestação não planejada.

INTRODUCTION

Adolescence is a stage of growth and development of the human being, located between childhood and adulthood, marked by physical, psychic and social changes, defined by the United Nations as the age group comprised between 10 and 19 years of age1.

Precocious early sexual life among adolescents is an increasingly prominent feature and these youngsters may come across unusual situations such as Sexually Transmitted Infections (STIs) and contamination by the Human Immunodeficiency Virus/Human Immunodeficiency Syndrome (AIDS). In addition, it is during adolescence that sexuality manifests itself more clearly, and because of the unpreparedness of the young person in dealing with this aspect, not only do the risks of STIs increase but also increase the chances of an unwanted pregnancy2-3 .

From the beginning of the AIDS epidemic in 1980 through June 2014, Brazil had 756,998 registered cases of HIV/AIDS. The highest concentration of cases in Brazil covers the age group from 25 to 39 years, but 81,205 cases occurred in the group between 15 and 24 years. In the last 10 years there has been an increase in the detection rate, with an increase of 53.2% in young people aged 15 to 19 years and 10.4% in the 20 to 24 age group4. Regarding pregnancy in adolescence, in 2013, approximately 20% of live births were from adolescent mothers5.

The methods of prevention and contraception are known by much of the population of reproductive age, as well as by health professionals and educators. However, among adolescents, the question of the efficacy and use of these methods isn´t always explored, and this information is extremely important for the practice of prevention6.

Brazil is a country that is vast in territory and diverse in relation to the cultural, social and economic aspects of its population. Therefore, understanding the vision of the young people of the diverse localities on the factors that involve the reproductive planning and the STIs is fundamental for the structuring and implementation of strategies that serve adolescents in an equitable way.


OBJECTIVE

To describe the knowledge about contraceptive methods and Sexually Transmitted Infections among adolescents of public schools in the municipality of Senhor do Bonfim, Bahia, Brazil.


METHODS

This is a descriptive study of a quantitative approach, carried out in state schools in the urban area of the municipality of Senhor do Bonfim - BA, and consists of a cut of a research project entitled "Adolescence and Sexuality".

185 adolescents were surveyed. Initially the proposal was to carry out a census and to study the 457 students enrolled in the third year of high school in three schools that were within the inclusion criteria. However, the great school dropout observed in classrooms made it impossible for the total number of adolescents between 14 and 19 years old to be surveyed.

The inclusion criteria considered were: adolescents of both sexes, within the age group of 14 to 19 years old enrolled in the third year of high school of the three state schools located in the urban area of the municipality of Senhor do Bonfim in the year 2014.

The data were collected through a self-administered structured questionnaire, developed from the literature review and the questionnaire produced by the World Health Organization prepared for the verification of adolescents' health7. A pre-test was performed with 17 high school students from one of the state schools and later the instrument was adjusted according to the demands that arose during its application. The final questionnaire consisted of 52 questions, divided into five blocks: 1) socioeconomic and family characteristics; 2) sources of information and knowledge on reproductive health; 3) relationship and use of contraceptives; 4) knowledge about HIV/AIDS and STI; 5) Condoms, knowledge and attitudes. Of these 52 questions, 29 addressed aspects of adolescents' knowledge about sex education, contraception and STIs.

The questionnaire was applied to the adolescents in their respective classrooms, and initially, the youngsters were guided by the researchers about the objectives of the study, filling the instrument, and in the condition of being accepted to participate in the research, the reading and signing of the Term of Free and Informed Consent (TCLE) (young adults) and the Term of Assent (young people under age). In relation to minors, a previous meeting was held with the parents and guardians where they signed the TCLE to authorize the youth to participate in the study. Data collection was performed between September and November 2014.

The research was approved by the Research Ethics Committee of the State University of Bahia, based on Resolution 466/2012 of the National Health Council, and received approval no. 558,605.

The collected data were stored in databases, processed and analyzed in the program Statical Package for Social Sciences (SPSS) version 9.0. In the first step, with the objective of evaluating the typing quality, a database consistency analysis was performed with the listing of the simple frequencies of the variables and later the typing errors were corrected. Next, an exploratory and descriptive analysis of the studied sample was developed by calculating the absolute frequencies of the variables studied.


RESULTS

The study consisted of 185 adolescents between the ages of 16 and 19 years old, and there were no young people under 16 years old in the classes surveyed. Table 1 shows the sociodemographic characteristics of the group studied, where 83.3% (n=150) lived in the urban area, 60% (n=111) were female, 31.4% (n=58) were between (N=172) were single, 55, 55 were non-offspring, 72.3% (n=133) were black/brown, 88.0% 5% (n=102) were denominated Catholics and 79.2% (n=145) had monthly family income less than a minimum wage.




Table 2 presents the results referring to the source of information on sexuality, and it is observed that for a third of the young people, the parents are the main source of information about sexuality. 78.4% (n=145) reported that they had attended some class on sexuality and 96.2% (n=178) stated that they should have more classes on sexuality in school.




Regarding knowledge about family planning and prevention of STIs, Table 3 shows that for 68.2% (n=116) of those surveyed, condoms are the most appropriate method to prevent pregnancy in adolescence. Regarding the mechanisms known to prevent STIs, 98.9% (n=182) reported the condom.




Regarding knowledge about STIs and their symptoms, it can be seen from Table 4 that 98.4% (n=182) of the students already heard about HIV/AIDS and, regarding which symptoms an STI two thirds pointed to the presence of ulcers, sores and itching in the penis or vagina.




Table 5 provides the opinion on aspects related to STIs and condom use. 38% (n=69) of the adolescents reported that contamination by STIs sharing the same toilet and/or towel, 13% (n=23) agreed that STI contagion may occur by sitting in the place where the infected person was sitting.




It was observed that 45% (n=81) indicated that the condom diminishes the pleasure of intercourse, 30% (n=56) stated that the condom can leave the penis and disappear inside the woman's body during intercourse. In 19.9% (n=36) of the young the condom is suitable for use only in occasional relationships, 17.7% (n=32) agreed with the affirmation that the use of two condoms at the same time increases the chance of prevention (Table 5).

Of the respondents, 9% (n=16) agreed that there was no need to use a condom in the first relationship, since there was no risk of gestation, 5.5% (n=10) stated that they didn´t need to use a condom in the first because there is no risk of STIs contagion (Table 5).


DISCUSSION

In the present study, the main source of information about sexuality cited by the youngsters were their parents (34.1%, n=58). In a survey conducted in the city of Bauru-SP with students from a public school, the proportion of young people who had their parents as the main source of information was even greater (82%)8. Until recently, topics related to sexuality were considered within families as taboos, being reprimanded and silenced. Nowadays, in some family nuclei this topic has been discussed in a transparent way through dialogue and the search for professional support, when necessary9.

The figure of the teacher ranked sixth in relation to the sources of information, which differs from researches conducted in Goiânia-GO and Great Britain where about 80% of young people reported that the main place for information on sexuality is the school10,11. The lack of observation of the teacher among the most important sources of information in the present study is worrisome, which makes question the importance of the school in the performance of its social function as educator, besides being a space of daily coexistence of the adolescent, being a place where the young person can lead and clarify doubts, questions, mainly related to sexuality.

It is also noticeable that the media has an important participation in the acquisition of knowledge related to the sexuality aspects, where the internet has assumed the second position in relation to the main sources of information for the young people of the schools researched. The media are widely disseminated and the value attributed to them can be a cause for concern as they aren´t the most adequate mechanisms for obtaining sufficient clarification on the subject10, since misinformation is often disseminated and the approach isn´t always adequate to raise awareness of young people.

Almost all of the adolescents studied pointed out the need for more classes on sexuality in school. In a survey carried out with students from a state school in São Paulo-SP, 54.7% of the young people said that the school doesn´t carry out sexual orientation3. In addition to the scarcity of activities that discuss aspects related to sexuality, in the moments in which these actions are developed, the schools direct the discussion to a biological focus, where the subjective dimension of sexuality is left aside, so that the acquired knowledge is far from the which is experienced by the student, and such an approach doesn´t normally correspond to expectations about adolescents' doubts and questions3.

Regarding the methods that are most appropriate for contraception in adolescence, the condom was the most cited (68.2%, n=116). But it is important to emphasize that just quoting the method doesn´t mean that there is necessarily adequate knowledge about its use, advantages, disadvantages and forms of access12.

Regarding the known methods to prevent STIs, condoms were also reported by almost all the students analyzed (98.9%, n=182). A similar result was observed in a study carried out in two public schools in Rio de Janeiro-RJ5.

Although young people have some knowledge about how to prevent STIs, there is a growing trend of AIDS in the young population5. Thus, reinforcing conceptions about STIs and HIV/AIDS may enable the process of reflection and action of adolescents reducing their vulnerability to these diseases13.

The most known STI by the group studied was HIV / AIDS (98.4%, n = 182), a fact observed in other studies conducted in Araçatuba-SP and Canoas-RS, where 91.2% and 92.3%, respectively , of the young people knew this pathology14-15. In relation to the other types of infections, more than half of the young people referred to know as Gonorrhea, Syphilis, Hepatitis, Genital Herpes and Human Papillomavirus (HPV) as sexually transmitted diseases. In a study carried out in Araçatuba-SP, it was verified that the majority of the young men pointed out to know, in addition to HIV/AIDS, Herpes, HPV, Gonorrhea, Syphilis and Condyloma14. Thus, it is observed that these adolescents know an average of five to six STIs, which shows a good level of information regarding the existing infections.

Regarding the knowledge about the symptoms that an individual may present when acquiring STIs, more than half of the young people cited the following decreasing frequency: ulcers and sores, itching, runny nose - on the penis or vagina, and pain when urinating. A study carried out with Embu-SP students showed that the presence of wounds in the genital organs was also the most common symptom, followed by itching and itching in these organs16, corroborating with the present study the three most common signs and symptoms. Knowing the most common signs and symptoms resulting from STI contamination may contribute to the self-care of adolescents, since the recognition of symptomatology represents an alert for the demand for health services for the diagnosis and treatment.

It is important to highlight that in the present study, myths, prejudices and fantasies involving sexuality issues were observed, such as the possibility of STI contamination when sharing the same towel or sitting in the same place as the infected person was sitting. Misinformation coupled with lack of information and biological conditions increases vulnerability to the transmission of STIs in adolescence17. In addition, the dissemination of misconceptions about STI contamination can lead to prejudiced behavior in cases where the person with the infection is known and can generate stigma in these young people, which can lead to psychological and social sequelae in the adolescent's life.

It was pointed out by almost half of the young people that the condom lessens the pleasure of sexual intercourse. In the study with students from a municipal college in Canoas-RS, it was observed that 28.5% of the adolescents considered that the condom interferes negatively with sexual pleasure15. It should be emphasized that opinions such as this may contribute to the abandonment of the use of condoms by adolescents.

The idea that condoms are suitable for use only in casual relationships was reported by 9.9% (n=36) of the respondents. This conception was corroborated by a survey of young people enrolled in public schools in the State of Paraíba, which showed that the use of condoms was also associated with occasional partners18. Thus, it is observed that the type of affective involvement, such as relationship status "staying" or dating can interfere with the use of condoms, and that the condom, besides being seen as a barrier to sexual pleasure, may be associated with infidelity or mistrust, being used only in relationships with "unknown" partners19.

Another important issue was regarding the first intercourse and the non-use of the condom, since some interviewees stated that the woman has no risk of becoming pregnant (9%, n=16) and acquiring STIs (5.5%, n=10 ) in the first relation. Failure to use condoms in addition to being inexperienced and difficult to manage is also due to the presence of beliefs that, at the first sexual intercourse, it isn´t possible to conceive or infect STI20.

The use of contraceptive methods depends on a number of factors, including financial issues and access to methods, as well as the degree of freedom and autonomy achieved in adolescence.

As limitations of the study is that some young people have not answered some of the questions proposed. In research with adolescents, it is possible for the participants not to answer the questions in a reliable way, mainly the questions related to the beginning of the sexual relation, number of partners and use of methods of contraception and prevention, since even being guaranteed the confidentiality in the research, adolescents they may be afraid that aspects related to their intimacy will be discovered. The great school dropout was also another limitation that made it impossible to study a larger sample.


CONCLUSION

The study shows that parents have a preponderant role in the sexual education of their children in adolescence; it is perceived that the family has acquired space and notoriety within the discussions about sexuality with young people. However, the school didn´t play a relevant role in sex education in the present study, and young people themselves demonstrate the need for more classes and activities on the subject.

It is also necessary to evaluate the role of the media in the dissemination of this information to adolescents, because in a context of easy and quick access to diverse information, they can either aid in the diffusion and construction of knowledge, or be a sufficient source of doubts and misunderstandings and imprecise understandings regarding sexual aspects.

It was observed that adolescents have adequate knowledge about methods of prevention of STI and contraception, but some still show misconceptions, such as the belief that there is no possibility of acquiring STI or gestation at the first sexual intercourse.

In this context, it is necessary to understand the knowledge of adolescents and identify the gaps present, so that strategies can be structured and implemented by families, schools and health professionals, improving the sexual education of these young people, thus reducing the risks of unwanted pregnancy and contamination by STIs.


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