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Study on the Knowledge of and Attitude towards AIDS-related Issues Among Marginal Youth - Executive Summary

This report is developed from a study on the knowledge of and attitude towards AIDS (Acquired mmunodeficiency Syndrome) related issues amony marginal youth in Hong Kong initiated by the Commission on Youth. In view of the increasing risk of HIV (Human Immunodeficiency Virus) infection among the marginal youth, it is hoped that the study could help to identify agents and focuses for designing HIV/AIDS education to them, and draw up recommendations on how best to minimise the risk of HIV infection among the marginal youth in Hong Kong.

Research Objectives

The major objectives of this study were:

  • to assess the level of their knowledge and understanding on AIDS;
  • to find out their attitude towards AIDS-related issues, their belief and orientation on love and sex;
  • to examine their sexual and drug-taking practices in order to indentify any risk-taking behaviours on AIDS;
  • to identify the psycho-social factors that affect their risk-taking behaviours on AIDS;
  • to solicit their ideas and opinions on AIDS prevention education programmes; and
  • to make suggestions on AIDS prevention education programmes for marginal youth.

Research Design

  • Study Population and Sample

    To ensure the accessibility in making contact with marginal youth, the study population is confined to the active and potential clients of the 30 Outreaching Social Work Service Teams operating in different districts of Hong Kong. The clients of these outreaching teams are those adolescents who tend to have problems or difficulties regarding their families, schools and education, work, peers, self-functioning and social norms. Most of them have exhibited behavioural problems and have association with street gangs. As in March 1993, the total number of active clients the outreaching teams had handled was 8,763. Self-administered questionnaires had been sent to all the 30 Outreaching Social Work Service Teams for their clients to fill in. At the end of the data collection period, a total of 801 completed questionnaires was returned and became the study sample for this study. When several key demographic characteristics of the sample are compared with the population, it is found that the present study sample resembles the study population.

  • Research Methods

    A survey method was adopted to collect data for this study. Self-administered questionnaires were sent to potential respondents through the outreaching social work teams. Existing local studies on AIDS among adolescents were reviewed to identify gaps and to ponder exploratory research questions in the inquiry into the AIDS-related knowledge, attitude, belief and practices of marginal youth. After the review, a preliminary survey questionnaire was constructed. Most of the questions on knowledge and attitude were taken from the questionnaires used in past studies. New questions were constructed to find out their sexual and drug-use practices. To identify the psycho-social factors affecting their AIDS risk behaviours, questions on peers' use of condom, peer influence and general life concerns were asked.

    A pilot test of this preliminary questionnaire was taken place during June in 1996. Six outreaching teams were chosen for this pilot test. A total of 28 clients of these teams had participated. After they had completed the preliminary questionnaire, focus group discussions were held with them to find out any difficulties they might have in understanding the questions, in terms of both wording and relevancy. They were also asked for suggestions on adding new questions and/or rephrasing the questions. Based on their feedback, the final version of the questionnaire was worked out.

    Given that some questions in the questionnare were sensitive and quite personal, it was very important tot ensure that the respondents provide valid answers in completing the questionnaire. One way to ensure their co-operation was through the assistance of their outreaching social workers who had already established a stable relationship with them. To solicit their assistance, a briefing session was held with members of each social work outreaching team on the objectives of the study, possible difficulties encountered by their participating clients and possible problems they might have in "supervising" the clients in completing the questionnaire either in group or alone. Finally, a total of 1,100 copies of the final version of the questionnaire was sent to the 30 social work outreaching teams in July, 1996 to be distributed to their clients. At the end of August, a total of 803 questionaires were returned. Discarding 2 incomplete questionnaires, 801 marginal youth became the respondents of this study.

Characteristics of Respondents

The sex distribution of the respondents were 62.3% males and 37.8% females. The age of respondents ranged from 12 to 23 years with most of them fell within the range of 14 to 18. The majority (59%) of respondents was students, 21% working and 20% idle at home. More than half of the respondents had attained Form 3 or above in their educational attainment. Most of the respondents were grown up in low-income families with their parents had only attained junior secondary education or below. 67.7% of them were living in public housing estates.

Summary of Findings

  • Knowledge on AIDS

    Among the 23 questions on tapping AIDS knowledge, the average number of questions answered correctly by the respondents was 16.85 with standard deviation of 3.54. In general, the AIDS knowledge level was not low among the marginal youth. Although most of the respondents gave correct answers to the commonest modes of transmission through unprotected sexual intercourse (90.4%), sharing needle in injecting drugs (95.4%), and from infected mother to her unborn baby (83.9%), misconceptions still existed. For examples, 45.4% believed that a bite from a mosquito which had bitten an infected person might cause infection; the majority got confused over whether blood donation (53.4%) or blood transfusion (64.1%) was a way of getting HIV; and more than 20% found contact with an AIDS patient's sweat or saliva to be a mode of HIV transmission. Besides, a large number of them still misconceived that some practices could keep them from contracting the disease. These practices included having sex with a virgin (29%); taking contraception pills before sex (17.9%) and taking a shower before sex (16.7%). All these misconceptions and uncertainties might lead to unsafe sex practices that would be the future focuses in the messages of the HIV/AIDS education programmes.

  • Attitude and Belief

    Six questions were designed in this survey to measure the attitude of the marginal youth towards AIDS patients. Most of the respondents were supportive towards AIDS patients if they were their friends and classmates. However, not many of them showed supportive attitude towards strangers who got AIDS. Also, not many of them were positive about themselves being an AIDS patient as over 64% claimed they would try to avoid other people after they were infected. As a whole, only 30.7% of the respondents gave negative answers on four or more questions on attitude towards AIDS patients. However, it should be noted that quite a large number of them (25.2%) believed AIDS patients to be promiscuous and those with such a belief tended to be negative towards AIDS patients. It should also be noted that those respondents who were more knowledgeable about AIDS tended to have more positive attitude towards AIDS-related issues. All these reflected that knowledge on AIDS was a necessary condition for the elimination of prejudice against AIDS patients.

  • Orientation on Love and Sex

    Two sets of questions were adopted to find out respondents' own orientation on love and sex and their acceptance of certain "liberal" norms on love and sex prevailing among adolescents today. In general, their own orientation on love and sex was very liberal for most of them would engage in sex when their boy/girl friends requested even though their emotional ties was superficial and would not mind whether their future spouse was a virgin or not. It could be concluded that marginal youth were sexually liberal and they tended to separate love from sex. Their attitude towards sexual affairs could be described as "easy come, easy go".

  • Sexual Practices and AIDS Risk-taking Behaviours

    iven their liberal orientation on love and sex, it would not be a surprise to find out that 40% of them had actual sexual experience. Relatively more females (44.7%) than males (37.3%) had sexual experience. Most of their sexual encounters were spontaneous without planning. And, most of these encounters resulted in vaginal intercourse. The youngest age reported at which one had his first sexual intercourse was 11. Twelve males and six females admitted that they exchanged sex for money (commercial sex workers) once in awhile and one male claimed that he did it often. Three females and 37 males admitted that they had bought sex before. Among those having sexual experience, 39.5% claimed that they had more than one sexual partner in the past twelve month. Male respondents tended to have more sexual partners than female respondents. Around 41% of them reported that they used condom at the last intercourse but only 17.1% claimed that they used condoms every time when they engaged in sex. All these figures struck us with the fact that many marginal youth engaged in unsafe sex.

    To assess their AIDS risk status in relation to their sexual practices, four questions on "whether having more than one sexual partner in the last 12 months", "whether using condoms at last sexual intercourse", "whether using condoms consistently" and "whether having commercial sex" were used to construct a risk status scale. Their risk status was classified into no/low risk (having 1 or nil negative return of these 4 questions), medium risk (having 2 negative returns) and high risk (having 3 or more negative returns). Based on this classification, 28.6% of them attained a no/low risk status, 49.5% medium risk status and 21.9% high risk status. The present study showed that the marginal youth was at a higher risk of HIV infection. It should also be noted that one's knowledge level on AIDS did not relate to one's risk status. The present study further confirmed the fact that knowledge alone did not automatically help an individual to change their AIDS risk-taking behaviours.

  • Drug-use Practices and AIDS Risk-taking Behaviours

    Regarding drug-use practices, 37.1% of the respondents (297 respondents) claimed that they had tried at least one type of drugs before. Among them, 56% had abused more than one type of drugs (i.e. poly-drug abusers). Most of them described themselves as occasional or freelance abusers. Only forty-six respondents (15.5% of those having abused drugs) admitted that they were addictive to some kind of drugs. There was no difference in the type of drugs abused between males and females. The first three commonest drugs abused by the respondents were marijuana (28.8%), cough medicine (13.5%) and pills (11.5%). The top three commonest methods of taking the drugs were taking orally, inhaling through cigarette and inhaling through nose. Only twenty-five respondents (3.1%) claimed that they had used needles to inject drugs in the past year but none of them reported that they had shared needles with others. In asking those who had sexual experience on how often they had taken drugs or alcohol before engaging in sex, over 34% of them claimed they did it often. The observations made here suggested that the drug-use practices of marginal youth did not directly expose them to HIV infection. However, drug and alcohol use before sex might impair their judgement on adoption safer sex practices.

  • Perceived Susceptibility

    In assessing their perceived susceptibility to HIV infection, 26.5% of the respondents found no possibility for them to get infected, 45.9% low possibility, 25.6% average possibility and 2% high possibility. Since the marginal youth, in general were more adventurous, rebellious and less health conscious, they tended to have an unrealistic optimism on HIV infection even though they have unsafe sex practice. Much worrying us was that their low perceived susceptibility of getting the virus could weaken their senses of self-protection and would further encourage them to practise AIDS risk-taking behaviours.

  • Sources of Information and Perceived Effective Agents

    Over half of the respondents thought they had adequate knowledge about AIDS. Still, a large number of them (46.4%) would like to know more. As expected, television was the main channel for the respondents to learn about AIDS. Most of them got information on sex from their friends and classmates. Their knowledge about contraception came mainly from television. Other major sources of information on AIDS and sex included radio, newspapers and magazines. When they had queries on AIDS and sex, most of them would like to consult their friends first. For AIDS queries, they would also consult teachers and AIDS hot-line, and for sex queries, they would also consult social workers and read the sex-inquiry column in newspapers or magazines for guidance and information.

    As all the above sources of information and possible channels/types of persons they would consult were given, we should pay attention to the "other answers" provided by the respondents themselves. These "other answers" included close friends of the family, doctors, books, video and comic books. In fact, a hierarchy of agents was identified by them as the most convincing agents in providing HIV/AIDS information. Doctors/nurses (435 counts) came out on top in this hierarchy, followed by HIV/AIDS patients (418 counts), social workers (271 counts), pop song singers (239 counts), teachers (146 counts) and parents (139 counts). Given these other sources of information and hierarchy of agents, new agents and alternative modes of communication in transmitting AIDS messages to adolescents should be explored.

  • Psycho-social Factors Affecting AIDS Risk-taking Behaviours

    To understand AIDS risk-taking behaviours of adolescents, some theoretical arguments had been set forth to make sense of their relevant behaviours. Psychologically, risk-taking might be an intrinsic characteristic of adolescents. Socially, however, their risk-taking behaviours might be a form of adaptive measure to seek acceptance from their peers or attention from their significant others, like their parents. In general, marginal youth, like average adolescents, was susceptible to peer influence.

    In explaining why the marginal youth did not use condoms during sexual intercourse, the 183 respondents (58.1% of those who had sexual experience) put forward a hierarchy of factors. The first set of factors was consisted of "Not Prepared" and "Too Troublesome" (156 counts). This illustrated a basic personality trait of adolescents who did not always plan for their action. The second set of factors comprising of "Not Comfortable" and "Reducing Sensitivity" (107 counts) reflected their self-assessment of condom efficacy. The third set of factors which included "Trust the Partner", "Rejected by the Partner" and "Afraid to be Found Mistrustful" (81 counts) was an indicator of one's perceived self-efficacy in initiating and enforcing behavioural change.

    To further make sense of this hierarchy, some relevant observations should be elaborated here. There were 42.7% of the respondents admitting that they had been worried about getting HIV. Those who had such a worry tended to find their chance of getting HIV a bit higher than those without such a worry. However, among those with actual sexual experience, their worry did not lead to safer sex practices as it did not relate to their risk status. As most of their sexual encounters were spontaneous, it would be understandable that they would not have time to get a condom. While many of them were aware of the risk of getting AIDS, their resolution on having no casual sex and no sharing of needle as the basis on which they assessed their AIDS susceptibility might explain why they found using condoms unnecessary. Regarding the factor of self-efficacy in adopting safe sex practices, the marginal youth had to overcome interpersonal pressures and sentiments. In adopting unsafe sex practices, marginal youth was seemed to be susceptible to peers group influence as they alleged if their friends did not use condom, they were more reluctant to use condom during sexual intercourse.

Recommendations

Concluding the implications from the findings in the present study, the following recommendations are made:

  • Targeted AIDS publicity and education for marginal youth should be launched.
  • AIDS message for marginal youth should be comprehensive, behavioural-specific and cultural-specific.
  • Medical professionals, HIV/AIDS patients and social workers are the appealing and convincing agents in communicating the AIDS message to marginal youth.
  • Innovative channels, such as through creative performance art: drama, talk show, painting, comics, interactive video games etc. should be adopted in imparting the AIDS message to marginal youth.
  • Skills-specific training programmes in inducing behavioural changes in AIDS risk-taking behaviours should be conducted to marginal youth.
  • A teaching and information kit or package on HIV/AIDS which not only aims to impart AIDS knowledge but also to sustain the behavioural changes in response to HIV/AIDS epidemic should be developed.
  • AIDS training activities should be rendered to Outreaching Social Workers whom are believed to be an effective agent or intermediary in conducting the skills-specific and behavioural changes programme to the marginal youth.
  • A social support environment among the marginal youth in alerting and preventing HIV/AIDS infection should be cultivated and promoted.
  • Parents of marginal youth is believed to be a natural agent within their families to impart AIDS and related knowledge and the preventive measures. Thus, AIDS training programmes for their parents should be launched.
  • Comprehensive sex education for adolescents should be started at an earlier time, such as higher primary classes as a pre-requisite for effective AIDS control among the youth population, especially the marginal youth in Hong Kong.
  • Last but not the least, publicity and education on minimising drug and alcohol use among the marginal youth should be implemented.

Limitations of the Study and Future Efforts

Our concern for marginal youth in the midst of AIDS epidemics led to the present study. Given the operating definition of marginal youth by outreaching social work teams, it should be noted that not all those adolescents with problems regarding the family, school, education, vocation, peers and social functioning have come into contact with outreaching social work teams. Thus, the findings of this study cannot be generalised to the whole population of marginal youth (there is no accurate figure on the size of the marginal youth in Hong Kong) but can only be generalised to the clientele of Outreaching Social Work Service in Hong Kong.

In identifying and understanding the psycho-social factors influencing the AIDS risk-taking behaviours of marginal youth, we have failed to measure directly how the family, such as parental attitude and guidance, affect such behaviours. It is also not the purpose of the present study to examine any causal model among variables determining the AIDS risk-taking behaviours. So, future studies should aim to understand adolescents' AIDS risk-taking behaviours by taking into consideration their social, familial and school experiences in explaining the occurrence of these behaviours. This consideration is essential in constructing more concrete, specific and effective AIDS education and prevention programmes for marginal youth in future.