Beruflich Dokumente
Kultur Dokumente
1
# Oxford University Press 1997 Printed in Great Britain
SUMMARY
This paper reviews the current literature related to HIV/ Social research can contribute to the achievement of
AIDS and university students, and discusses how this safer sexual behaviour in three ways. First, by describing
information can be used in health promotion program- the range of the problem. Second, by detecting the most
ming and evaluation. Research related to HIV/AIDS dominant factors that a¡ect the acceptance or rejection
among university students has focused primarily on the of recommended health behaviours. Such factors have to
assessment of knowledge, attitudes and behaviours and, be studied on the personal level, as well as on the social
to a lesser extent, on the e¡ectiveness of educational organizational levelsöthe speci¢c community and its
interventions. Ensuring the greatest success involves a culture. Third, by evaluating the e¡ectiveness of educa-
multifaceted and coordinated e¡ort which brings tional interventions by monitoring changes in health
together faculty, administration, students, health educa- beliefs and behaviours, and particularly in association
tion professionals and the external community of stu- to speci¢c methods of intervention. Repeated surveys
dents. Any program targeting HIV/AIDS can be and evaluation studies are necessary since beliefs and
included in a more comprehensive initiative for improv- behaviour change over time. Based on the ¢ndings of
ing and maintaining student health. The skills learned to such studies, health promotion should be planned, imple-
reduce the risk of HIV infection are transferable to mented and continuously evaluated, updated and
other health issues and involve empowering students to changed. This indicates that health promotion is one of
take control and responsibility for their actions. This the areas where social science theory, research and prac-
empowerment, combined with good knowledge and tice have to be intertwined on an ongoing basis in order
healthy attitudes, will allow the skills learned to be used to be e¡ective.
when students are outside of the university setting.
INTRODUCTION
behaviour, changing partners frequently. They mote our knowledge and understanding of these
thus constitute a group. Of the 4250 000 cases of issues and lead to e¡ective suggestions regarding
AIDS that have been reported to the Centers for directions for further research and implementa-
Disease Control and Prevention in the United tion.
States since 1981, fewer than 1% have occurred
among 13^19-year-olds, and about 20% among
20^29-year-olds (Centers for Disease Control, KNOWLEDGE AND CONCERN ABOUT
1993). Given that the median duration of the incu- H I V/A ID S
bation period, between infection with HIV and
onset of AIDS, is nearly 10 years, many 20^29- In general, studies of college students indicate
year-olds with AIDS may have been infected that they have a relatively high level of know-
during adolescence (Morris et al., 1993). In 1989, ledge, including general knowledge, knowledge
AIDS ranked as the sixth leading cause of death about HIV/AIDS transmission and prevention
among 15^24-year-olds in the US (National (Svenson and Varnhagen, 1990; Green et al.,
Center for Health Statistics, 1994). 1991). Most of the studies, however, report some
Two-thirds of the reported AIDS cases among caveats in knowledge which lead to signi¢cant
although necessary, are not su¤cient to promote university students who had sexual intercourse at
the desired behaviour. a young age and those who have had many sexual
Coupled with studies that reveal relatively high partners continue to have a high number of
knowledge is an extensive literature that indicates sexual partners, regardless of their level of know-
that college students are beginning to realize they ledge concerning AIDS. This is consistent with
are at risk for AIDS and are concerned about con- the ¢ndings of DuRant and Sanders (1989) who
tracting HIV. For example, Hingson et al. also found that frequency of sexual intercourse
(1990a, b) found that the percentage of 16^19- among adolescents was associated with the
year-old adolescents who worried about AIDS number of years of sexual activity and the
increased from 46 to 74% between 1986 and 1988. number of years of dating.
Other studies have produced similar results, indi-
cating that 45^60% of university students express
some concern over the possibility of HIV infection CONDOM USE
(Baldwin and Baldwin, 1988; Gottlieb et al.,
1988; Svenson and Varnhagen, 1990; Varnhagen Risky sexual behaviour includes participation in
and Svenson, 1990). casual sex, often changing sexual partners, and
Cochran et al. (1990) also reported a small strongly predict actual condom use. Other recent
increase in condom use among university stu- research has indicated that consistent condom
dents. On the other hand, 44% of the students indi- use is primarily explained by psychosocial factors,
cated that they had not changed their sexual such as being able to communicate about the use
behaviour to reduce their risk of HIV infection. of condoms with sexual partners, peer-group
Some researchers have detected increasing trends norms which support the use of condoms, and
toward greater condom use as a function of the positive beliefs about the e¡ects of the condom on
frequency of sexual intercourse (DuRant and San- pleasure during intercourse (Catania et al., 1989;
ders, 1989), and as a function of greater number Carmel, 1990; Carmel et al., 1992; DiClemente,
of sexual partners (Varnhagen et al., 1991). 1992; Oswald and Pforr, 1992). Thus, the peer
Others report opposite trends (Traeen et al., group and in£uencing social norms may provide
1992b). an e¡ective target for health education.
There are indications that adolescents (16^19-
year-olds) who have sex after drinking or using
marijuana use condoms less frequently than C O M M U N I C AT I O N
when not drinking or using drugs (Strunin and
1994). In both studies, signi¢cantly more mothers grams have been reported (Varnhagen and Sven-
than fathers reported that they had discussed the son, 1990; Waldron et al., 1995; McAleavy et al.,
importance of condom use with their children. 1996). Varnhagen and Svenson (1990) assessed
the e¡ectiveness of an AIDS peer education pro-
gram compared to other types of education and
E VA L U AT I O N S O F H E A LT H no participation in an AIDS education program.
E D U C AT I O N P R O G R A M S Knowledge and attitudes did not di¡er signi¢-
cantly across the three groups demonstrating a
Reports of evaluations of AIDS-related educa- relatively high awareness in the university popula-
tional programs for adolescents or university stu- tion. However, those students who participated
dents are often not very encouraging in the peer education program were more likely to
(DiClemente, 1992). Baldwin and Baldwin, for engage in safer sexual practices including
example, found that taking a university education condom use and communication with partners on
course did not a¡ect students' sexual behaviour, follow-up 6 months after the program.
including with respect to condom use, number of
sexual partners, or frequency of casual sex (Bald-
Health authorities, university administrators and to the use of condoms among young adults: (i)
students, as well as the mass media, should coop- acceptance of a recommended behaviour, for
erate in order to achieve the desired goal (Weiss those who have not experienced sexual inter-
et al., 1995). course; (ii) changeöfor those who practiced sex
Berg et al. (1993) outlined steps for the develop- but without using a condom, and (iii) mainte-
ment and implementation of a peer education pro- nanceöfor those who use condoms but who have
gram for university students. It was to be encouraged to continue such use on a regular
recommended that any campus-wide education basis. It might be that di¡erent messages are
program be directed by a multidisciplinary steer- appropriate for students who di¡er on such base-
ing committee with representation from faculty line intervention conditions (Carmel, 1990). It is
and students from a number of faculties. Strong therefore recommended to di¡erentiate among
links with campus groups and department chairs such conditions when studying HIV/AIDS-
are considered essential for the program's success related issues among young persons.
and to gain better access to students. Such a The use of theoretical models in studies of
model requires a strong commitment and a need health beliefs and behaviour is helpful to the orga-
for an individual to have a coordinating role to nization of knowledge in a systematic conceptual
tematically and repeatedly used in comparative AIDS pandemic in women and children. Lancet, 336, 221^
studies of di¡erent population groups, might sig- 224.
Cochran, S. D., Keidan, J. and Kalechstein, A. (1990) Sexually
ni¢cantly and in a short time increase our know- transmitted diseases and acquired immunode¢ciency syn-
ledge of health-education-relevant issues. drome (AIDS): changes in risk reduction behaviors among
young adults. Sexually Transmitted Diseases, 17, 80^86.
Address for correspondence: DeBuono, B. A., Zinner, S. H., Daamen, M. and McCormack,
Larry Svenson W. M. (1990) Sexual behavior of college women in 1975,
Surveillance Branch 1986, and 1989. New England Journal of Medicine, 322,
Alberta Health 821^825.
PO Box 2222 DiClemente, R. J. (1992) Psychosocial determinants of
condom use among adolescents. In DiClemente, R. J. (ed.)
Edmonton
Adolescents and AIDS: A Generation in Jeopardy. Sage,
Alberta T5J 2P4 Newbury Park, CA.
Canada DiClemente, R. J., Pies, C. A., Stoller, E. J., Straits, C., Olivia,
G. E., Haskin, J. and Rutherford, G. W. (1989) Evaluation
of school-based AIDS education curricula in San Francisco.
REFERENCES Journal of Sex Research, 26, 188^198.
DiClemente, R., Zorn, J. and Temoshok, L. (1986) Adolescents