Psychosocial And Behavioral Factors Associated To Std/aids Risk ...
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Artigo Original
267
PSYCHOSOCIAL AND BEHAVIORAL FACTORS ASSOCIATED TO STD/AIDS
RISK AMONG HEALTH STUDENTS
Elma Mathias Dessunti2
Alberto Olavo Advincula Reis3
Dessunti EM, Reis AOA. Psychosocial and behavioral factors associated to STD/AIDS risk among health students.
Rev Latino-am Enfermagem 2007 março-abril; 15(2):267-74.
This study aimed to identify and compare psychosocial and behavioral factors associated to STD/AIDS
risk among students enrolled in the first and last years of the Nursing and Medical Undergraduate Programs at
State University of Londrina. A convenience sample was selected from 263 enrolled students, and the 183
students who were sexually active (70.4%) had their data assessed. The Aids Risk Reduction Model framework
was used to design the questionnaire in which a 5% statistical significance level was considered. Some risk
factors were identified such as the perception of invulnerability, multiple sexual partners, consumption of
alcoholic beverages before intercourse, and the discontinuous use or no use of condom. The risk factors are
common both to the freshman and senior students, with no significant differences related to the passage of
time or to the students’ higher educational level. Senior students tend to be monogamous which makes them
feel safer and decrease the use of condom with their sexual partners.
DESCRIPTORS: acquired immunodeficiency syndrome; sexually transmitted diseases; risk factors; sexual
behavior; prevention & control
FACTORES PSICOSOCIALES Y COMPORTAMENTALES ASOCIADOS AL RIESGO DE
ETS/SIDA ENTRE ESTUDIANTES DEL ÁREA DE LA SALUD
Este estudio tuvo como objetivo identificar y comparar los factores psico-sociales y comportamentales
asociados al riesgo de ETS/sida entre estudiantes del primero y del último año de los cursos de Enfermería y
Medicina de la Universidad Estatal de Londrina. Fue seleccionada una muestra por conveniencia, compuesta
por 263 alumnos matriculados, de los cuales fueron analizadas las informaciones de 183 estudiantes sexualmente
activos (70,4%). Para la elaboración del cuestionario, se utilizó la estructura del Modelo de Reducción de
Riesgo de Sida, adoptándose el 5% como nivel significativo. Algunos factores de riesgo fueron identificados
tales como, la percepción por la falta de vulnerabilidad, múltiples compañeros sexuales, el uso de bebidas
alcohólicas antes de las relaciones sexuales y la falta de uso o uso descontinuado del preservativo. Se concluyó
que, esos factores son comunes a los dos grupos, no generándose cambios significativos al paso del tiempo, ni
con el incremento en el nivel educativo de los mismos. Los alumnos del último año tienden a adoptar un único
compañero, lo que les genera mayor seguridad, disminuyendo por tanto el uso de preservativo con sus
parejas sexuales.
DESCRIPTORES: síndrome de inmunodeficiencia adquirida; enfermedades de transmisión sexual; factores de
riesgo; conducta sexual; prevención & control
FATORES PSICOSSOCIAIS E COMPORTAMENTAIS ASSOCIADOS AO RISCO DE
DST/AIDS ENTRE ESTUDANTES DA ÁREA DE SAÚDE
Este estudo objetivou identificar e comparar os fatores psicossociais e comportamentais associados
ao risco de DST/aids entre estudantes do primeiro e do último ano dos cursos de Enfermagem e Medicina da
Universidade Estadual de Londrina. Selecionou-se uma amostra de conveniência, composta pelos 263 alunos
matriculados, tendo sido analisados os dados dos 183 estudantes sexualmente ativos (70,4%). Utilizou-se a
estrutura do Modelo de Redução de Risco da Aids para a elaboração do questionário, adotando-se 5% como
nível de significância estatística. Alguns fatores de risco foram identificados como a percepção de
invulnerabilidade, a referência a múltiplos parceiros sexuais, o uso de bebidas alcoólicas antes das relações
sexuais e o uso descontínuo ou não uso do preservativo. Conclui-se que esses fatores são comuns às duas
séries, não havendo mudanças significativas com o passar do tempo e com a maior graduação dos alunos. Os
alunos do último ano tendem a adotar a parceria única e parecem sentir-se mais seguros, diminuindo o uso do
preservativo com seus parceiros sexuais.
DESCRITORES: síndrome de imunodeficiência adquirida; doenças sexualmente transmissíveis; fatores de risco;
comportamento sexual; prevenção & controle
1 Study extracted from Doctoral Dissertation; 2 PhD Professor at State University of Londrina, e-mail: elma@sercomtel.com.br; 3 PhD Professor University of
São Paulo College of Public Health
Disponible en castellano/Disponível em língua portuguesa
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268
INTRODUCTION
prevention strategies through its teaching, research,
care and extension functions.
This study aimed to identify psychosocial and
In human resource training, the university
behavioral factors associated with the risk of sexually
must consider that its students constitute a group of
transmitted diseases (STD) and AIDS among health
adolescents and young adults with a high risk of STD,
students. This group of future professionals will directly
including HIV, since they are initiating sexual activity
or indirectly intervene in educative actions linked to
at an early stage and frequently change partners(6).
these diseases. Thus, the knowledge of psychosocial
A study performed with college students in
and behavioral factors associated to the risk of STD/
the health area showed that the majority presents
AIDS is extremely important to identify this
precarious knowledge, reinforcing the need to
population’s current stage of preparation to deal with
implement specific and continuous educative actions
people vulnerable to these diseases.
for this group(7).
The political, economic and social impact of
This population must also be prioritized in
STD/AIDS is of great importance in underdeveloped
research, since it is comprised of young people, one
and developing countries because it is the cause of
of the priority segments for preventive actions. In
great morbidity among women between 15 and 44
addition, college students in the health area are
years old(1). In developed countries, there has been
considered capable of assessing their own risk and
a decline in STD rates, despite an estimated 12 million
associated factors, approaching other than biological
cases per year for the United States(2). The World
aspects related to AIDS transmission.
Health Organization (WHO) estimated that 40 million
The analysis of medical course curricula
adults and children were living with HIV until the end
revealed that STD/AIDS are unsatisfactorily
of 2001, one third of whom are young people between
addressed, both qualitatively as quantitatively, since
15 and 24 years old(3).
not all subjects that have an interface with the theme
During the epidemic phase of HIV/AIDS, the
address it, and those that do are limited to clinical
incidence and prevalence of SDT needs to be
aspects, to the detriment of psychosocial, cultural and
monitored, because the presence of genital wounds
behavioral aspects(8).
favors the penetration of HIV, increasing infection risks
The didactic activities developed in the
by up to 18 times, when one of the partners has an
undergraduate Nursing course at Londrina State
untreated SDT(4). Another reason to monitor STDs is
University (UEL) involve student participation in
that they are transmitted during sexual intercourse,
different care levels, benefitting contact between
presuming negligence regarding the consequences of
faculty and students from various courses. This
the sexual relationship, such as not using condoms.
allowed us to experience diverse situations in the
Young adults are exposed to the risk of
relationship between students and patients with STD/
acquiring HIV because they get involved with multiple
AIDS, many of which involve prejudice, fear,
partners and many of them do not use a condom in
insecurity, communication difficulties, among others.
all sexual intercourse. In addition, most adolescents
On the other hand, it can be perceived that the
is initiating sexual activity earlier, exposing themselves
students avoid talking about their sexual lives and
to the risk of STD at a younger age.
seem to treat problems related to STD/AIDS as “the
In this context, many STD/AIDS prevention
others’ problems”, which gives the idea they are
programs have been implemented all over the world
“untouchable” by the epidemic.
in the attempt to contain these infections.
This situation made us inquire about the
Undergraduate courses, especially in the health area,
sexual behavior of these students, who are future
have tried to address the issue. However, a tendency
professionals and health educators. That is, what are
towards a biologistic focus on the issue is observed,
the psychosocial and behavioral factors related to the
to the detriment of preparation for preventive
risk of STD/AIDS among health students, especially
education.
those from Nursing and Medical undergraduate
The lack of special education in medical or
courses? Do these factors differ between first and
psychology course curricula compromises the training
last-year students from each course? Did the contents,
of future professionals to address sexuality(5). The
personal and group experiences provided by
university has a fundamental role in STD/AIDS
university life contribute to any change in the
Rev Latino-am Enfermagem 2007 março-abril; 15(2):267-74
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Dessunti EM, Reis AOA.
269
psychosocial and behavioral factors, to the extent that
high-risk sexual behavior and increase low-risk
fifth-year students are in a different phase than first-
activity; 3) search and adoption of strategies to reduce
year students?
high-risk sexual behavior(10).
Thus, in view of these questions, this study
Thus, some instrument questions refer to data
proposed the following objectives: identify and
that characterize the sample (age, gender, course,
compare the psychosocial and behavioral factors
year, marital status) and data that characterize sexual
associated to the risk of infection by HIV or other
activities (age of sexual initiation, number of sexual
STD among first and last-year students from the
partners, use of contraceptive methods, stable and/
Nursing and Medical undergraduate courses at UEL.
or occasional relationship), while others refer to the
This study is expected to provide support for
ARRM variables, from which the following were
STD/AIDS prevention work among health students,
selected: knowledge about transmission forms,
preparing them for professional actions that are more
perceived vulnerability, discussion about STD/AIDS,
adequate to reality.
stereotyped health beliefs, type of sexual relationship,
condom use, use of alcoholic beverages before sexual
intercourse(10-12). A large majority of the answers were
METHOD
closed and the variables could be measured on an
ordinal scale.
An analytical survey was performed with
The structured questionnaire was previously
college students from the Nursing and Medical
tested and data were collected after authorization by
programs at Londrina State University (UEL). This
the Research Ethics Committee and after contacts and
research was carried out at the UEL Health Science
clarifications to the respective course boards.
Center in Londrina, Northern Paraná, Brazil.
Students were oriented about the research objectives
An intentional sample was selected from first-
and, after they had agreed to participate, they filled
and last-year Nursing and Medical undergraduate
out the instrument. Participants were instructed not
students at UEL (263 registered students) in 2000.
to identify themselves, thus guaranteeing the secrecy
This sample is composed of 260 students (98.9%)
of the answers. Moreover, to keep the privacy of the
who answered the research instrument. Through this
answers, the questionnaire was accompanied by a
sample, which represents all first- and last-year
“term of responsibility” signed by the researcher,
students of the above mentioned courses, an
assuming responsibility for the collected data and for
inferential analysis can be made from the results
total secrecy about the individual answers. After being
observed in the study with the students of the two
filled out, the questionnaire was put in a sealed
proposed years.
envelop, with the researcher’s guarantee that it would
The instrument was structured on the basis
only be opened after the return of all answered
of the variables of the AIDS Risk Reduction Model –
questionnaires per year and course.
ARRM. Only data from sexually active students were
Data were tabulated through the epi-info
considered, that is, 183 (70.4%) of those who
program, version 6.04. Other computer programs
answered the questionnaire. This criterion was
used were Microsoft Excel for Windows 97, S-Plus 4.5
adopted as necessary to use the model variables,
and SPSS 8.0. To characterize the group profile of
since they are centered on populations with non-zero
the students under study, an exploratory analysis with
risk of acquiring STD/AIDS.
descriptive measures is presented (mean, median and
The ARRM was proposed by Catania, Kegeles
standard deviation), and frequency tables and Box-
and Coates in 1990 and, among health behavior
Plot charts are constructed. Some questions were also
models, it provides a structure that covers several
analyzed descriptively, using the result of the
psychosocial and behavioral factors associated to the
frequency tables.
risk of STD/AIDS, approaching the individual
To compare students per course year,
vulnerability aspects mentioned by Mann and
homogeneity tests were used for categorized data
Tarantola(9). The ARRM identifies three stages that
(Chi-square and Fisher’s exact test) and the non-
could influence the risk of acquiring STD/AIDS: 1)
parametric test for ordinal data (Mann-Whitney). The
recognition and identification of one’s own sexual
statistical tests were calculated at a significance level
behaviors as risk factors; 2) commitment to reduce
of 0.05 (5%).
Psychosocial and behavioral factors...
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270
RESULTS AND DISCUSSION
across both genders, with 50% of the cases varying
between 16 and 18 years old (mean 16.9 for men
In total, 260 (98.9%) Nursing and Medical
and 16.6 for women). A greater variability is perceived
students answered the questionnaire. We analyzed
among last-year students, with men initiating sexual
the answers of those sexually active, that is, 183
activity between 16 and 20 (mean 17.7) and 50% of
(70.4%) students.
women initiating between 17 and 20 years old (mean
A study of the sexual behavior of the Brazilian
18.4).
population, performed in 1998(13), showed that
approximately 60% of people between 16 and 19
years old had already initiated sexual activity,
increasing to 92.3% between 20 and 24 years old.
K
V
[
Specifically among college students from a city in the
V
K
X
CE
interior of São Paulo, it was found that 63.2% had an
WCN
active sexual life(14).
GZ
U
QH
The data that characterize the sample of sexually
G
I
C
V
)GPFGT
active college students are presented in Table 1.
CT
5V
/CNG
(GOCNG
Table 1 - Distribution of the number and percentage
0
(KTUV
.CUV
of first- and last-year Nursing and Medical students
;GCT
according to age, gender, marital status and course
**One blank answer was excluded
Figure 1: Start age of sexual activity of first- and last-
o
T a
t l
Cou s
r e e
Y ar
a
V
a
i
r b e
l s
P
a
V u
l e
F s
r
i t
Last
year Nursing and Medical students, according to
n = 183 %
(
) n = 83 %
(
) n = 100 %
(
)
gender and course year. (n=182**)
g
A e
17 o
t 19 e
y a s
r o d
l
46 2
( 5 7
, )
46 5
( 6 8
, )
0 0
( 0
, )
20 o
t 22 e
y a s
r o d
l
69 3
( 8 5
, )
30 3
( 7 0
, )
39 3
( 9 8
, )
A study performed with the general Brazilian
0 0
, 00 *
*
23 o
t 25 e
y a s
r o d
l
52 2
( 9 1
, )
3 3
( 7
, )
49 5
( 0 0
, )
population found a lower mean age for the first sexual
26 o
t 45 e
y a s
r o d
l
12 6
( 7
, )
2 2
( 5
, )
10 1
( 0 2
, )
intercourse among men than in the present study
i
M s
s i g
n
e
r
s
t
l
u
s
= 4
e
G nder
(15.6 years old). In the case of women, the mean
a
M e
l
87 4
( 7 5
, )
46 5
( 5 4
, )
41 4
( 1 0
, )
age found is similar to that of first-year students in
0 0
, 52*
Fe a
m e
l
96 5
( 2 5
, )
37 4
( 4 6
, )
59 5
( 9 0
, )
this study (17 years old)(13). Among medical students
i
M s
s i g
n
e
r
s
t
l
u
s
= 0
a
M
a
t
i
r
l S a
t u
t s
at Ceará Federal University, the mean age for the
Si g
n e
l
170 9
( 2 9
, )
82 9
( 8 8
, )
88 8
( 8 0
, )
first sexual intercourse was 15.8 years old, that is,
a
M
i
r
r ed C
/ o
e
s
n
a
u
s
n
l
0 0
, 07 *
*
13 7
( 1
, )
1 1
( 2
, )
12 1
( 2 0
, )
between 9 and 27 years old(15).
i
n
U on
i
M
i
s
s
g
n
e
r
s
t
l
u
s
= 0
The number of sexual partners reported by
Cou s
r e
UEL students varied between one and 15 in their life,
i
s
r
u
N
g
n
78 4
( 2 6
, )
30 3
( 6 1
, )
48 4
( 8 0
, )
0 1
, 06*
and the general mean is 3.07 (DP=2.42) partners for
e
M di i
c e
n
105 5
( 7 4
, )
53 6
( 3 9
, )
52 5
( 2 0
, )
i
M
i
s
s
g
n
e
r
s
t
l
u
s
= 0
first-year and 3.42 (DP=3.26) for last-year students.
*Pearson’s Chi-Square Test; **Fisher’s Exact Test
The majority (68.2%) reported having sexual
intercourse with two or more partners during the
Table 1 shows no significant difference
period, with no significant difference between course
between first- and last-year students in terms of
years. To better evaluate the significance of this
course or gender. As expected, there was a significant
indicator, the existent proportion between the number
difference regarding age and marital status, although
of partners and age can be established. However, our
only 7.1% of the students were married or had a
sample has a larger concentration of people between
consensual union.
17 and 25 years old, which dispenses with this care.
Figure 1 shows that these students reported
It is important to mention that the number of sexual
a start age of sexual activity between 12 and 28 years
partners of unknown serological state and several
old. The younger individuals (first year) are initiating
expositions increase the risk of STD/HIV/AIDS.
sexual activity earlier than the senior students,
In the last 12 months, the number of sexual
regardless of gender. First-year students were similar
partners among UEL students varied from zero to six
Rev Latino-am Enfermagem 2007 março-abril; 15(2):267-74
Psychosocial and behavioral factors...
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Dessunti EM, Reis AOA.
271
and the general mean was 1.24 (DP 0.90) sexual
discontinued use or no use of condoms, which results
partners among first and 1.45 (DP=1.18) among last-
in higher risk of exposure to HIV and other STD.
year students. The majority of them (71.9%) reported
The contingent of young people who maintain
sex with only one partner in the last year, with no
unprotected sexual intercourse is still very large and,
significant difference between course years.
even under contraceptive protection, young people
It should be mentioned that neither 23
who have many partners and do not use condoms
students who reported having several partners during
systematically are unprotected against STD and AIDS.
their life without determining how many, nor seven
The level of knowledge about AIDS
other students who did the same regarding the last
transmission forms was established according to a
12 months were included in the mean estimations.
codification of items that ranged from 14 (higher
This could increase the above mentioned means,
knowledge) to 70 points (lower knowledge). The sum
especially in the first case. The data presented in this
of mean values was 18.8 and 18.2 points for first-
research are similar to data presented in the literature,
and last-year students, respectively, showing a very
showing that many UEL students are getting involved
good level of knowledge, with no statistical difference
with multiple partners, regardless of the course. This
between the years. In general, the knowledge level
can lead them to acquire STD/AIDS, especially if
about AIDS found among students was high. Although
condom use is not consistent.
considered necessary, many researchers have shown
The continuous use of a contraceptive method
that this high level of knowledge is not sufficient to
during the whole period of sexual active life was
reduce sexual activities of risk(6,10).
reported by 67.6% of the studied students, with no
Knowledge about HIV transmission
statistical difference between the years. The most
constitutes the first step in the reduction of risk
cited contraceptive methods of continuous use were
behaviors, but perception or belief in personal risk is
condom (34.1%), contraceptive pill (28.6%), calendar
necessary and essential for a change in behavior with
method (6.0%) and coitus interruptus (withdrawal),
a view to risk reduction.
(4.4%).
This risk perception, one of the variables of
We found a significant difference between the
the ARRM model, can be evaluated by the degree of
two years (p=0.01) regarding the use of oral
concern/anxiety related to the danger of acquiring
contraceptives, with a higher proportion of users
STD/AIDS. However, it is important to highlight that
among last-year students. However, the use of this
the perception of risk should not be considered only
method has made many young adults abandon
at the individual level, but also in the social and cultural
condom use, since there is a great concern to avoid
context, clearly influencing preventive actions. In our
pregnancy, to the detriment of STD/AIDS prevention.
study, a low degree of concern or anxiety about having
Although the difference in condom use as a
acquired STD/AIDS in the past can be observed, with
contraceptive method was not significant, the
some degree of concern regarding the possibility of
proportion of first-year students who use it on a
acquiring it in the future, both among first- and last-
regular basis is higher than among last-year students
year students. When this variable is analyzed in terms
(40.2% and 29.0% respectively). It is important to
of probability, it is clearly perceived in Table 2 that
emphasize that 65.9% of all students reported
the STD/AIDS are seen as “other people’s disease”.
Table 2 - Descriptive statistics of the perception of personal risk of acquiring STD/AIDS among first- and last-
year Nursing and Medical students
Cou s
r e e
Y ar
a
M nn
h
W
n
t
i ey
P o
r bab
y
t
i
l
i
F s
r
i t
Last
U e
T st
p
e
M an
e
M d a
i n
S a
t nda d
r E o
r
r
r
e
M an
e
M d a
i n
S a
t nda d
r e o
r
r
r
f
O acq i
u i
r g
n
e
h
t
A D
I S i
v
s
u
r
in
4 1
, 2
4
0 6
, 8
4 0
, 9
4
0 6
, 4
0 7
, 1
e
h
t
e
n
t
x i
f e
v
e
y a s
r
f
O
o
s
e
m o e
n
o
y
r
u age
1 8
, 9
2
0 8
, 6
2 0
, 4
2
0 8
, 7
0 2
, 4
a q
c
i
u i
r g
n
e
h
t
A D
I S i
v
s
u
r
f
O a q
c
i
u i
r g
n
o
s
e
m S D
T
in
e
h
t
4 0
, 1
4
0 7
, 6
4 0
, 6
4
0 7
, 2
0 6
, 8
e
n
t
x i
f e
v
e
y a s
r
f
O
o
s
e
m o e
n
o
y
r
u age
1 8
, 7
2
0 8
, 4
2 0
, 4
2
0 8
, 9
0 1
, 8
a q
c
i
u i
r g
n
o
s
e
m S D
T
The perception of personal risk was analyzed on a scale from 1 to 5. The scores close to 1 indicate a very high probability of acquiring STD or AIDS
Psychosocial and behavioral factors...
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272
Both first- and last-year students judge
Table 3 - Distribution of the number and percentage
themselves with little or no probability of acquiring
of first- and last-year Nursing and Medical students,
STD/AIDS, while individuals of the same age are seen
according to the type of relationship in the last 12
with high probability of acquiring these diseases.
months, existence of stable relationship and duration
This low perception of risk among UEL
of the relationship
students is confirmed, since 62.8% of them classify
o
T a
t l
Cou s
r e e
Y ar
themselves as “low risk” and 23.9% as “no risk”
a
V
a
i
r b e
l s
P
a
V u
l e
F s
r
i t
Last
n = 183 %
(
) n = 83 %
(
) n = 100 %
(
)
regarding the possibility of acquiring STD/AIDS.
y
T pe of e
r a
l
o
i
t nsh p
i
n
i
h
t e a
l st w
t e v
l e
o
m n h
t s
Although the perception of personal risk is
a
t
S b e
l
88 4
( 8 1
, )
31 3
( 7 3
, )
57 5
( 7 0
, )
low among the UEL students who participated in the
a
t
S b e
l a d
n e e
v
a
u
t
n
l
41 2
( 2 4
, )
18 2
( 1 7
, )
23 2
( 3 0
, )
0 0
, 04 *
*
study, 8.2% of them reported having presented some
E e
v
a
u
t
n
l
42 2
( 2 9
, )
29 3
( 4 9
, )
13 1
( 3 0
, )
o
N
e
n
12 6
( 6
, )
5 6
( 0
, )
7 7
( 0
, )
STD in the past.
a
V
e
u
l
s a
l
k
c i g
n = 0
Being acquainted with someone who has
Ex s
i e
t ncy of cu e
r
r nt s a
t b e
l
e
r a
l
o
i
t nsh p
i
AIDS or knowing about someone who has AIDS can
e
Y s
1
1 4 6
( 2 3
, )
39 4
( 7 0
, )
75 7
( 5 0
, )
0 0
, 00*
o
N
69 3
( 7 7
, )
44 5
( 3 0
, )
25 2
( 5 0
, )
lead people to a higher perception of vulnerability to
a
V
e
u
l
s a
l
k
c i g
n = 0
the infection. Hence, last-year UEL students should
e
T m
r
of s a
t b e
l
e
r a
l
o
i
t nsh p
i
n
(
1
1
=
4)
have a higher perception of risk than first-year
1
<
e
y ar
23 2
( 0 5
, )
13 3
( 4 2
, )
10 1
( 3 5
, )
students, since they had several contacts with patients
1 3
-
|
e
y a s
r
33 2
( 9 5
, )
12 3
( 1 6
, )
21 2
( 8 4
, )
0 0
, 02 *
*
3 5
-
|
e
y a s
r
29 2
( 5 9
, )
1
1
2
( 8 9
, )
18 2
( 4 3
, )
with HIV/AIDS during the course. However, no
5 or
o
m e
r
e
y a s
r
27 2
( 4 1
, )
2 5
( 3
, )
25 3
( 3 8
, )
statistical difference was observed between students
a
V
e
u
l
s a
l
k
c i g
n = 2
of both years.
*Pearson Chi-square test; **Fisher’s Exact Test
To adopt preventive actions, people should
Among the 42 students who reported
be convinced of their personal risk of acquiring HIV/
involvement with eventual partners in the last 12
AIDS, which many times is determined by their beliefs.
months, 69% are first and 31% last-year students.
Thus, heterosexual men who do not use drugs and
also women tend to underestimate their personal risk,
Table 4 - Distribution of number and percentage of
due to AIDS being popularly associated to masculine
first- and last-year Nursing and Medical students,
homosexual practices and to the consumption of
according to condom use in the last 12 months and
injection drugs.
some variables related to their use
Students in general do not present stereotyped
beliefs regarding people with AIDS, which was
o
T a
t l
Cou s
r e e
Y ar
a
V
a
i
r b e
l s
P
a
V u
l e
demonstrated by the low scores of the analyzed
F s
r
i t
Last
n %
(
)
n %
(
)
n %
(
)
variables, which could totalize from 7 to 35. The general
Condom use du n
i
r g vag n
i al or anal n
i e
t c
r ou s
r e n
i
h
t e
sum of the means was 9.4 for first-year students and
a
l st 12
o
m n h
t s n
(
1
= 83)
e
Y s
94 5
( 5 6
, )
49 6
( 5 3
, )
45 4
( 7 9
, )
9.8 for last-year students, without difference in terms
So e
m i
t
e
m s
46 2
( 7 2
, )
17 2
( 2 7
, )
29 3
( 0 8
, )
0 0
, 67*
of behavior between the two groups. However,
o
N
29 1
( 7 2
, )
9 1
( 2 0
, )
20 2
( 1 3
, )
alternatives such as “I am not the kind of person who
i
M
i
s
s
g
n
s
e
u
l
a
v
= 4
1
The condom escaped n
i
h
t e a
l st 12
o
m n h
t s n
(
1
= 40)
could get AIDS” and “I don’t have a sexual relationship
At e
l a t
s o
e
c
n
37 2
( 6 8
, )
17 2
( 6 6
, )
20 2
( 7 0
, )
with the kind of person who could have AIDS” presented
0 9
, 51*
o
N
101 7
( 3 2
, )
47 7
( 3 4
, )
54 7
( 3 0
, )
the highest mean scores and highest standard errors
i
M
i
s
s
g
n
a
v
e
u
l
= 2
for students of both years, confirming the perception
The condom b o
r ke n
i
h
t e a
l st 12
o
m n h
t s n
(
1
= 40)
At e
l a t
s o
e
c
n
32 2
( 2 9
, )
1
1
1
( 6 9
, )
21 2
( 8 0
, )
of invulnerability regarding infection by HIV/AIDS.
0 1
, 20*
o
N
108 7
( 7 1
, )
54 8
( 3 1
, )
54 7
( 2 0
, )
The analysis of data in Table 3 indicates that
i
M
i
s
s
g
n
a
v
e
u
l
s = 0
not all students have stable sexual partners, with a
*Pearson Chi-square
significant difference between students of the two
years, prevailing more stable relationships between
Among UEL students who reported sexual
last than between first-year students, both in the last
relationships in the last 12 months, 44.4% indicated
12 months and in recent relationships. Likewise, the
eventual use or no use of condoms (Table 4). It is also
duration of the stable relationship is longer among
observed that many students report that it broke or
last-year students (p=0.002).
escaped at least once in the last 12 months. Some
Rev Latino-am Enfermagem 2007 março-abril; 15(2):267-74
Psychosocial and behavioral factors...
www.eerp.usp.br/rlae
Dessunti EM, Reis AOA.
273
questions can be posed here, such as not choosing the
CONCLUSIONS
condom by its quality, not being accustomed with its
use, not having access to an adequate condom size,
College students from the health area at UEL
placing it incorrectly and using inadequate lubricants.
are well informed about AIDS transmission. This is
When questioned about who took the decision
expected, since it is a differentiated clientele among
to use the condom, 71.9% of the students reported
the social-cultural strata. However, some factors of
the couple, probably due to good communication
risk to STD/AIDS are highlighted, such as the
perception of personal invulnerability among freshmen
between the partners.
and seniors. This was verified by the low degree of
Descriptive statistics of condom use
preoccupation/anxiety of acquiring these diseases in
frequency with stable and eventual partners in vaginal
the past and the little concern about acquiring them
and anal sexual relationships demonstrated a higher
in the future. Still, a majority considers itself with little
tendency of less condom use among last-year students
or no probability of acquiring STD/AIDS, while
in vaginal intercourse with eventual partners than
individuals of the same age are seen with great
among first-year students. That is, last-year students
probability of acquiring these infections. Another factor
with stable relationships are the ones who least use
considered of risk is the reference to multiple sexual
condoms on a regular basis in their sexual
partners during life, both by first- and last-year
relationships.
students. The latter tend to adopt a single partner,
Analyzing the possibility of condom use being
which perhaps justifies the higher percentage of
influenced by the duration of the relationship among
eventual or no use of condoms in sexual relationships.
non married heterosexual adults, a study showed that
This risk is even higher for seniors who report
the condom was used at the beginning of the
continuous use of contraceptive pills, which can
relationship. However, as the relationship continued
contribute to non-use of condoms, with a significant
and trust was established, the preservative was no
difference from first-year students. Regarding condom
longer used(16).
use as a contraceptive method, there was no statistical
The use of alcoholic beverages before sexual
difference between the two course years, but it can
intercourse, seen as strong predictors of risk behavior,
also be consider a factor of risk if we analyze that the
majority of them report no or discontinued use. Most
was reported by 68.8% of students who answered
students also report the use of alcoholic beverages,
the question. This can interfere negatively in condom
which can lead to non-use of condoms in sexual
use, leading to the risk of acquiring STD/AIDS. The
intercourse. In general, students showed themselves
use of other drugs was reported by 4.0% of the
very similar on the different items under study, and
students.
there were no significant changes over time or
The use of substances that disinhibit sexual
according to graduation level.
repression, such as alcohol for example, or the use
The psychosocial and behavioral factors
of injection drugs is correlated with a higher
associated to the risk of STD/AIDS among college
probability of involvement in sexual risk behavior. In
students, as well as the similarity observed regarding
Brazil, study performed with college students in Ceará
these factors among first- and last-year Nursing and
found that 18.3% of men and 2.7% of women reduce
Medical students at UEL indicate the that educative
condom use when they consume alcoholic
programs must be directed to adolescents and
beverages(15).
continued in college, preparing these future
In general, this study showed the magnitude
professionals for educative activities, emphasizing not
of the STD/AIDS risk among college students, a group
only biological, but also psychosocial and behavioral
which does not consider itself at risk of acquiring these
ones. The different approaches to vulnerability must
infections, with many students who have not
be highlighted, not only the individual, but also the
incorporated safe sex practices in their sexual
programmatic and the social, thinking about these
activities.
students as agents that transform reality.
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Recebido em: 4.5.2006
Aprovado em: 13.9.2006
