XIII INTERNATIONAL AIDS CONFERENCE

Objective: The purpose of this study is to verify if there are differences regarding sexual behavior and drug use between adolescents from a private and a public primary school in the City of São Paulo, Brazil.

Methods: A self applied questionnaire and focal group with ten students at each time were applied to 89 and 48 students of both gender, in a public and private school respectively, coursing the 8th year of primary grade. The girls and the boys were separated each other for both activities, and anonymity was guaranted for all students.

Results: We had 89 students (43 males, 46 females) from the the public school, aged 14 to 18 years, and all of them agreed to answer the questionnaire. In the private school there were 4 refusals among 48 students (27 males, 21 females),13 to 16 years of age. 19 students (29.7% of males and 19% of females) from the public school have already had a sexual intercourse, with the average age of the first coitus at 11.9 and 14.1 years for male and female respectively, without significant difference in gender. On the other hand, only 1 male teenager had sexual activity in the private school, revealing an important difference between schools (OR=13.62, p=0.0017). Alcohol usage was not different among students from both schools. Knowledge about HIV transmission was good among teenagers of both schools, and both groups have already had at least one course about AIDS prevention. 3% of students (2 males and 1 female) from the public school had a STD.

Conclusions: Although the teenagers from the private and public primary schools did not show differences on knowledge about AIDS and HIV transmission, there is a significant difference between their sexual behavior and drug use in practice. As a consequence, educational programmes for safe sex and harm reduction of drug use must take this difference into account to be effective.

Risk behaviour for HIV infection surveys have been generally made for specific groups like injecting drug users, prostitutes and prisoners for example, where the prevalence of this disease is expected to be higher than in general population.

In this sense, much effort has been put on developing tools for applying questionnaires and role playing techniques that privilege those especific groups, both for mapping behaviour and planning intervention strategies to reduce HIV infection, coupled with educational programmes.

These approaches have been partially successful in their objectives to control AIDS pandemic, because they left out most of the potential population that in fact is in full connection with those specific groups, namely: heterosexual adolescents and adults, both male and female.

More than 20 years ago, adolescents born in the 1980’s grew up watching and listening to the campaigns for preventing HIV infection and developing AIDS. Today´s teenagers have had a huge exposition to information on HIV/AIDS, what we can call “The AIDS Culture”.

However, social and economical differences are expected to play some influence on how adolescents perceive this cultural phenomenon on the end of the 20th century, and consequently how they behave.

This is of particular importance in big urban centers, like the City of São Paulo, in Brazil, the 3rd biggest city in the world, where social unequalities are easy seen in a same neighbourhood, from extreme poverty to extravagant wealth.

Among some other variables, economical status drives the access to primary education roughly into 2 types of schools in the City of São Paulo, Brazil: private schools, for wealthy people that consider them better a priori; and public schools, supported by government and mostly occupied by lower social classes nowadays.

In order to investigate the impact of the AIDS culture on the current adolescent generation,
we carried out a survey among students of two primary schools in São Paulo City, Brazil.

Two primary schools, located in the central urban area of the City of São Paulo, were selected for this study. One of them is a State Public School, where students come from families of the working class social strata. The second school is a private one, where students are from the middle and upper class social strata.

Before making the questionnaire the educators sent the autorization to the responsible to
autorize (or not) the research because all of them were persons under legal age.

The questionnaires were applied to students coursing the morning period of the 8th year of both schools, in 1998 and 1999. We have made this option because the 8th year is the last year before they enter high-school.

The questions were about individual caracters: gender, sex, age, city; age of first sexual intercourse (if they had had sex or not), sexual habits (between last 6 and 12 months), knowledge on STD, HIV and AIDS, use of alcohol and illicit drugs and relationship of drug use.

The girls and the boys, for this study, were separated from each other, for answering the questionnaire and after it was making a focal group it was a meeting among ten teenagers each time coordinated by two psychologists from the staff where they listened to the student’s knowledge, habits and beliefs about the transmission of HIV and observed the emergent(s) (common problems that have been affecting everybody) . After listening and providing the students with the right information, they were given a condom and taught how to use it. Then, they watched an educational movie about HIV and AIDS prevention.

The anonymity for both activities was guaranted for all students.

We have used the answers of the questionnaire and the written reports to make the comparison between the public and private school, applying Chi-square Test and Fisher Exact Test where appropriate. Odds Ratio (OR) was calculated using EPI-INFO software, version 6.0, and the related p value.

In the end of this study, 137 questionnaires were applied, distributed as follows:

- public school: 89 students (43 males, 46 females), 14 to 18 years of age

- private school: 48 students (27 males, 21 females), 13 to 16 years of age

There were no refusals from parents of the public school, but 4 teenagers from the private school were not allowed to enter the study by their parents, under the reasoning that their “children were too young to get information about AIDS”.

Regarding sexual activity, we have found a significant difference between schools (OR=13.62, p=0.0017), having the 19 public school teenagers experienced one or more sexual intercourses (29.7% of males and 19% of females), with the average age of the first coitus at 11.9 and 14.1 years for male and female respectively, without significant difference in gender. On the other hand, only 1 male teenager had sexual intercourse in the private school. As a consequence, 3% of students from the public school (2 males and 1 female) have already had a STD.

Considering alcohol drinking habits, there was no statistical difference among students from
both schools and gender.

Marijuana (cannabis) was the most common illicit drug used in both schools. Although the public school students uses more drugs than the private school students, the difference is not statistically significant.

Knowledge about HIV transmission was very good among teenagers in both schools. Both
groups have already had at least one course about AIDS prevention.

Descriptive and qualitative analysis was conducted from the questionaires and from focal groups to verify opinions on gender, beliefs, habits, knowledge about Aids, the beginning the sexual relationship, care of parents and the use of illicit drugs in both schools.

Some phrases were selected and are shown below, evidencing worries, fears, prejudices and
backgrounds that should interfere in those youngsters attitudes and behaviours.

“When a girl left the school and went to her house she was raped by two boys…”

“It’s difficult to talk about our problems with our parents…”

“…she got pregnant…it is her problem…”

“…definitely, the girls have understood that the pregnancy was their problem…and they had
a beautiful love night.”

“…but if he is a MACHO MAN all the women fall in love with him!”

O’Leary et al (1993) says that there isn’t a “don’t know” about AIDS and it isn’t about economic level or social education in school but with the way of knowledge has been transmitted to the persons, whose are in different level of age, status and, mainly, culture. This culture has taught the same methods through the centuries without innovation.

Lowen (1988) makes a comparison between the rapist and the seducer whose both men have a violent action that express a great hostility to the women. To Lowen (1988), it is a serious problem with mother’s man that these men haven’t resolved since their chilhood that envolves Edipus’s Complex (Freud).

To rape and to seduce a person (for him) is a basic disturb in the narcissus’s personality,
it is to deny a feeling.

We can note the necessity of these students in speaking about their everyday problems that,
without knowing conciously, are leading them to the risk of being contamined by the HIV.

The knowledge and the efforts of the projects and programs to prevent the HIV transmission
and the spread of the epidemic of the century must not neglect teenagers and their specificity.

Educators must think and consider the advantages of these real factors before developping
new programes of prevention of AIDS to the students in primary schools.

Lowen A.; Narcisismo: negação do verdadeiro self, Editora Cultrix,4 edição, São Paulo,1988
(portuguese).

O’Leary S. and Cheney B.;TRIPLA AMEAÇA: AIDS e mulheres: dossiê panos, Rio de Janeiro,
ABIA, Recife, PE., SOS corpo, Londres, Inglaterra, Panos Institute, 1993. (portuguese)