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Better awareness needed on HIV and STIs among Northern Province youth, study suggests

23 Jan 2022

 
  • Finds knowledge on HIV and STIs and attitudes towards HIV low among youth in vocational training centres in Vavuniya and Kilinochchi compared to same in WP
  • Adequate knowledge and attitudes towards HIV positively associated with school education/learning
  BY Ruwan Laknath Jayakody Even though knowledge regarding the human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) and attitudes towards HIV were low among youth in vocational training centres in the Vavuniya and Kilinochchi Districts in the Northern Province, compared to those in the Western Province (WP), risky sexual behaviours and alcohol consumption on their part was low, a local study found. Furthermore, since adequate knowledge and attitudes towards HIV were positively associated with school education and learning, such can be utilised to improve knowledge and attitudes towards the same among youth in these districts. These findings and recommendations were made in a paper on “STI/HIV vulnerability among out-of-school youth in vocational training centres in the Vavuniya and Kilinochchi Districts” which was authored by D.K.J. Thanthree (Acting Consultant Venereologist at the Sexually Transmitted Diseases (STDs) Clinic in Kilinochchi), V.S. Dharmakulasinghe (Consultant Venereologist at the STD Clinic in Panadura), N. Jayasekara (Consultant Venereologist at the STD Clinic in Badulla), and H.A.C.W. Hathurusinghe (Consultant Venereologist at the STD Clinic in Kegalle) and published in the Sri Lanka Journal of Sexual Health and HIV Medicine (6) in December 2020.  Out-of-school youths have been defined in the Workforce Investment Act of 1998 and the Workforce Innovation and Opportunity Act of 2014 as eligible youths who are school dropouts or eligible youths who have received a secondary school diploma or its equivalent but are deficient in basic skills, unemployed, or underemployed. As of 2001, dropout rates between Grades Six and 11 were 3% in the Sinhala medium and 6% in the Tamil medium while around 37% are not proceeding beyond the upper secondary level of school education. These out-of-school youths are, per the National Youth Policy, searching for occupations. Sri Lanka is a country with a low prevalence of HIV, and the estimated number of people living with HIV in 2019 is 3,600 (3,200 to 4,200), and from among them, per the National Survey on Emerging Issues among Adolescents in Sri Lanka by the United Nations Children’s Fund Sri Lanka, 15-20% are young adults in the 15 to 24 years age group. According to the Family Health Bureau, 22% of out-of-school adolescents are sexually active and 5.3% of all registered pregnancies are teenage pregnancies. As per the integrated biological and behavioural surveillance survey done in 2018 (Report on the National Size Estimation of the Most at Risk Populations for HIV in Sri Lanka), 7.9% of female sex workers, 22.3% of men who have sex with men, 6% of intravenous drug users, 30% of beach boys, and 26% of transgender women were between the ages of 18 to 24 years. Each of the districts in the Northern Province (Jaffna, Kilinochchi, Mannar, Mullaitivu, and Vavuniya) has a STD clinic while three clinics function as antiretroviral therapy centres with 2.2% of cumulative patients living with HIV obtaining services from them. However, according to Thanthree et al., the number of clinic attendees in the Northern Province is relatively low compared to the rest of the country. The National Youth Corps (NYC), the Vocational Training Authority (VTA), and the National Apprentice and Industrial Training Authority (NAITA) are government institutions providing technical and vocational training for out-of-school youths with different abilities. Hence, in order to identify the vulnerability of out-of-school youths in the Vavuniya and Kilinochchi Districts towards STDs, Thanthree et al. sought to study and determine the knowledge, attitudes, and high-risk behaviour towards HIV and STIs and identity-based factors associated with risky behaviours among out-of-school youths in vocational training centres in Vavuniya and Kilinochchi. For this purpose, a descriptive, cross-sectional study was conducted among out-of-school youths in the NYC, the VTA, and the NAITA centres in Vavuniya and Kilinochchi. The study population was aged 15 to 24 years and were school dropouts or those deficient in basic skills and were attached to vocational training centres in Vavuniya and Kilinochchi. A systematic sampling method was used to select 303 participants from a sample of 900. A structured, self-administrated questionnaire containing close-ended questions was used as the data collection tool. The questionnaire assessed socio demographic data, knowledge, and attitudes towards HIV and STIs and the assessment of risky behaviour including substance and alcohol abuse and unprotected sexual exposure. The mean (average) age of the participants was 18.5 years. The majority (51.2%) was male. The majority (157 – 51.8%) was Sinhalese. Even though the majority (212 – 70%) lived with parents, 68/22.4% lived with a single parent. Only 76/25% had adequate knowledge and 207/68% knew about the mother to child transmission of HIV. The majority (216 – 71%) had obtained HIV knowledge from school while 47/16% had received knowledge from healthcare institutions. Only 34/11% had correct attitudes. Awareness of STDs symptoms related to males and females, was assessed separately while 14 did not respond. The majority (182 – 63% and 198 – 68%) were unaware of male and female symptoms, respectively. Regarding male symptoms, only 38/13% correctly identified urethral discharge, while 42/14.5% recognised genital ulcers as a symptom. In female symptoms, only 37/13% correctly identified vaginal discharge. Genital ulcers and lower abdominal pain were recognised by 36/12% and nine/3%, respectively. Only 118/39% knew about places for HIV testing, while 10/3.3% had done HIV testing (seven/70% had done testing from a STD clinic while three/30% had done it from a private laboratory). Only 15/5% were sexually active and 12/80% were male. All had heterosexual relationships; 11 were single; two lived together with a sexual partner; and four/27% were involved in commercial sex out of the sexually active participants, and all of the latter were single. Regarding knowledge related to condoms and the use of a condom, 45/15% knew about the places where condoms are available and of them, 39/87% were males. Only five male participants had obtained condoms during the course of the last year. Regarding the affordability of condoms, 206/68% were not aware of such while 23/7.6% believed that it was affordable. In the self assessment of the HIV risk, 99/32.7% suggested that they were at high risk, while 46/15% believed that they did not have a risk while nearly half (149 - 49%) were not aware of their risk for HIV. Adequate knowledge was significantly associated with sex and knowledge received with school education. Having a good attitude was significantly associated with sex and knowledge received through school education. Sexual activeness was not associated with sex, age, alcohol consumption, other substance abuse, the educational level, or having adequate knowledge of HIV. Discussing the findings, Thanthree et al. noted that knowledge of STIs and HIV was low among youth in the vocational centres in Vavuniya and Kilinochchi but observed, however, that 207/68% knew about the mother-to-child transmission of HIV.  A.V.P. Madhavi, S.S. Subasingha, D.P. Chandrasekara, and M.S. Jayakotana’s “Schoolchildren’s knowledge, attitudes, and beliefs regarding STIs/HIV: A comparative, descriptive study in rural and urban settings in Sri Lanka” found that schoolchildren in rural and urban surroundings in Colombo had good knowledge about HIV, with around 90% correctly identifying the mode of HIV transmission. The Sri Lanka College of Sexual Health and HIV Medicine has noted that out-of-school youths in youth corps in the Western Province had a higher level of knowledge on STIs and HIV, and that it was positively associated with age and the education level. In the instant study, age and the education level were not associated with adequate knowledge, while sex and knowledge received at school were associated with HIV-related knowledge. In the instant study, the male gender had good knowledge compared to females. Learning about HIV from school had, in the instant study, a connection to having adequate knowledge on HIV. The correct attitude towards HIV was low among participants (34 – 11%) in the instant study; however, the proper attitude was associated with gender and learning about HIV from school. Around 40% in the instant study knew about HIV testing facilities whereas in youth corps centres in the Western Province, deficiencies in knowledge on HIV testing were revealed. Only 5% was sexually active in the instant study, which is relatively low compared to the study done in the Western Province where 15.5% of Colombo youth corps and 25% in vocational training centres in the Colombo District were sexually active. All in the instant study had heterosexual exposures, while 10% and 24% in Colombo-based vocational centres and youth corps had homosexual relationships, respectively. Only 27% in the instant study, had involvement with commercial sex. A total of 79.2% youth in Colombo, per the earlier study, had multiple partners. However, 12/80% sexually active participants had last had sex without a condom, in the instant study, which was less in the Western Province (69%). Nearly one-fifth/21% consumed alcohol, and only 7% were currently drinkers, in the instant study, which is low compared to the national figure of 14.5% male youth being current alcohol users, per L. Somatunga, L. Ratnayake, W. Wijesinghe, Y. Yapa, and M. Cooray’s “National alcohol use prevalence survey in Sri Lanka (2008)”. Related to safe sex, in the instant study, only 45/15% knew about places where condoms were available, and therefore knowledge regarding condom availability was low when compared with youth in Colombo, where 65.2% knew that condoms were available in pharmacies.  If you or someone you may know is in need of adequate information regarding safe sexual practices and/or STD/HIV testing, the following places/websites may be of assistance:  National STD/AIDS Control Programme – Sri Lanka: (011) 2 667 163 / (011) 2 667 029  Family Planning Association of Sri Lanka: (011) 2 555 455  www.know4sure.lk


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