High-School Students’ Knowledge and Attitudes towards HIV/AIDS and Main Sources of Information on Sexual Health: A Nation-wide Cross-sectional Study in Greece


Απόστολος Γ. Πελτέκης
Παναγιώτα Α. Παρανού-Λιόλου
Έλενα Σ. Παππά
Άννα Π. Καβούρη
Κωνσταντίνος Β. Χατζημωράκης
Abstract
In Greece, a substantial percentage of adolescents start their sexual activity at an early age, leading to increased chance of exposure to various sex-related risks, such as HIV/AIDS. At the same time, sexual education is quite degraded in the Greek school, while little is known about the Greek family’s role in children’s sexual development. The current study of a stratified national sample of 4,090 second and third grade high-school students, with a mean age of 16.45 years, looked into: (a) students’ main sources of sexual information, (b) level of satisfaction from sexual education in family and in school, (c) knowledge about HIV/AIDS, and (d) attitudes towards people living with HIV. Friends (75%) and the internet (55%) were the most frequently reported sexual information sources, much lower being the mother (34%), father (23%) and school (18%). Gender affects the choice frequency of certain information sources, especially family. Satisfaction from sexual education in family was relatively high (60%), but much lower for school (30%). Students present a rather homogenous picture of moderate knowledge about HIV/AIDS and positive attitudes towards people living with HIV. Mother and the internet, as sexual information sources, are related to better knowledge and more positive attitudes towards HIV/AIDS, while the opposite is observed regarding father and TV. Children’s sexual education in Greece and the role of family and school need further examination and systematic interventions. Adolescents’ sexual education and behaviour remain a demoted area of investigation in Greece and more research and systematic interventions are needed.
Article Details
  • Section
  • RESEARCH PAPERS
Downloads
Download data is not yet available.
References
Bailin, A., Milanaik, R.,&Adesman, A. (2014). Health implications of new age technologies for adolescents: a review of the research.Current Opinion in Pediatrics, 26(5),605-619. doi:10.1097/MOP.0000000000000140
Bleakley, A., Hennessy, M., Fishbein, M., &Jordan, A. (2009). How sources of sexual information relate to adolescents’ beliefs about sex. American Journal of Health Behavior, 33(1), 37-48.
Bongardt, D., Reitz, E., Sandfort,T., &Deković, M. (2015). A meta-analysis of the relations between three types of peer norms and adolescent sexual behavior. Personality and Social Psychology Review, 19(3),203-234. doi: 10.1177/1088868314544223
Brener, N. D., Billy, J.O.,& Grady, W. R. (2003). Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. JournalofAdolescentHealth, 33(6), 436-457.
Γερούκη, Μ. (2011). Η σεξουαλική αγωγή στο σχολείο. Θεωρία και πράξη – οι απόψεις των εκπαιδευτικών. Αθήνα: Μαραθιά.
Γιαννίκος, Ε., Παπαδόπουλος, Α., &Νιάκας, Δ. (2010). Μελέτη των γνώσεων, απόψεων και της συμπεριφοράς μαθητών Λυκείου σχετικά με το AIDS. Ελληνικά Αρχεία AIDS, 18(2), 71-78.
Carey, M. P., &Schroder, K. E. (2002). Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Education & Prevention, 14(2), 172-182. doi:10.1521/aeap.14.2.172.23902
Chambers, L. A., Rueda, S., Baker, D. N., Wilson, M. G., Deutsch, R.,Raeifar, E., ... Stigma Review Team (2015).Stigma, HIV and health: a qualitative synthesis. BMC Public Health, 15, 848. doi:10.1186/s12889-015-2197-0
Creatsas, G.,& Elsheikh, A. (2002). Adolescent pregnancy and its consequences. European Journal of Contraception & Reproductive Health Care, 7(3),167-172.
Currie, C., Gabhainn, S. N., Godeau, E., Roberts, C., Smith, R., Currie, D., ... Barnekow, V. (2008). Inequalitiesinyoungpeople’shealth. HBSC international report from the 2005/2006 survey. Ανακτήθηκε απόhttp://www.euro.who.int/__data/assets/pdf_file/0005/53852/E91416.pdf?ua=1
Currie, C., Roberts, C., Morgan, A., Smith, R., Settertobulte, W.,Samdal, O, &Barnekow-Rasmussen, V. (2004). Young people’s health in context. Health behaviour in school-aged children (HBSC) study: International report from the 2001/2002 survey. Ανακτήθηκεαπόhttp://www.euro.who.int/__data/assets/pdf_file/0008/110231/e82923.pdf?ua=1
Currie, C., Zanotti, C., Morgan, A., Currie, D., Looze, M., Roberts, C., ... Barnekow, V.(2012). Social determinants of health and well-being among young people. Health behaviour in school-aged children (HBSC) study: International report from the 2009/2010 survey. Ανακτήθηκε από http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf?ua=1
Ελληνική Στατιστική Αρχή (2017, Αύγουστος). Έρευνα χρήσης τεχνολογιών πληροφόρησης και επικοινωνίας από νοικοκυριά και άτομα έτους 2017 (Δελτίο τύπου). Πειραιάς: Ελληνική Στατιστική Αρχή. Ανακτήθηκε από https://www.statistics.gr/statistics?p_p_id=documents_WAR_publicationsportlet_INSTANCE_qDQ8fBKKo4lN&p_p_lifecycle=2&p_p_state=normal&p_p_mode=view&p_p_cacheability=cacheLevelPage&p_p_col_id=column-2&p_p_col_count=4&p_p_col_pos=1&_documents_WAR_publicationsportlet_INSTANCE_qDQ8fBKKo4lN_javax.faces.resource=document&_documents_WAR_publicationsportlet_INSTANCE_qDQ8fBKKo4lN_ln=downloadResources&_documents_WAR_publicationsportlet_INSTANCE_qDQ8fBKKo4lN_documentID=298929&_documents_WAR_publicationsportlet_INSTANCE_qDQ8fBKKo4lN_locale=el
EuropeanCentreforDiseasePreventionandControl (2015). Sexually transmitted infections in Europe 2013.Ανακτήθηκε από https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/sexual-transmitted-infections-europe-surveillance-report-2013.pdf
European Centre for Disease Prevention and Control (2017α). HIV and AIDS. In ECDC. Annual epidemiological report for 2015. Ανακτήθηκε από https://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-HIV-AIDS.pdf
European Centre for Disease Prevention and Control (2017β). HIV testing. Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Ανακτήθηκε από https://ecdc.europa.eu/sites/portal/files/documents/HIV%20testing.pdf
Evangeli, M., Pady, K., & Wroe, A. L. (2016). Which psychological factors are related to HIV testing? A quantitative systematic review of global studies. AIDS & Behavior, 20(4), 880-918. doi:10.1007/s10461-015-1246-0
Fan, X., Miller, B. C., Park, K. E., Winward, B. W., Christensen, M.,Grotevant, H. D., &Tai, R. H. (2006). An exploratory study about inaccuracy and invalidity in adolescent self-report surveys. Field Methods, 18(3), 223-244. doi:10.1177/152822x06289161
Ζησόπουλος, Κ., Βούλτσος, Π., &Βασιλειάδης, Ν. (2010). Η άρνηση των ιατρών να περιθάλψουν HIV θετικούς ασθενείς. Ελληνικά Αρχεία AIDS, 18(2), 54-60.
Gesesew, H. A, TesfayGebremedhin, A., Demissie, T. D., Kerie, M. W., Sudhakar, M., &Mwanri, L. (2017). Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis. PLoSOne, 12(3),e0173928. doi:10.1371/journal.pone.0173928
Ηλιάδου, Μ. &Αγραφιώτης, Δ. (2007). Γνώσεις, στάσεις και χρήση μεθόδων αντισύλληψης από νέους 18-24 ετών. Πιλοτική έρευνα στην περιοχή Αθηνών. Ελληνικά Αρχεία AIDS, 15(3), 125-133.
Heywood, W., Patrick, K., Smith, A. M., &Pitts, M. K. (2015). Associations between early first sexual intercourse and later sexual and reproductive outcomes: a systematic review of population-based data. Archives of Sexual Behavior, 44(3), 531-569. doi:10.1007/s10508-014-0374-3
Ho, S. S., &Holloway, A. (2016).The impact of HIV-related stigma on the lives of HIV-positive women: An integrated literature review.Journal of Clinical Nursing, 25(1-2), 8-19.doi:10.1111/jocn.12938
Ιωαννίδη-Καπόλου, Ε., &Αγραφιώτης, Δ. (2005). Σεξουαλικότητα(ες) στην εποχή της αβεβαιότητας και του AIDS. Αθήνα: Πολύτροπο.
Inchley, J., Currie, D., Young, T., Samdal, O., Torsheim, T., Augustson, L., ... Barnekow, V. (2016). Growing up unequal: gender and socioeconomic differences in young people’s and well-being. Health Behavior in School-aged Children (HBSC) study: International report from the 2013/2014 survey. Ανακτήθηκεαπόhttp://www.euro.who.int/__data/assets/pdf_file/0003/303438/HSBC-No.7-Growing-up-unequal-Full-Report.pdf?ua=1
Ioannidi-Kapolou, E. (2004). Use of contraception and abortion in Greece: A review. Reproductive Health Matters, 12(24), 174-183.
Κέντρο Ελέγχου και Πρόληψης Νοσημάτων (2018). Δελτίο επιδημιολογικής επιτήρησης της HIV/AIDS λοίμωξης στην Ελλάδα, 31-12-2017 (Τεύχος 32). ΚΕΕΛΠΝΟ: Αθήνα. Ανακτήθηκεαπόhttps://www.keelpno.gr/Portals/0/Αρχεία /HIV/2018/ΕΠΙΔΗΜΙΟΛΟΓΙΚΟ_ΔΕΛΤΙΟ_HIV_2017.pdf
Kakavoulis, A., & Forrest, J. (1999). Attitudes and values in sexual behaviour and sex education: a cross-cultural study among university students in Greece and Scotland. International Review of Education, 45(2), 137-151. doi:10.1023/A:1003688807427
Kalemi, G., Gkioka, S., Tsapatsari, P., Tzeferakos, G., Kandri, T., Psarra, M. L., ... Douzenis, A. (2017). Stigma and self-esteem: a case of HIV-positive sex-workers. Psychiatriki, 28, 67-74.
Kallipolitis, G., Stefanidis, K., Loutradis, D., Siskos, K., Milingos S., &Michalas, S. (2013). Knowledge, attitude, and behavior of female students concerning contraception in Athens, Greece. Journal of Psychosomatic Obstetrics and Gynecology, 24(3), 145-151.
Kanuga, M., & Rosenfeld, W. D. (2004). Adolescent sexuality and the internet: the good, the bad, and the URL. Journal of Pediatric and Adolescent Gynecology, 17(2), 117-124. doi:10.1016/j.jpag.2004.01.015
Kirby, D. (2011). Reducing adolescent sexual risk: a theoretical guide for developing and adapting curriculum-based programs. California, USA: ETR Associates.
Kirby, D., Laris, B. A., &Rolleri, L. (2006). The impact of sex and HIV education programs in schools and communities on sexual behaviors among young adults. NorthCarolina, USA. Ανακτήθηκε από http://www.sidastudi.org/resources/inmagic-img/dd1054.pdf
Kotchick,Β. Α., Shaffer, Α., Forehand,Ρ., & Miller, K. S. 2001. Adolescent sexual risk behavior: Amulti-system perspective. Clinical Psychology Review,21(4),493-519.
Kring, A. M.,& Gordon, A. H. (1998).Sex differences in emotion: expression, experience, and physiology. Journal of Personality and Social Psychology, 74(3), 686-703. doi:10.1037/0022–3514.74.3.686
Lara, L. A. S.,& Abdo, C. H. N. (2016). Age at time of initial sexual intercourse and health of adolescent girls. Journal of Pediatric and Adolescent Gynecology, 29(5),417-423. doi:10.1016/j.jpag.2015.11.012
Li, H., Li, X., Zhang, L.,& Chow, E. (2016). Effects of multiple types of stigma on the probability of HIV disclosure to sex partners: a systematic review. Sexual Health, 13(6), 516-529. doi:10.1071/SH16089
Lohrmann, C., Välimäki, M., Suominen, T., Muinonen, U., Dassen, T.,&Peate, I. (2000). German nursing students' knowledge of and attitudes to HIV and AIDS: Two decades after the first AIDS cases.Journal of Advanced Nursing, 31(3), 696-703.
Matziou, V., Perdikaris, P., Petsios, K., Gymnopoulou, E., Galanis, P., &Brokalaki, H. (2009). Greek students' knowledge and sources of information regarding sex education. International Nursing Review, 56(3),354-60. doi:10.1111/j.1466-7657.2009.00727.x
Merakou, K., Costopoulos, C., Marcopoulou, J., &Kourea-Kremastinou, J. (2002). Knowledge, attitudes and behaviour after 15 years of HIV/AIDS prevention in schools. European Journal of Public Health, 12(2), 90-93.
Montgomery, P., &Knerr, W. (2018). Review of the evidence on sexuality education. Report to inform the update of the UNESCO International Technical Guidance on Sexuality Education. Ανακτήθηκε από http://unesdoc.unesco.org/images/0026/002646/264649e.pdf
Mousiolis, A., Baroutis, G., Papantoniou, N., Costalos, C., &Antsaklis, A. (2013). Maternal age demographic trends in Greece from 1980 to 2008. Journal of Reproductive Medicine, 58(5-6), 246-255.
Παπαθανασίου, Χ.,&Αγραφιώτης, Δ. (2003). AIDS και χώρος εργασίας: Στάσεις και αναπαραστάσεις εργοδοτών για τα άτομα με HIV λοίμωξη. Ελληνικά Αρχεία AIDS, 11(3), 149-160.
Παπαθανασίου, Χ., &Αποστολίδης, Θ. (2009). AIDS και κοινωνικές αναπαραστάσεις: Μια έρευνα ανάλυσης των δημοσιευμάτων του τύπου στην Ελλάδα. Στο Κ. Ν. Φελλάς (Επ.), Κοινωνία και υγεία. Ψυχοκοινωνικές και πολιτισμικές προσεγγίσεις στον κυπριακό και ελλαδικό χώρο (σελ. 197-226). Αθήνα: Κριτική.
Parker, R., Wellings, K., & Lazarus, J. V. (2009). Sexuality education in Europe: anoverview of current policies. Sex Education: Sexuality, Society and Learning, 9(3),227-242. doi:10.1080/14681810903059060
Part, K., Moreau, C., Donati, S., Gissler, M., Fronteira, I., Karro, H. (2013). Teenage pregnancies in the European Union in the context of legislation and youth sexual and reproductive health services. Acta Obstetrica et Gynecologica Scandinavica, 92(12),1395-406. doi:10.1111/aogs.12253
Peltekis, A. P., Paranou-Lioliou, P. A., Pappa, E. S., Kavouri, A. P., & Chatzimorakis, K. V. (2018, Ιούλιος). High school students’ knowledge and attitudes towards HIV/AIDS: Baseline measures and the effectiveness of a nationwide, school-based program for HIV prevention and stigma reduction in Greece. Αναρτημένη ανακοίνωση στο 22ο Παγκόσμιο Συνέδριο AIDS, Άμστερνταμ, Ολλανδία. Ανακτήθηκε από http://www.aids2018.org/Portals/4/File/AIDS2018_Abstract_book.pdf?ver=2018-08-06-160624-427
Pötsönen, R., &Kontula, O. (1999). Adolescents' knowledge and attitudes concerning HIV infection and HIV-infected persons: how a survey and focus group discussions are suited for researching adolescents' HIV/AIDS knowledge and attitudes. Health Education Research, 14(4), 473-484. doi:10.1093/her/14.4.473
Σύλλογος Οροθετικών Ελλάδας «ΘετικήΦωνή» (2017). The people living with HIV stigma index. Ελλάδα. Ανακτήθηκε από http://www.stigmaindex.org/greece
Sabin, C. A. (2013). Do people with HIV infection have a normal life expectancy in the era of combination antiretroviral therapy?BMC Medicine, 11, 251. doi:10.1186/1741-7015-11-251
Salakos, N., Bakalianou, K., Gregoriou, O., Iavazzo, C., Paltoglou, G., &Creatsas, G. (2008). Abortion rates and the role of family planning: a presentation of the Greek reality. Clinical and Experimental Obstetrics & Gynecology, 35(4), 279-283.
Salakos, N., Koumousidis, A., Bakalianou, K., Paltoglou, G., Kalampokas, T.,&Iavazzo, C. (2010). Unwanted pregnancy and induced abortion among young women 16-22 years old in Greece: a retrospective study of the risk factors. Clinical and Experimental Obstetrics & Gynecology, 37(4), 303-309.
Samkange-Zeeb, F. N., Spallek, L.&Zeeb, H. (2011). Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: a systematic review of published literature. BMC Public Health, 11, 727-739. doi:10.1186/1471-2458-11-727
Simon, L., &Daneback, K. (2013). Adolescents’ use of the internet for sex education:Athematic and critical review of the literature. International Journal of Sexual Health, 25(4), 305-319. doi:10.1080/19317611.2013.823899
Steensma, T. D., Kreukels, B. P., de Vries, A. L., & Cohen-Kettenis, P. T. (2013). Gender identity development in adolescence. Hormones and Behavior,64(2), 288-297. doi:10.1016/j.yhbeh.2013.02.020
Tountas, Υ., Dimitrakaki, C., Antoniou, A., Boulamatsis, D., &Creatsas, G. (2004). Attitudes and behavior towards contraception among Greek women during reproductive age: Acountry-wide survey. European Journal of Obstetrics & Gynecology and Reproductive Biology, 116(2), 190-195. doi:10.1016/j.ejogrb.2004.02.023
Tsitsika, A., Andrie, E., Deligeoroglou, E., Tzavara, C., Sakou, I., Greydanus, D., ... Bakoula, C. (2014). Experiencing sexuality in youth living in Greece: Contraceptive practices, risk taking, and psychosocial status. Journal of Pediatric and Adolescent Gynecology, 27(4), 232-239.doi:10.1016/j.jpag.2013.11.009
Tsitsika, A., Critselis, E., Kormas, G., Filippopoulou, A., Tounissidou, D., Freskou, A., ... Kafetzis, D. (2009). Internet use and misuse: a multivariate regression analysis of the predictive factors of internet use among Greek adolescents. European Journal of Pediatrics, 168(6), 655-665. doi:10.1007/s00431-008-0811-1
Tsitsika, A., Greydanus, D., Konstantoulaki, E., Bountziouka, V., Deligiannis, I., Dimitrakopoulou, V., ... Kafetzis, D. (2010). Adolescents dealing with sexuality issues: a cross-sectional study in Greece. Journal of Pediatric and Adolescent Gynecology, 23(5), 298-304. doi:10.1016/j.jpag.2010.03.001
Turnbull, T., Schaik, P., &Wersch, A. (2010). Adolescents’ preferences regarding sex education and relationship education. Health Education Journal, 69(3), 277-286. doi:10.1177/0017896910369412
United Nations Educational, Scientific and Cultural Organization (2018). International technical guidance on sexuality education. An evidence-informed approach. Ανακατήθηκεαπόhttp://www.unaids.org/sites/default/files/media_asset/ITGSE_en.pdf
United Nations Population Fund (2014). UNFPA operational guidance for comprehensive sexuality education: a focus on human rights and gender. Ανακτήθηκε απόhttps://www.unfpa.org/sites/default/files/pub-pdf/UNFPA%20Operational%20Guidance%20for%20CSE%20-Final%20WEB%20Version.pdf
Vaidakis, D., Moustaki, I., Zervas, I., Barbouni, A., Merakou, K., Chrysi, M., ... Panoskaltsis, T. (2016). Knowledge of Greek adolescents on human papilloma virus (HPV) and vaccination: Α national epidemiologic study. Medicine (Baltimore), 96(1), e5287.doi:10.1097/MD.0000000000005287
Vassilikou, K., &Ioannidi-Kapolou, E. (2014). Sex education and sex behaviour in Greek adolescents: a research review. Social Cohesion and Development, 9(2), 143-154.
Visser, M. J., Kershaw, T., Makin, J. D., Forsyth, B. W. (2008). Development of parallel scales to measure HIV-related stigma.AIDS and Behavior, 12(5), 759-771. doi:10.1007/s10461-008-9363-7
Vlachadis, N., Iliodromiti, Z., Vlachadi, M., Siristatidis, C., Deligeoroglou, E., &Vrachnis, N. (2013). Adolescent birth rates in Greece: features and recent unfavorable trends. Acta Obstetricia et Gynecologica Scandinavica, 93(1),121-122. doi:10.1111/aogs.12270
Whitfield, C., Jomeen, J., Hayter, M.,& Gardiner, E. (2013). Sexual health information seeking: a survey of adolescent practices.Journal of Clinical Nursing, 22, 3259-3569. doi:10.1111/jocn.12192
Widman, L., Choukas-Bradley, S., Noar, S. M., Nesi, J., & Garrett, K. (2016).Parent-adolescent sexual communication and adolescent safer sex behavior: ameta-analysis.JAMA Pediatrics, 170(1), 52-61. doi:10.1001/jamapediatrics.2015.2731
World Health Organization (1999). Improving health through schools: national and international strategies.Ανακτήθηκε απόhttp://www.who.int/school_youth_health/media/en/94.pdf?ua=1
Φρούντα, Μ. (2014). Καινοτομικά προγράμματα αγωγής υγείας στη μέση εκπαίδευση: καθηγητές και σεξουαλική διαπαιδαγώγηση εφήβων. Διδακτορική διατριβή. Τμήμα Φιλοσοφίας, Παιδαγωγικής και Ψυχολογίας, Πανεπιστήμιο Ιωαννίνων, Ιωάννινα.https://www.didaktorika.gr/eadd/handle/10442/36233