Risk behaviors and predisposition for HIV infection among the secondary school students’ in Barbados – results from a national survey. Alok Kumar, Richard Carter, Carmita Douglin, Geeta Kumari, Carol Jacob Queen Elizabeth Hospital & School of Clinical Medicine and Research, Cave Hill Campus, University of West Indies, Ministry of Education and Youth Affairs, and National HIV/AIDS Commission, Government of Barbados.

Objectives To asses the risk taking behaviors among the secondary school children Findings would be useful in designing, implementing and evaluating preventive measures directed against this vulnerable population group.

Methods Data for this report is drawn from the behavioral surveillance survey of secondary school children in Barbados A cross sectional nation wide survey conducted in 2004 Conducted among 922 youths, aged 11 to 18 years, attending secondary schools

Methods The survey was based on a multi-stage systematic random sample of all secondary schools in Barbados. The survey instrument was a self- administered questionnaire comprised predominantly of closed-ended questions.

Methods Questions addressed family and socio- demographic characteristics, sexual history and risk taking behaviors and the respondents risk perception with respect to HIV infection. Questionnaire included definitions of vaginal sex, oral sex and anal sex.

Results (n=922) Majority of respondents were blacks (80.7%) & born in Barbados (86.9%) Males constituted 52.6 % and females 47.3% of respondents Mother was present in 86.1% of the households and father was present in only 40.9%

Sexual activity – second. school child. Over all 24.8% (195/787) had some form of sexual intercourse Among the 414 female respondents 105 (25.4%) had some form of sexual intercourse and Among the 373 male respondents 90(24.1%) had some form of sexual intercourse.

HIV risk burden of the surveyed secondary school children. Risk burden N(%) Vaginal Sex in last 4 months (n=107) None12(11.3) 117(15.8) >2>239(36.4) Not Sure38(35.5) Number of Sex Partners in last 4 months (n=107) None7(6.4) 166(61.6) > 227(25.2) Not Sure9(8.4)

ResponseFrequencyPercentage Yes No No Answer587.4 Total Have you ever drunk alcohol ResponseFrequencyPercentage Not Applicable Everyday131.7 Two or three times a week Two or three times a month Rarely No answer Total Frequency of Alcohol Consumption

ResponseFrequencyPercentage Yes No No Answer Total Have you taken drugs

Sexual relations and condom use - secondary school children. Nos. (%) Condom Use during last Sexual Encounter(n=195) Yes101(51.8) No78(39.9) No Answer16(8.2) Reason for No Condom Use during last Sexual Encounter(n=78) Condoms are uncomfortable18(23.1) Embarrassing to use condoms2(2.6) Unable to get condoms16(20.5) Had sex with partner who was not a sex worker6(7.7) Had sex with my regular partner18(23.1) Partner did not want to3(3.8) Other4(5.1)

HIV Risk perception – secondary school children. What do you think is the risk of most of your friends for catching HIV? Over all n=787(%) No Risk 108(13.7) Low 212(26.9) Medium 124(15.8) High 143(18.2) No Answer 200(25.4) What do you think is the risk of most of your friends for catching HIV? Not Sexually active n=592(%) No Risk 43(7.3) Low 144(24.3) Medium 135(22.8) High 121(20.4) No Answer 149(25.2) What do you think is the risk of most of your friends for catching HIV? Sexually active n=195(%) No Risk10(5.1) Low65(33.3) Medium61(31.3) High13(6.7) No Answer46(23.6.9)

What do you think is your risk of catching HIV infection? Sexually Active n=195(%) No Risk19(9.7) Low67(34.4) Medium62(31.8) High14(7.2) No Answer33(16.9) What do you think is your risk of catching HIV infection? Sexually Not active n=592(%) No Risk299(50.5) Low177(29.9) Medium79(13.3) High8(1.4) No Answer29(4.9)

Summary findings It is clear that the historical pattern of early initiation to sexual intercourse, multiple partners and inconsistent condom use continue to be manifested in this survey when the findings of this study was compared to that from the survey conducted in 1992.

Summary findings Over one-eighths of respondents consume alcohol on more or less regular basis and a little less than one-eighths have experienced drugs.

Summary findings Perhaps one of the most significant findings from the survey derives from the last slide where 9.7% respondents asserted that they were at no risk of HIV infection and another 34.4% assessed their risk as low despite being sexually active.

Conclusions These findings constitute high risk for predisposition to STI and HIV infection in this population. When counterpoised with limited negotiation skills and power in sexual encounters, the implications of this finding for action by all concerned become necessary.

Acknoledgements This report is based on the data gathered during the Behavioral Surveillance Survey of Secondary School Children in Barbados This survey was supported by a grant form the Ministry of Education and Youth Affairs, Govt. of Barbados. The survey itself was facilitated by the Ministry of Education and Youth Affairs and National HIV/AIDS Commission, Govt. of Barbados.

Thank you

Box 5 –Respondents’ Attitudes to Condom Use Statement Yes/Probably Yes MaleFemale Condoms/rubbers only for men having sex with female prostitutes Would feel less sexual pleasure if you used a condom Would it be more difficult for male to ejaculate with a condom Would male friends think badly of you if you carried condoms in pocket/wallet22.0 Think a girl is willing to have sex with someone she just met if she has condoms with her Would steady partner think you had sex with someone else if you insisted on condom use Would partner get angry if you insisted on condom use Would partner refuse to have sex with you if you insisted on condom use Respondents’ Attitudes to Condom Use

The following are terms for different kinds of sexual intercourse.. Vaginal intercourse means that your partner puts his penis in your vagina or you put your penis in your partner’s vagina.. Oral sex means that your partner puts his/her mouth on your genitals or you put your mouth on your partner’s.. Anal sex means that your partner puts his penis inside your anus or you put your penis inside your partner’s anus. From this point forward, if sexual intercourse is mentioned it refers to any of the three (3) sexual practices described above.