1. HIV/AIDS Knowledge and health- related behaviors: a hearing vs. deaf or a boy vs. girl issue? C. A. Bisol, T.M. Sperb, T.H. Brewer, S. K. Kato, G. Shor-Posner Universidade de Caxias do Sul - UCS Universidade Federal do Rio Grande do Sul – UFRGS BRAZIL University of Miami Miller School of Medicine – UM USA Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

2. Background Deaf adolescents face all the developmental tasks that characterize adolescence. At the same time they must deal with hearing impairment and its consequences in terms of communication, education, health access and work opportunities. Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

3. Literature regarding deaf youths usually reports insufficient knowledge and understanding of HIV/AIDS, and that they are at greater risk of HIV infection compared to hearing youths. Literature regarding deaf youths usually reports insufficient knowledge and understanding of HIV/AIDS, and that they are at greater risk of HIV infection compared to hearing youths. Background ( cont'd ) Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

4. Objective Describe HIV/AIDS knowledge and health-related attitudes and behaviors among deaf and hearing adolescents in the South of Brazil. Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

5. Methods Deaf and hearing students volunteered to answer a computer-assisted questionnaire (CASI) in the computer lab of the University of Caxias do Sul. The questionnaire was improved through focus groups discussions and adapted: – –simultaneous video translation of questions to Brazilian Sign Language (Libras). – –a branched decision-tree structure that considered students’ level of sexual experience and hearing status. Data were analyzed using SPSS 14.0 for Windows software package. Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

6. Interface of the Questionnaire Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

7. Participants

8. Results

9. HIV/AIDS Knowledge... Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

10. School education… School education… Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

11. Health-related attitudes and behaviors No relevant differences were found for: –number of sexual partners in the last 12 months; –condom use when have sex; –condom use last time they had sex. Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

13. However... We found a high rate of sexual abuse among the deaf youths (31%, p=<.001). Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

14. Boys were more sexually active than girls (boys= 62.5%, girls=38.5%, p=.035) Boys were more sexually active than girls (boys= 62.5%, girls=38.5%, p=.035) Girls discussed sexual issues more frequently with their mothers than boys ( Mann-Whitney U=664,00; p =.002) Girls discussed sexual issues more frequently with their mothers than boys ( Mann-Whitney U=664,00; p =.002) Girls visited gynecologists more than boys visited urologists Girls visited gynecologists more than boys visited urologists (boys=17.5%, girls 61.5%, p<.001) (boys=17.5%, girls 61.5%, p<.001) Boys vs. Girls Issues Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

15. Drugs... Alcohol consumption did not differ Alcohol consumption did not differ (boys= 75%, girls=59.6%, p =.182) (boys= 75%, girls=59.6%, p =.182) Boys smoked more than girls Boys smoked more than girls (boys=22.5%; girls=7.7%, p =.068) Boys used more drugs than girls Boys used more drugs than girls (boys=20%, girls=3.8%, p =.018) Fisher’s Exact Test Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

16. Sexual debut and partnership... No significant differences were found for either hearing vs. deaf or boys vs. girls, although No significant differences were found for either hearing vs. deaf or boys vs. girls, although hearing students reported being more sexually active than the deaf. Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

17. Conclusions Lower levels of HIV/AIDS knowledge and of school education and the high rates of reported sexual abuse among the deaf demonstrate the need to: Lower levels of HIV/AIDS knowledge and of school education and the high rates of reported sexual abuse among the deaf demonstrate the need to: –improve school based instruction; –tailor health education to deaf adolescents communication needs; –improve protection against sexual violence. Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

18. Conclusions ( cont'd ) The similarities found in terms of behavior when deaf adolescents were compared to hearing adolescents: – –question the common-sense views of deaf individuals as socially inadequate or sexually immature; – –question the excessive emphasis placed on knowledge for the promotion of behavior change. Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

19. Results obtained when boys and girls were compared indicate that, even within the deaf community youths are a heterogeneous group affected by several social determinants that must be considered when promoting health-related attitudes and behaviors for preventing HIV/AIDS. Conclusions ( cont'd ) Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.

20. Acknowledgements Study supported by: Fogarty AITRP Grant D43 TW 000017 (University of Miami, USA); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) - National Counsel of Technological and Scientific Development of Brazil. HIV/AIDS Research Lab – University of Caxias do Sul Bisol, C. WEAD02 – Beyond Barriers: Disabilities and AIDS. XVII International AIDS Conference. Mexico City, 3-8 August 2008.