CHAPTER I

INTRODUCTION By Richelle Greganda and Vher Sison

Background of the Study

The health concern that has gripped the world in recent years is the spread of the

human immunodeficiency virus (HIV), the main cause of AIDS. In 2014, the UNAIDS

estimated that AIDS had claimed about one million lives and an increasing number of

people continue to contract the disease. An estimated two million people were infected

with HIV in 2014, bringing the total infected population at 42 million (as cited in WHO

Global Summary of HIV/AIDS, 2014).

In the Philippines, the first AIDS case was diagnosed in 1984, although it was only

in 1986 that AIDS was declared a notifiable disease. The number of HIV cases continues

its upward trend, with the latest figure from the Department of Health AIDS Registry

showing an accumulated 28,428 HIV Ab seropositive cases since 1984. Of this number,

2413 had developed to full blown AIDS. Overall, official death toll for AIDS related cases

had already reach 1309 (Department of Health, 2015).

The face of growing threats of HIV/AIDS infection is particularly among young

people. Worldwide, they are considered one of the more vulnerable segments of the

population insofar as HIV/AIDS infection is concerned. The population within the age

range 15-24 continues to comprise the major bulk of HIV infections. Based on estimates

by the UNAIDS, more than half of new infections belong to this age group (UN, 2014).

The vulnerability of young people to sexually transmitted infection is associated with their

growing involvement in risk behaviors such as early and unprotected sex, having multiple

partners, drug use and alcohol abuse. Recent statistics on adolescent sexuality in the
Philippines point to an increasing number of young people engaged in premarital sexual

intercourse and other risky sexual practices (Kisses Jabson, DZRH, 2014)

(Natividad, DRDF, 2013) Based on the recent adolescent survey, premarital sex (PMS)

prevalence among young adult aged 15-24 rose from 6.3 per cent in 2002 to 13.6 per

cent in 2013. Majority of the sexual experiences are spontaneous in nature, and in most

instances, unprotected. There is also liberalizing views on sex among the young. In 2013,

35 percent of Filipino youth approved of men having PMS while 29 percent approved of

the same behavior for women. Approval of PMS for women almost doubled in 2013 from

the 13 per cent approval posted in 2002 (Young Adult Fertility and Sexuality Study, 2013).

However, as more people are engaging in sex at earlier ages, they do so bereft of

sufficient information on reproductive health, notably, the consequences of early sex

(Ohio State University, 2011).

Theoretical Framework By Richelle Greganda and Vher Sison

The study is supported by theory of Pender which is Health Promotion Model. This

theory defines health as a positive dynamic state rather than simply the absence of

disease. Health promotion is directed at increasing a patient's level of well-being including

knowledge. The health promotion model describes the multidimensional nature of

persons as they interact within their environment to pursue health.

Pender's model focuses on three areas: individual characteristics and

experiences, behavior-specific cognitions and affect, and behavioral outcomes. The

theory notes that each person has unique personal characteristics and experiences that

affect subsequent actions. The set of variables for behavior specific knowledge and affect

have important motivational significance. The variables can be modified through nursing
actions. Health promoting behavior is the desired behavioral outcome, which makes it the

end point in the Health Promotion Model. These behaviors should result in improved

health, enhanced functional ability and better quality of life at all stages of development.

The final behavioral demand is also influenced by the immediate competing demand and

preferences, which can derail intended actions for promoting health.

The Health Belief Model is a framework for motivating people to take positive

health actions that uses the desire to avoid a negative health consequence as the prime

motivation. Having knowledge per se on negative consequences of HIV the desire to

avoid HIV can be used to motivate adolescent into practicing safe sex or abstaining from

it at all.

This research looks at the knowledge of Filipino adolescents on HIV/AIDS and

how this relates on their decision to engage in premarital sex and adopt safe sex

practices and preventive practices on HIV/AIDS. This paper takes the premise that

correct information on reproductive health empowers one in decision making. Thus,

given sufficient information on HIV/AIDS, young people will be more cautious of their

sexual practices, particularly the use of condom during premarital sexual episodes. In

the AIDS Risk Reduction Model developed by Catania, et. al., (as cited UCLA 2015), an

adequate knowledge of AIDS was identified as necessary in recognizing ones behavior

as high risk, which in turn, could lead to action towards modification of behavior (Brusk,

2013). The exploration of HIV/AIDS knowledge and its possible link to sexual practices

provides important windows from which to frame adolescent sexual behaviors and the

risk of infection among young people in the country. This provides important bases for

program and policy interventions that will address adolescent reproductive health.
 Conceptual Paradigm By Richelle Greganda and Vher Sison

Knowledge
Preventive Practices
-Nature and Mode of Transmission
of HIV -Abstaining from Sex

-Consequences of having HIV -Safe Sex (Contraceptive)

-Sexual Awareness -HIV Testing for High risk individuals

-Contraceptive Awareness

Decreased HIV Infection among

Adolescents

Figure1. Conceptual Paradigm Showing the Effect of Increase HIV Knowledge

leads to Increase Preventive Practices that results to Lower HIV infection among

adolescents

Conceptual Framework By Richelle Greganda and Vher Sison

The study determined the effect of increase HIV awareness and the increase

preventive practices associated with it among adolescents.

The first box in the illustration showed the awareness or knowledge about HIV on

Level I to IV college students. This knowledge denotes knowing the nature and mode of

transmission, consequences of having HIV, and having sexual and contraceptives

awareness and that an increase of this will lead to preventive practices.

 The second box represented the preventive practices associated with HIV such as

abstaining form Sex, being faithful to an uninfected partner, having safe sex

(contraceptives) and HIV testing for high risk individuals. The arrow represents represent

the relationship between the variables.

The outcome that the researchers hoped to achieved is that when knowledge is

increased mutually preventive practices is also increased thus lowering the HIV infection

among adolescents.

Statement of the Problem By Zyra Bruzo and Vher Sison

This study will determine the relationship between knowledge and preventive

practices about HIV among adolescents.

The study will answer the following questions:

1. What is the level of knowledge of adolescents in terms of:

1.1 Nature and Mode of Transmission of Infection,

1.2 Consequences of having Infection,

1.3 Sexual Awareness, and

1.4 Contraceptive Awareness?

2. What is the level of preventive practices among adolescents in terms of:

1.1 Sex Abstinence,

1.2 Use of Contraceptives

1.3 Health Practices of HIV

1.4 HIV Teaching

1.5 Health Values & Beliefs

 3. Is there a significant relationship between the levels of knowledge and level of

preventive practices of HIV among adolescents?

Hypothesis By Zyra Bruzo

The hypothesis will be tested at 0.05 level of significance.

There is no significant relationship between level of knowledge and level of preventive

practices among adolescents

Significance of the Study By Zyra Bruzo

The result of the study benefits the following persons:

Adolescents. The findings of the study will give awareness as well as further information

about HIV, alarm them about its increasing cases, how would it be prevented and their

knowledge in all aspects. These adolescents will be enlightened about the hot issue as

of today.

Parents. The results of the study will urge them to counsel their children on HIV. This will

show them how important they are as the first educator of their children about this

sensitive topic. The study will provide them the information that they need to be able to

satisfy their childrens curiosity about HIV

Members of the Health Care System. The outcome will be a basis in planning a

comprehensive health education about HIV to adolescents at school and at the

community.
School And Community . They will be more knowledgeable and will be aware on how

they can prevent the disease specified in this study.

Further Researchers. They can widen their consciousness and concern regarding this

sensitive topic. They will be helped in case they intend to dig deeper or replicate this

study. This study can serve as their review of literature and help them improve and satisfy

their research.

Scope and Limitation

This study established the idea of acknowledging the outraging cases of HIV

nowadays at preventing it as possible as every individual can. The respondents of this

study were 100 adolescent students (50 males and 50 females), of Calamba Doctors

College enrolled in academic year of 2016-2017.

This study includes all college students and Senior High School students since the

questionnaire were more relevant for their age group.

Definition of terms By Christian Sison

The following terms used in the study are operationally defined as follows: Commented [ER1]: ITO LANG ANG MGA TERMS NA IDEDEFINE
NYO AT DEFINE IT ACCORDING TO HOW YOU USE IT OR MEASURE
IT. MAY QUESTIONNAIRE NA BA KYO?

Knowledge refers to the awareness of adolescent in terms Commented [ER2]: HOW WILL YOU MEASURE THIS
AWARENESS?
IN TERMS OF: FOLLOWED BY THE SUBVARIABLES USED IN THE
Consequences of Having HIV STUDY

Contraceptive Awareness be knowledgeable about conception, its methods,

the uses, and proper application of it.

Sexual Awareness being aware of ones own sexual identity

Preventive Practices methods to avoid the occurrence of the disease like.

HIV testing - is an antibody screening test (immunoassay), which tests for

the antibodies that your body makes against HIV. The immunoassay may be

conducted in a lab or as a rapid test at the testing site. It may be performed

on blood or oral fluid (not saliva).

Safe sex or use of contraceptives use various devices, drugs, agents,

sexual practices, or surgical procedures to prevent hiv infection or passing of

the infection to the fetus under its development

Low immune system when immune system is low, HIV will take advantage

of the current state of the body where in all of the defences are low, then

there occurs other opportunistic diseases such as tuberculosis, pneumonia,

liver failure, Cryptococcal meningitis, etc.

Sexual intercourse - sexual contact between individuals involving

penetration, especially the insertion of a man's erect penis into a woman's

vagina, typically culminating in orgasm and the ejaculation of semen.

Transmission - the action or process of transmitting something or the state

of being passes or transmitted.

Pregnancy - The state of carrying a developing embryo or fetus within the

female body.
 Chapter II

Review of Related Literature

Variables Associated with HIV/AIDS

Behavior Quantitative and qualitative studies over the past decade and a half

have contributed to our understanding of factors that influence HIV/AIDS

related behaviour and its importance, for the purpose of this study, to briefly

review here some of the variables for which strong and persistent links have

been found. The results of these studies clearly highlight how behavior is an

outcome of a complex interaction of a variety of factors including knowledge,

perceived threat, perceived self-efficacy, proximity to people who have been

affected by HIV/AIDS, among other factors. A first important aspect is the

strong and consistent link that has been found in a number of studies

between the level of knowledge of HIV/AIDS and sexual activity (Magnani,

2012). People with a higher level of knowledge appear to be more likely to

abstain from high-risk sexual activity and to consistently use a condom

(Magnani, 2012). A second important dimension appears to be the link

between level of sexual activity and school attendance as well as knowledge

of HIV. Those who attended school to a later age are more likely to initiate

sex later and to use a condom than those who dropped out (Mangnani, 2012).

A further important aspect of the pandemic is the potential implications of the

silence that surrounds the disease. Various studies have pointed out the

important relationship between talking about H1V/AIDS and strategies for

coping and addressing the consequences of the virus. In a study of the

effectiveness of peer education and sexuality in Germany, Appel and Kleiber

(2014) found that communication skills were an important intervening variable

in adolescents' capacity to manage personal relations. Communication also

extends to people with HIV/AIDS. Disclosure of HIV status is a further aspect

of communication which may also have a very important influence on the

quality of life in the context of HIV infection (Butler, Williams, Howland &

Storm 2009). Related to communication is the aspect of emotional expression

and depth of processing which appears to have a distinct relationship with

overall well-being of people with HIV/AIDS and is also related to their long

term survival (Penn, Watermeyer, Evans 2013). There is some support also

for a relationship between fatalism and HIV/AIDS attitude and knowledge

variables and subsequent behavior. This link has not been very consistently

studied, and should be seen as an open area for further research, but the

limited studies done in this field do indicate that that fatalism can be strongly

associated with negative attitudes towards the disease and with negative

perceptions of other groups such as people living with HIV/AIDS (Yi, Sandfort,

Shidlo, 2010). Mass media exposure has also been linked to behavioral intent

and behavior. (Wakefield, Loken, Hornik, 2010), in their study of condom use

among adults in Philadelphia, found that by mass media exposure such as

television, radio and newspapers were significantly more likely to report

behavior change than those who did not listen.

Adolescence
Adolescence is a stage of development transition. It bridges between

childhood and adulthood and is considered generally to being at about 12 to

13 and to end in the late teens or early twenties. The period of adolescence is

characterized by the physical, intellectual, temperamental and emotional

changes in their attitudes and behavior. The World Health Organization

defined adolescence as progression from appearance of secondary sex

characteristics (Puberty) to sexual and reproductive maturity, development of

adult mental process and adult identity and transition from total socio-

economic dependence to relative independence.

Knowledge of HIV/AIDS

The 2009 Philippines National Demographic and Health Survey showed that

general awareness of HIV/AIDS among men and women is almost universal

in the country (NSO, 2009). HIV is mainly transmitted through sexual contacts

between an infected and a non- infected person. Consequently, the HIV

prevention programme has mainly sought to reduce further sexual

transmission through three important programmatic ways, namely promotion

of abstinence, mutually faithful monogamy among uninfected couples and

condom use by those that cannot abstain. These are important ways to avoid

the spread of HIV/AIDS.

HIV/AIDS -related knowledge among youth

Knowledge of how HIV is transmitted is one of several factors that enable

youth to protect themselves from the virus. Correct knowledge can also

reduce stigma and discrimination against people living with HIV/AIDS. Youth
with comprehensive knowledge are those who agree with prompted questions

that individuals can reduce their chances of contracting HIV by having sex

with only one faithful, uninfected partner and by using condoms, those who

know that a healthy-looking person can have the AIDS virus, and those who

know that HIV cannot be transmitted by mosquito bites or sharing food with a

person who has HIV. HIV/AIDS knowledge among young people globally

constitutes a major challenge to the control of this scourge. Most people

become sexually active in adolescence. The need to admit that young people

are having sex but lack the proper knowledge to protect themselves is

important in the fight against HIV/AIDS. Young people are now the epicenter

and bear a disproportionate burden of this pandemic

(WHO/UNICEF/UNAIDS, 2012). In 2013, national surveys found that 40% of

young men and 36% of women had accurate HIV knowledge. Both in

Philippines and globally, women had lower levels of HIV knowledge. Most

youth were aware that being in monogamous relationship with a person of the

same sero status is an effective prevention strategy (YAFS Survey, 2013).

Research has shown that women and men who have never married, but who

have been sexually active, are most likely to know about the major means of

avoiding HIV. Education is strongly correlated with knowledge about AIDS

prevention (UNESCO, 2014).

Myths and misconceptions

In addition to knowing about effective ways to avoid contracting HIV/AIDS, it

is also useful to be able to identify incorrect beliefs about AIDS to eliminate

misconceptions. Common misconceptions about AIDS include the idea that

all HIV-infected people appear ill and the belief that the virus can be

transmitted through mosquito or other insect bites, by sharing food with

someone who is infected, or by witchcraft or other supernatural means. In

Philippines, surveys continue to indicate that young people between 15-24

years harbor serious misconceptions about HIV and how it is transmitted

(Rehal, 2012). Even though it is now common knowledge that the HIV agent

cannot be transmitted through mosquito bites, many people still believe that

mosquitoes are a good vehicle for HIV transmission. In Philippines where

mosquitoes are endemic, this misconception is significant because it implies a

pessimistic attitude that regardless of what one does, one is subject to HIV

infection as a resident of a mosquito infested region. It also poses a

compliance challenge for any educational intervention effort targeted at this

group (Regan, Morisky, 2012)

Knowledge of condom sources among youth

Condom use among young people plays an important role in the prevention

of transmission of HIV and other sexually transmitted infections, as well as

unwanted pregnancies. Knowing a place to get condoms helps youth to

obtain and use condoms. Furthermore, knowing where condoms can be got

puts youth in a better position to make informed decisions on issues

pertaining their sexuality.

Practices: HIV/AIDS-related behaviour

Youth in general indulge in sexual relations for various reasons. The basic

reason is self-gratification and enjoyment (Ellis, 2013). A survey done in

Atlanta, USA showed that the reasons for sexual activity among youth were;

forced by partner; peer pressure; carried away by passion; to prove normality;

to prove love for boyfriend; tantalizing movies and films; seeking physical

pleasure and desire to be a mother (Eaton et al. 2011). Sexual behavior

indicators among youth; abstinence, being faithful, and condom use among

youth. The acronym ABC represents a prominent message to youth on

behaviors to follow to prevent HIV infection: abstinence, be faithful, use

condoms. The approach used in Philippines has been named the ABC

approach - firstly, encouraging sexual abstinence until marriage; secondly,

advising those who are sexually active to be faithful to a single partner or to

reduce their number of partners; and finally, especially if you have more than

one sexual partner, always use a condom. A number of factors helped to

encourage people to take up these strategies (DOH, 2014).

Prevalence of HIV among Youth

Generally, cases of HIV infection among youth aged 15-24 represent more

recent infections and serve as an important indicator for detecting trends in

both prevalence and incidence. An attempt was made to estimate incidence

by subjecting all HIV-positive samples to the BED-assay. However, recent

evidence suggests that this test overestimates incidence (UNAIDS, 2005).

Research Design
Counseling and Testing

Although young people believe that knowing ones HIV status is important, a

majority of them have not tested for HIV. A study found that although 90% of

respondents believe that men and women who intend to have sex, pregnant

women, and engaged couples should test for HIV, only 21% of respondents

aged 15 19 and 43% of respondents aged 20 24 had tested for HIV

(BBC, 2009).

Qualitative data supports the disparity between knowledge and behavior.

Almost all participants in a qualitative study considered VCT as an important

way of preventing the spread of HIV. However the majority of males aged 20-

24 said they wouldnt test for HIV unless it was mandatory because of stigma

and discrimination, fear of descending into despair and hopelessness,

worrying about eventual death, etc. (Ali, 2010) Other reasons for young

people not wanting to test for HIV include not being sick, not wanting to think

about self-exposure to HIV and not wanting to know ones status (BBC,

2009).

Stigma and Discrimination

Many young people still hold discriminating attitudes against people living

with HIV or AIDS. At the national level, the BBC found that 52.5% of In-

School-Youth and 58.4% of Out-Of-School-Youth had at least one

stigmatizing attitude towards people living with HIV or AIDS. The highest
level of stigma was found among In-School-Youth (31%) and Out-Of-School-

Youth (41.5%) when asked if they would willingly purchase food sold by an

HIV infected shopkeeper/food seller (BBC, 2010).

However, stigma and discrimination is relatively lower in urban centers than

in rural areas.

Participants in a rural site in Philippines stated that if a family member had

HIV or AIDS, they would be kept separate from the family and their status

would be kept hidden from the community (Ali, 20011).

Sexual Health Knowledge

Young people in Philippines are more often exposed to negative aspects of

their own sexual health and sexuality. Perceptions held by youth about

sexual health are incomplete and tend to be associated with negative

aspects of sexual health, i.e. HIV/AIDS, STIs, female circumcision, risks of

premarital and marital sex, unwanted pregnancy, sexual harassment, health

complications caused by rape, precautions people take before having sex,

etc (Ali, 2009).

In DOHs conducted in 2008, young men and girls aged 15-19 who practiced

abstinence associated various feelings, beliefs and actions with the act of

sex. For example, respondents reported that sex was a means to express

love, happiness, excitement, and a means to satisfaction and relief from

sexual feelings. Respondents also felt that sex occurs as a natural

phenomenon; can occur during a loss of self control; can be done at the right
or wrong time; can happen with or without partner consent and can expose a

person to disease and unwanted pregnancy. Young girls also assigned value

to sex when practiced among married couples and assigned danger to sex

when practiced accidentally and without planning (DOH, 2009).

In the same study, randomly picked older young people aged 18 -21 held

similar to attitudes to their younger counterparts. They also touched on the

importance of sex for procreation (men) and the need to be physically fit for

sexual activity (women). Young men also alluded to sex being an activity

possible between same sexes and between men and animals (DOH, 2009).

Youth in the study regions (and particularly those in urban settings) seemed

to have a lot of knowledge about sex and sexual development processes.

The source of information is from school, media and reading material on

romance and love. Rural youth seemed less informed. Nevertheless, youth

expressed that they want more information about sexual development

(biological/behavioral) (Ali, 2009).

Awareness among young people about STIs and their symptoms is low. A

study analyzing DOH data also found that young women were more aware

than young men of both womens and mens symptoms, but young men knew

more about mens symptoms (Maria, 2010).

Risk Perception

In Philippines, young people are seen by others as the population group at

highest risk for HIV due to their multiple developmental stages and
experimentation with new and risky activities such as early sexual initiation

and drug abuse. However, many young people consider themselves to not

be at risk for HIV because they reported that they didnt engage in risky

behavior or took the necessary precautions (BSS, 2012). Nevertheless, the

association of risk with different types of risky behaviors among young people

and the consistency at which they utilize the necessary precautions is

debatable.

For example, many young people do not view certain risky sexual practices

as risky. A BBC study found that significantly less respondents believed that

sex at an early age (below 18) and anal sex were highly risky to ones health.

The proportions of males, youth aged 20 -24, rural respondents and married

respondents who believed these sexual practices were highly risky were

lower than their counterparts (females, 15 19, urban, and single

respondents) (BBC, 2008).

Yong people are aware of the risks associated with having sex. A quantitative

baseline study found that between 80 and 90% of respondents believed that

certain sexual practices were highly risky to ones health. These practices

were sex with someone with an STI, casual sex, sex without knowing

partners status, sex after alcohol and drug use, sex without a condom,

continuing sex after a condom breaks, or having multiple sexual partners

(BBC, 2008).

The majority of youth in both urban and rural settings understood the

importance of safe sex and linked safe sex with avoiding sex without a
condom, avoiding casual sex and being faithful to one HIV negative partner.

Nevertheless, youth also mentioned a disconnect between knowledge and

practice (Ali, 2009).

A recent study also found that high school students have low HIV risk

perception in the short term. Twenty-nine point one percent of high school

students reported that their chances of catching the virus were low and

28.2% felt that there was no chance of infection. However, 81.9% of sexually

active respondents reported that there was a chance of being infected if they

continued with their current and 87.1% reported that there was a very high

likelihood of contracting HIV in their lifetime (G/Mariam, 2012).

Sexual debut

The mean age of sexual debut in Philippines for men is 21.1 and for women

is 16.4 (DOH, 2011). In a study conducted among government and non

government high schools, 70% of sexually active respondents began having

sex between the ages of 15 19 and 28.6% started having sex before the

age of 15. The average age of sexual debut among respondents was 15.3

years (G/Mariam, 2012).

Social attitudes about the suitable age for sexual debut are different than the

actual age. Findings from a qualitative study revealed that although young

people believed that the right age for engaging in sexual relationships was 18

20 for both sexes, actual practice deviated from these beliefs. For example,

the majority reported that young people begin to have sex at 14. In other
regions, participants reported the norm being 15 and 16 for girls and boys

respectively (Ali, 2009).

Young people gave the following reasons for early sexual debut: exposure to

porn films, peer pressure, the degree of family control, financial constraints

(especially for girls), alcohol consumption, early marriage (rural areas).

Among upper class, youth also rent big houses to hold day parties where

they smoke, drink, watch porn films and participate in sexual initiation

activities. (Ali, 2009)

The majority of young people suggested the right age for marriage for women

should be 18 22 and for men it should be 25 and above. The latter age was

seen as desirable because this is the age where a young person would have

finished University and have become economically independent (Ali, 2009).

Sexual behavior

Many recent studies have shown that young people have become more

knowledgeable about ABC as methods of HIV prevention; however, safe

sexual behavior has not necessarily increased comparatively. Results from

the 2008 BBC shows that ISY and OSY participants claimed that among their

age group, inconsistent practice of all three prevention methods was the

norm (BBC, 2008).

Furthermore, a nationally representative study using data from the 2009 DOH

concluded that sexually active young people in Philippines exhibit highly risky

sexual behavior evidenced by the proportions of multiple sexual partners, low

condom use, and low contraceptive use. For example, the study highlighted

that 65.8% of young males and 24.6% of young females who ever had sexual

intercourse had two or more sexual partners in the last 12 months (Maria,

2012).

Nevertheless, virginity for boys and girls is perceived to be of benefit both in

rural and in urban areas. In a cross sectional survey of 3,743 young people, a

large percentage of rural and urban males and their female counterparts

viewed the benefits of virginity to be a pre-condition for marriage and

protection from HIV/STIs (for partners) (Berhane, et. al, 2009).

Regardless of the perceived benefits of virginity, young people between the

ages of 20 24 are five times as likely to be sexually active than those aged

15 19. A quantitative study conducted in Cavite, Laguna, Batangas, Rizal

and Quezon regions found that 64% of respondents between the ages of 20-

24 were sexually active versus the 14% of 15 19 year olds who reported

they were sexually active (BBC, 2009).

In a quantitative study of 758 high school students (most of whom were aged

15 - 19), 31% stated they were sexually active. Ninety percent of these

respondents were aged 15 19 of which 58.6% were male and 32.2% were

female (G/Mariam, 2012). This data is interesting considering that results

from the 2009 BBC show that 9% of ISY stated they were sexually active.

Results from a qualitative study showed that high school students perceive

that most of their peers are in relationships and/or having sex. Reasons for
having sex included: peer pressure, hopelessness, inability to control sexual

drive, sex for money (particularly females), and rape (G/Mariam, 2012).

Types of sexual intercourse practiced among young people are varied.

Vaginal sex is still the most commonly practiced type of sex by young people.

Sixty-two point five percent of sexually active respondents from the G/Mariam

study practiced vaginal sex, followed by 19.1% for oral sex, and 11.6% for

anal sex. More anal sex is practiced between male and female high school

students, Males reported higher practice of anal and oral sex than females

followed by men having anal sex with either gender and then male-to-male

anal sex.

Interestingly, the same study found that condoms are used only for vaginal

sex; and of those had vaginal sex, only 19.7% reported condom use

(G/Mariam, 2012).

The study also showed that about two-thirds of high school students agree

that oral sex is a common practice among their peers and 25% of them see

anal sex as a common practice.

In a comparison of government high schools to non-government schools, the

amount of individuals reporting practicing vaginal sex was practically equal.

However, anal and oral sex was more prevalent in government schools.

(G/Mariam, 2012)

Misconceptions about sexual modes of transmission prevail among young

people. High school students engaged in anal and oral sex because of the
following reasons: to keep their virginity, avoid unwanted pregnancy, prevent

HIV transmission, to experience extra satisfaction/pleasure, and as foreplay

before vaginal sex. (G/Mariam, 2012)

Young people use a number of slang words to refer to anal, oral or group

sex, and masturbation. For example oral sex was referred to as jobo

(meaning to get down to my private part for sucking or licking), threesome,

foursome referring to group sex; and tikol, to refer to masturbation

(G/Mariam, 2012).

Multiple sexual partners

Sexually active young people (those who engage in any type of sex anal,

oral or vaginal) in Philippines often have had more than one sexual partner.

This trend is more statistically visible among young men then young women.

The trend is also more apparent in Manila and certain regions where having

multiple partners is socially condoned for some groups. For example, 25% of

sexually active ISY in Manila reported having more than one partner in the 12

months preceding the 2009 BBC. Similarly, among sexually active ISY

respondents from all regions, 22.7% had had more than one partner in the

last 12 months and males were 12 times more likely to have had more than

one sexual partner than females.

More recent data from a qualitative study of government and non-

government high schools estimates a higher proportion of sexually active

young people. The study found that 63.9% of sexually active high school

students reported having sex with regular partners, 6% reported having sex

with strangers and 2.8% with CSWs (G/Mariam, 2012). Risk perception

among high school students is somewhat low; 48.2% of ISY who had had

more than one sexual partner in the past year or who had risky sex felt that

they were at no or low risk of HIV infection. Eighty-five percent of OSY felt

that they were at no or low risk of HIV infection because of low exposure to

sexual activity, no exposure to needle use and trust in partner (BBC, 2009).

Sexually active young people also seem to have different partners for

different sexual activities. Fifty percent of sexually active students from the

G/Mariam study who reported they had 2+ partners in their lifetime reported

that they had 2+ partners for vaginal sex, 64.2% had 2+ partners for oral sex

and 53.1% had 2+ partners for anal sex.

The study also found that government school students have more vaginal

sex partners than non-government school students, however the latter had

more anal and oral sex partners (G/Mariam, 2012).

Generally, young people agree that their many of their peers are in multiple

sexual partnerships. Young people stated that is common for youth (boys

and girls) to have an average of three partners one for school, one located

on the road from school to home and one who resides in their community

(G/Mariam, 2012).
Many young people also assert that having multiple partners is considered

adventurous among many male youth. Young men in the 20 24 age group

in Manila also felt that it was becoming more common for young girls to have

2 sexual partners - one for love (younger/boyfriend) and the other for money

(much older /sugar daddy) (Ali, 2009).

Younger youth are having more significantly more sexual partners than older

youth. In 2009, a quantitative study showed that respondents aged 15 19

had had 2.2 partners over the preceding 12 months versus the 1.2 partners

had by 20-24 year olds (BBC 2009).

Masturbation

As in other societies around the world, discussing and practicing

masturbation is a taboo subject in Philippines culture. However, similar to

other trends around the world, many young men and women do masturbate.

Among students surveyed in the G/Mariam study, the average age for first

masturbation was 13.9 years. Additionally, the study found that:

Among sexually active and non-sexually active high school students, 32.8%

had masturbated at least once in their lives; more males (23.4%) than

females (8.8%).

More sexually active students (59%) were found to have masturbated than

non-sexually active respondents (42.2%).

52.4% of respondents said they masturbated more than twice a week and

50.4% reported once a week.

Many high school students participating in FGDs believed that masturbation

was practiced mostly by boys but others argued that it was common among

females as well. Others reported that two close friends would practice group

masturbation while they were fully clothed (G/Mariam, 2012).

These students also maintained that their peers masturbate for the following

reasons: because there is a taboo of females asking males for sex; lack of

self confidence to ask ones partner for sex; it is seen as a performance test

for vaginal sex; and it is a way to control sexual urges (G/Mariam, 2012).

Marriage

A quantitative survey conducted in 2009 found that the average age of first

marriage for youth was 16 years. Overall, 43% of respondents were first

married at 16 to 18 years of age, 25% were first married between 13 and 15

and 10% before 12 years of age and 21% after 19 years. Both males and

females from the rural areas were more likely than urban respondents to get

married before 18 years of age (BBC, 2007).

Pregnancy and Contraception

Among young people, misconceptions about how and when pregnancy

occurs are high, both in both urban and rural areas. Approximately 40% of

respondents from the above study reported that they do not know if or do not

believe that pregnancy can occur at first sex intercourse encounter. This

percentage increases among the 15 19 age group (BBC, 2009).

Findings from the same study showed that 95% of respondents have heard

of a family planning method; birth control pills, injectibles and condoms were

mentioned in that order by all these respondents. However, a lesser

proportion of younger people and rural respondents reported ever or current

use of contraceptive methods (BBC, 2009).

On average, the majority of participants could mention five types of

contraceptive methods, however 15 18 year olds did not have

comprehensive knowledge of the methods, how to use them or where to

access them (Ali, 2009).

The majority of female discussants in regional sites noted that a married

woman cant decide for herself what contraceptives to use. If she does so

and her husband finds out, he feel disrespected, he may suspect her of

having extra marital affairs and conflict would ensue (Ali, 2009).

Sexual equality

A qualitative study highlights the dichotomy associated with gender equality

with respect to sexual rights and consent. Although the majority of

participants felt that women are entitled to the right of making their own

choices and making decisions about their sexual life and actions, the majority

also felt that women shouldnt have the right to refuse sex whenever asked

by her sexual partner (Ali, 2009).

A quantitative baseline study among respondents Manila supported these

findings. Approximately 23% of respondents felt that, even if they are

unwilling, it is acceptable for a man to have sex with a commercial sex

worker or his wife (BBC, 2009). (Participants were asked if it was completely

acceptable, acceptable or acceptable under certain circumstances)

The same study found that 6% of respondents believed that, if she is

unwilling, it is acceptable for a man to have sex with a woman he doesnt

know or with a virgin (BBC, 2009).

The 2009 qualitative study found that this was the case especially within

marriage where participants indicated that women should have special and

convincing reasons for not want sex and even then she would need to

discuss this with her partner before refusing outright. Participants also said

that those reasons would need to be discussed with her partner before she

can refuse outright (Ali, 2009).

In the rural context, sexual responsibility seems to be attributed to women

only with respect to the issue of sexual rights. Some rural male youth

participants were not in favor of womens sexual rights and argued that it

would contribute to unrestricted sex and therefore an increase in HIV. Many

of these male participants also felt that women should not have the right to

practice premarital sex (Ali, 2009). Research on current urban attitudes about

sexual responsibility is warranted to ascertain the level of societal approval of

womens sexual rights.

Participants justified these views by stating that refusal of sex by a partner

may cause a man to go satisfy his sexual desire elsewhere and this can lead

to HIV infection, divorce and conflict (Ali, 2009).

Sexual abuse and harassment

Sexual abuse and harassment is a sizeable social problem in Philippines. In

addition to varying harmful beliefs about sexual consent, young people must

contend with sexual abuse and especially harassment from varying arenas. A

large percentage (41.1%) of sexually active high school students reported

sexual harassment at home (whether verbal or physical). Most of the abuse

came from siblings, parents and other family mainly cousins. Most of the

harassment from parents was verbal as opposed to physical which for some

respondents made them think about sex and start it at an early age

(G/Mariam, 2012).

In the same study, of those who had been sexually abused physically at

home, twice as many individuals reported that the abuse had been anal as

opposed to vaginal. Abuse happens in school as well; 12.6% of respondents

reported that they were harassed and abused at schools by teachers or

students (teachers more than students, a .8% difference) (G/Mariam, 2012).

Although the majority of sexual abuse and harassment (among youth) is

committed against young women, sexual abuse of young boys occurs often.

A qualitative study of sexual abuse of young men in Manila found that 22% of

sexual abuse cases reported to the police were regarding sexual abuse of
boys. The majority of sexually abused boys are school children aged 10 to 18

years Eighty percent of the perpetrators of this abuse are children between

10 and 18 years old and 98% of the perpetrators are male (Hagos, 2011).

Additional research needs to be done on young women and mens

understanding of sexual harassment and their self efficacy and skills

associated with dealing with sexual abuse and harassment.

Forced sex/rape

Deep rooted inequitable male and female gender norms fuel harmful

attitudes with respect to sexual and gender based violence among many

young people in Philippines.

Among a studys urban sites, rape was considered a despised act and was

condemned, however in some of the studys rural sites, rape is considered

shameful and despicable if it involves a child. However, if the female victim is

above 16, it is considered resolvable between the victim/perpetrators

families (Ali, 2009).

Women many feel unable to say no to sex due to cultural pressures, potential

violence by their partners, economic dependence, fear of losing her partner,

rape or forced sex, forced marriage, lack of self confidence, awareness and

assertiveness (Ali, 2009).

Although many young people were aware of the adverse psychological,

physical, and physiological effects of rape and were aware that it is a

violation of womens rights and punishable by law; there were reports of

youth, particularly between 15 and 18 who believed that forced sex could

only be rape if the victim is a virgin (Ali, 2009).

Participants provided a number of major factors that contributed to rape or

forced sex. These included: lenience of the law and law-enforcement bodies,

low reporting of rape cases to police, addiction, girls negligence to avoid

being in potentially dangerous places at unseemly times, peer pressure,

uncontrolled sexual lust of rapists, mental disorder, cultural traits that

condone rape of divorcees or girls assumed to be not virgin, lack of

knowledge about human rights, and absence of free discussion about sexual

issues in the community. Moreover, some male groups argued that women

invite rape by dressing indecently (Ali, 2006).

Harmful sexual practices

In the previous study, the majority of youth from urban areas identified the

following as dangerous sexual practices: rape/forced sex, having multiple

sexual partners, uncontrolled sex, sex after drug and alcohol use,

homosexual activities, anal and oral sex, sex at an early age, sexual

incompatibility (men reaching orgasm before women do which could lead to

unfaithfulness on the part of either person), having sex while menstruating,

and imitating acts from porn films (Ali, 2009).

 Synthesis

Although AIDS has not spread rapidly in the Philippines, an analysis of data

from the 2013 Young Adult Fertility and Sexuality Study (Y AFS-II) shows

that young men are at considerable risk of infection through sexual routes.

Results from the survey of 15 to 24 year olds shows that over one-third of

young men engage in sex before marriage with a partner other than their

future wife. By age 24, 20 percent of young men have had sex with a

commercial sex worker. Although only slightly more than 2 percent of young

women in the Philippines report premarital sex with a partner other than their

future husband, women are at risk of HIV infection through the previous and

current sexual activities of their partners. Awareness of HIV/AIDS is nearly

universal, but knowledge is rather limited. Most young people (85 percent)

can identify at least one sexual mode of transmission, and 25 percent can

identify at least one non-sexual transmission mode. Misperceptions about

HIV transmission are not common, but 16 percent of young people who know

about AIDS believe that HIV can be transmitted by having contact with the

belongings of an infected person. Education and regular exposure to

television, radio, or newspapers increase awareness of and knowledge about

AIDS. Nearly all young men have heard of condoms. Most also know that

condoms, if used correctly, can protect against AIDS and other sexually

transmitted diseases (STDs). Only 23 percent of sexually active young men

have ever used a condom, however. Education, regular media exposure, and
urban residence all increase the likelihood of lifetime condom use, and young

men with good knowledge of AIDS are more likely than others to have ever

used a condom. Even in commercial sex, condom use is low. Only 27

percent of young men who visited a commercial sex worker during the year

before the survey report using condoms most or all of the time. Widespread

sexual activity combined with low condom use indicates the potential for a

serious AIDS epidemic in the Philippines. To prevent such an epidemic from

occurring, young people must be educated about the risks of infection, and

barriers to condom use must be alleviated.

 CHAPTER III

METHODOLOGY Commented [ER3]: USE FUTURE TENSE SINCE THIS IS A

PROPOSAL FOR APPROVAL PA

This chapter contains the discussion of the research design the sampling

technique used, the description of the participants, the instrument, the data gathering

procedures and the statistical treatment of the data collected.

Research Design By Christine Montenegro

The researchers used the descriptive correlational design, which is defined as a

research that describes variables and examines relationships among these variables.

Using this design will facilitate the identification of interrelationship in a situation. The

study may examine the variables in a situation. The study may examine the variables in

situation that has already occurred or is currently occurring. Researchers make no

attempt to control or manipulate the situation (Burns and Grove, 2007). Commented [ER4]: PLACE THE DEFINITION OF DESCRIPTIVE
AND DESCRIPTIVE CORRELATIONAL RESEARCH FORM AN
AUTHORITY (LIKE BOOKS) CITE THE AUTHOR AND THE YEAR

Research Locale By Christine Montenegro

This study will be conducted in Calamba Doctors College. The college was

established in 2002 through a vision of community service anchored on the

accommodation of the education needs of college students. Depicted as proudly

standing side by side with Calamba Doctors Hospital, the school is very accessible to

pedestrian vehicular traffic traversing a very short stretch off National Highway at Brgy.

Parian, Calamba City. It is one of the seven colleges of Nursing Calamba with a base

hospital of its own.

 Since its establishment, growth in enrollment, manpower, facilities and other

accommodations has taken on a positive stance. It was granted government recognition

by the Commission on Higher Education through Government Recognition no. 094,

Series of 2005, allowing it to offer Bachelor of Science in Nursing.

Sample and Sampling Technique By Christine Montenegro

The researchers will use convenience sampling technique in selecting the

respondents of the study. Convenience sampling means that the researcher chooses

the sample that is most conveniently available people as study participants (Polit, 2009).

The sample of the study were composed of 100 students both male and female

of Calamba Doctors College from different colleges who are enrolled in the first

semester of academic year 2015-2016. Commented [ER5]: INCLUDE SOME DEMOG PROFILE
(DP) IN YOUR QUESTIONNAIRE SO THAT YOU COULD
DESCRIBE YOUR SAMPLES BY DP INTHIS SECTION
By Christine Montenegro
Research Instrument

The researchers used self-made questionnaire as the tool of the study. The

questionnaire included statements towards the evaluations of Knowledge and

Preventive Practices on HIV among Adolescents.

Data Gathering Procedure By Christian Sison

The researchers asked the permission of dean of College of Nursing to conduct

the study. In order to support the validity of the data, interview has been conducted to
gather information. Room to room survey will be conducted. The researchers will
personally coordinate with the faculty in charge of the class and class presidents for
Commented [ER6]: THS IS A NARRATIVE STORY OF THE
PROCEDURR
AFTER A LETTER FROM. THE DEAN, ANOTHER LETTER TO THE
ADMINISTRATOR. THEN HOW DO YOU PLAN TO FELD THE
QUESTIONNAIRE ROOM TO ROOM OR EVEN OUTSIDE THE ROOM.
HOW AND WHAT WILL YOU TELL YOUR RESPONDENTS ABOUT
YOUR STUDY. FRO HOW ANY DAYS DO YOU PLAN TO DO THIS.
UNTIL YOU RETRIEVE ALLYOUR QUESTIONNAIRE
their assistance. Survey conduction will be held for two days. The questionnaire will be

given to the respondents and discuss the purpose of the survey. The retrieval of the

questionnaire will be done one hour after its distribution with the aid of the class

president.

A total of 100 questionnaires were given out for the male and female college student

and hundred percent of retrieval is attained. The data were tallied, tabulated and

analyze.

Statistical Treatment By Christian Sison

The following statistical methods and techniques were used to interpret data: Commented [ER7]:

The formula used : Wm=fx/f

Where: WM= weighted mean

= summation

f = frequency

x = assigned weight

The Likert scale was used to measure the answer of the repondents.

Point scale Range Description Interpretation

4 3.1 4 Strongly Agree High

3 2.1 3 Agree Moderate

2 1.1 2 Disagree Low

1 0.1 1 Strongly Disagree Very Low

Pearsons Correlation use to determine if there is a significant relationship,

between level of knowledge and level of preventive practices among adolescents Commented [ER8]:

The formula used:

r= N(xy) (x)(y)

[N(x) (x)][N(y) - (y)]

Where: X= independent variable

Y= independent variable

N=population