Indian Journal of Community Medicine

Introduction:

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are pandemic and are one of the greatest challenges to worldwide public health including India. According to the United Nations, there are about 4 million HIV infected people in India, and India is considered a high-risk country¹. Adolescents and young adults 15 to 24 years old are the hardest hit by HIV infection worldwide and a significant proportion of them live in India. Despite the high prevalence of HIV/AIDS, it has been reported that many adolescents do not know the transmission mode of this disease.

One way to promote safer choices among adolescents is by having open communication and discussions about sex and condom use. In India, due to the deep-seeded taboo on discussing sexuality² adolescents and their parents do not freely discuss sex and HIV related topics. Indian girls are more restricted than boys, and therefore it is essential to find out if there are still sex differences even in the face of the threat of HIV/AIDS.

Methods:

The study population was selected from 3 of the largest senior higher secondary schools in differnt regions in Mumbai, India. The questionnaire consisted of the health-behavior questions from the U.S. Centers for Disease Control Safer Choices project, and AIDS Social Assertiveness Scale. More details about the questionnaire, study and data collection approval can be found elsewhere³.

The respondents were 1250 eleventh and twelfth grade (known as "plus two") higher secondary school students between 15 and 18 years of age. An overwhelming number of the respondents parents were college graduates (66%, of the fathers and 50% of the mothers) suggesting that these students were from highly educated upper middle class families. Eighty percent of the respondents lived with both their parents in nuclear families or in traditional Indian joint families (with their parents and grandparents). Twenty percent of the children lived in single-parent families.

The questions assessed how comfortable students were in discussing sex-related and HIV-related issues. Six questions measured if and how much the students discussed sex-related matters with parents, other adults in the family and friends. In addition, two questions were asked about abstinence and condom use. The students were given the option to read a book if they were not interested in answering the questionnaire. Out of 1250 students, 11 did not respond to any item and returned blank questionnaires. Several other students who participated chose not to respond to a few items, so the responses do not total to 1250 for all of the questions. To analyze the data we used SPSS Version 10.1.3 (SPSS Inc., Chicago, IL).

Results and Discussion:

The major difference between boys and girls was in their comfort level talking about sex with their friends. Statistical significant sex differences were reported in discussing sexrelated issues with parents, other family members and friends. About 30% males were comfortable in discussing sex-related issues "a lot" with their friends whereas it was only 16% girls.

Most male and female Indian students do not have open communication with their parents and other family members. It was known that in United States students feel that discussing sexual safety, development, and societal concerns with their parents is important⁴ and was positively associated with intended condom use⁵. Although the numbers who discussed about sex-related issues with parents and others family members a lot was low for both girls and boys, it was lower for girls than boys. The possible reasons for poor communication are religious beliefs, and the traditional belief that sex is considered appropriate for discussion only after marriage with one's partner.

Also, safer sex norms and beliefs about protection through condom use were higher for boys compared to girls. The only possible explanation for the higher proportion of boys reporting open communication with friends may be because they were more westernized than girls. More studies are needed to further explain this possibility.

One of the strengths of this study is that it is the first published study assessing the communication patterns of adolescents with regard to sexual behavior, condom use, and HIV/AIDS in India. Neither discussions of sexual matters with significant others nor gender differences among teenagers in discusing sex and drug related issues with parents have been widely studied. However, fear of AIDS has made sex a legitimate topic of discussion in the Indian mass media. Such discussions will increase students awareness and knowledge about highrisk behaviors and how to avoid them. More research in this area will also help policy makers and health education professionals plan appropriate policies to control HIV/AIDS.

References:

1. UNAIDS. Global HIV/AIDS & STD Surveillance: Epidemiological Fact Sheet by country. 2002. http://www.unaids.org/hivaidsinfo/statistics/fact_sheets/pdf/India_en.pdf.
2. International AIDS Vaccine Initiative (IAVI). The AIDS Pandemic in India. IAVI Report-February/March 2001-2001. http://www.aegis.com/pubs/iavi/2001/IAVI 2001-0303.html.
3. Mathai R, Ross MW, Hira S. Concomitants of HIV/STD risk behaviours and intention to engage in risk behaviours in adolescents in India. AIDS Care. 1997; 563-75.
4. Rosenthal, D.A., & Feldman, S. The importance of importance: adolescents perceptions of parental communication about sexuality. Journal of Adolescence, 1999; 111-118.
5. Whitaker DJ, Miller KS, May DC. et al. Teenage partners communication about sexual risk and condom use: the importance of parent-teenager discussions. Family Planning Perspectives, 1999; 117-121.

1. Deptt. of Epidemiology,
2. Center for Health Promotion and Prevention Research,
3. Deptt. of Behavioral Science, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.