International Notes AIDS-Related Knowledge and Behaviors Among Teenagers -- Italy, 1990

As of December 31, 1990, the number of acquired immunodeficiency syndrome (AIDS) cases in Italy exceeded 8000 (1). Although 67% of AIDS cases in Italy occurred among intravenous (IV)-drug users, the role of transmission through heterosexual contact with human immunodeficiency virus (HIV)-infected persons has increased, accounting for 7% of cases in 1990, compared with 2% in 1985. As part of an AIDS epidemiology course in Frascati for regional AIDS epidemiologists (approximately 20 km (13 miles) south of Rome) in November 1990, course participants surveyed AIDS-related knowledge and behaviors among students attending the five high schools in the local school district. This report summarizes findings of the survey, which aimed to characterize AIDS-related knowledge and behaviors of this population.

Survey participants were students attending the five high schools in the district. Each school had five grade levels; ages of students range from 14 to 19 years. Of the 112 homeroom classrooms in the district, 27 classrooms were randomly selected for the survey. A self-administered, anonymous questionnaire, identical to that used to survey U.S. high school students (2), was administered to all 547 students in the selected classrooms.

Fifty-two percent of the respondents were male. A greater percentage of students were in the lower grade levels (range: 36% in grade level 1 to 10% in grade level 5), reflecting the smaller number of classes and smaller class sizes in the higher grade levels. Of the students sampled, 28% attended classical or scientific high schools, and 72% attended technical high schools--a distribution similar to that of the district.

Overall, 98% of students correctly identified IV-drug use and 95% correctly identified sexual intercourse without a condom as risk factors for AIDS. In addition, 54% knew that AIDS cannot be contracted from using public toilets; 51%, AIDS cannot be contracted by having a blood test; 48%, AIDS is not transmitted through insect bites; and 41%, AIDS cannot be contracted through blood donation. Although 92% identified condoms as protective, 64% knew that oral contraceptives do not protect against AIDS. In general, knowledge levels were higher in the upper grade levels and the classical and scientific schools.

Sixty-two percent of students reported obtaining their information about AIDS from television. Fifty-nine percent indicated they would ask medical personnel for correct information about AIDS; 18%, their parents; and 6%, their teachers.

One percent of students reported having used drugs intravenously (0.4% of females and 1.7% of males); 0.4% of students reported having shared needles. Twenty-three percent reported having had sexual intercourse, and 4% reported having had four or more sex partners. In general, sexual activity was reported more commonly by males, and males reported initiating sexual activity at an earlier age than females (Figure 1). Ages of initiating sexual activity were similar for students in all schools.

Although levels of knowledge concerning the protective effect of condoms were high, reported use of condoms was low: among sexually active students, 14% of males and 41% of females reported never using condoms; 54% of males and 37% of females reported always using condoms. Reported by: P Lorenzetti, MD, P Rossi, MD, Aosta; L Armignacco, MD, C De Siefano, MD, P Ferrara, MD, Basilicata; G Iannicelli, MD, M Sangalli, DBiol, M Zaccarelli, MD, Latium;A Belloni, MD, F Castelli, MD, A Parisi, MD, Lombardy; N Morandi, MD, A Morando, MD, R Stagnaro, MD, Liguria; M Amati, DBiol, S Battuci, MD, A Beretta, MD, Marches; G Paggi, MD, B Salassa, MD, Piedmont; C Germinario, MD, O Iacobellis, MD, S Lo Caputo, MD, Apulia; C Aiazzi, MD, D Milio, MD, M Rubino, MD, A Scasso, MD, Tuscany; G Gosetti, MD, TrentinoAlto Adige; M Alongi, DEd, D Arpaia, DEd, G Cicconi, DEd, F De Zardo, DEd, E Napolitani, DEd, 37th School District, Latium. D Greco, MD, P Pezzotti, DStatistics, S Saimaso, DBiol, A Tozzi, MD, AIDS Task Force, Istituto Superiore di Sanita, Rome, Italy. International Br, Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Although the proportion of incorrect responses among the students in this survey was higher than that reported in the United States (2), these findings are consistent with those from other urban high schools in Italy (3,4). Incorrect knowledge about means of transmission can lead to unnecessary fears and stigmatization of HIV-infected persons and may limit the effect of public health messages concerning the risks associated with IV-drug use and high-risk sexual practices. In addition, the incorrect belief that oral contraceptives protect against HIV infection may prevent persons from taking appropriate precautions to protect themselves. These findings indicate the need for educational efforts that promote correct knowledge and understanding of risk factors associated with HIV infection.

Previous surveys of students in Italy did not address IV-drug use. The prevalence of reported IV-drug use in this survey was lower than that of U.S. students, although differences may be accounted for in part by the relatively younger ages of the students in Italy and by cultural differences in the acceptability of reporting IV-drug-use behaviors. The findings of this survey are also consistent with previous reports that most IV-drug users in Italy share needles, and virtually all begin doing so within a year of beginning IV-drug use (5). In view of both these findings and the young age (mean: 28.5 years) of Italians diagnosed with AIDS (1) (which suggests that most became infected as teenagers), more effective IV-drug education is urgently needed.

In this survey, the percentage of students who reported having had sexual intercourse was considerably lower than that reported in other European countries and in the United States (6-8), although it is consistent with findings of other studies in Italy (9). The frequency of multiple sex partners also was lower than that reported in the United States. Although lower than in some countries, the proportion of sexually active teenagers nonetheless underscores the need for additional sex education.

Although a high percentage of students knew that condoms may protect against AIDS, routine use of condoms among sexually active teenagers was relatively low--a finding of particular concern for females. In view of the greater risk for heterosexual transmission from males to females than from females to males (10), levels of awareness about risk for HIV infection must be increased among females.

Only a small percentage of students reported having obtained AIDS information from school. However, attempts have been initiated to increase the role of schools in education about HIV infection and AIDS. In several regions in Italy, innovative HIV/AIDS education programs have begun in the schools. In addition, under the auspices of the Ministry of Education and the National AIDS Committee National Training Program for HIV Infection at the Istituto Superiore di Sanita, week-long workshops that involve participation of local authorities in the development of appropriate teaching materials and curricula are being held throughout Italy.

References

1. AIDS Task Force. Summary of AIDS cases notified in Italy as

of December 31, 1990. Rome, Italy: Istituto Superiore di Sanita, 1991.

2. CDC. HIV-related knowledge and behaviors among high school students--selected U.S. sites, 1989. MMWR 1990;39:385-9,395-7.

3. Signorelli C, Antelitano M, Fara GH. Evaluation of knowledge about AIDS in a group of young people in Milan. Fedeerazione Medica 1990;XLIII(2):159-63.

4. Marin V, Moretti G, Carlotto A. How much do young people know about AIDS? Medico Epaziente 1990;1:12-7.

5. Salmaso S, Conti S, Sasse H, and the Second Multicenter Study Group. Drug use and HIV-1 infection: report from the second Italian multicenter study. J Acquir Immune Defic Syndr 1991 (in press).

6. Fustenberg FF, Moore KA, Peterson JL. Sex education and sexual experience among adolescents. Am J Public Health 1985;75:1331-2.

7. O'Reilly KR, Azol SO. Adolescence and sexual behavior: trends and implications for STD. J Adolesc Health Care 1985;6:262-72.

8. Misfeldt JC, Werdelin L, Senderovitz F, Melbye M, Olsen V. The sexual habits of young Greenlanders and their knowledge of AIDS: a study done among students in vocational schools in Greenland in 1989. Ugeskr-Laeger 1990;22;152(4):237-9.

9. National AIDS Committee. Survey on the sexual behaviors of young people. PRAGMA: Rome, September 1989. 10. Padian N, Shiboski S, Jewell N. The relative efficiency of female-to-male HIV sexual trans mission (Abstract). VI International Conference on AIDS. Vol 1. San Francisco, June 20-24, 1990:159.

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