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Contributo para o conhecimento dos comportamentos sexuais nos adolescentes; promoção de saúde sexual e prevenção do VIH/SIDA
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O comportamento sexual dos jovens é actualmente, uma das principais preocupações da Saúde Pública internacional e nacional pela sua associação com várias consequências indesejáveis que, directa ou indirectamente, afectam a saúde e o bem-estar dos adolescentes, nomeadamente infecção pelo Vírus da Imunodeficiência Adquirida (VIH/SIDA), outras Infecções Sexualmente Transmissíveis (IST’s) e gravidez indesejada. Os comportamentos sexuais de risco têm sido identificados como uma das principais causas associadas com a mortalidade, morbilidade e problemas sociais nos jovens. O presente trabalho tem como objectivos gerais aprofundar o conhecimento sobre a sexualidade e os comportamentos sexuais nos adolescentes portugueses escolarizados e identificar necessidades e factores relevantes para a Saúde Sexual e prevenção do VIH/SIDA nos adolescentes.
Para a concretização destes objectivos foram efectuados dois estudos, um quantitativo e outro qualitativo.
O estudo quantitativo pretende descrever os conhecimentos, atitudes e práticas na área da sexualidade com relevância para a prevenção do VIH/SIDA nos jovens e analisar as relações entre os comportamentos sexuais adoptados e as variáveis sócio-demográficas, as psicossociais e as dos contextos sociais do jovem (família, pares, escola e comunidade). A amostra utilizada é composta por 3762 adolescentes que frequentavam o 8º e 10º ano de escolaridade e faz parte do estudo realizado em Portugal Continental em 2002 (Matos, Gonçalves, Dias, & Aventura Social, 2003) da Rede Europeia “Health Behaviours in School-aged Children (HBSC/OMS)”, da Organização Mundial de Saúde (Currie et al., 2004).
O segundo estudo, qualitativo, propõe-se identificar e aprofundar os factores e processos ligados à protecção e ao risco individuais e do contexto ecológico, visando compreender as dinâmicas subjacentes aos conhecimentos, atitudes e comportamentos sexuais relevantes para a prevenção do VIH/SIDA. Neste estudo foram realizados 12 grupos focais, utilizando uma amostra constituída por 72 adolescentes, 36 jovens do sexo feminino e 36 do sexo masculino, de seis escolas públicas do ensino regular situadas em diferentes regiões do país.
Nos resultados do estudo quantitativo, salienta-se a percentagem de adolescentes que refere já ter iniciado a actividade sexual, 23.7%. Relativamente à idade da primeira relação sexual, 48.2% dos adolescentes refere ter tido a sua primeira experiência sexual entre os 12 e os 14 anos e 17.3% aos 11 anos ou menos.
Quanto à utilização do preservativo, 29.9% dos jovens refere não o ter utilizado na última relação sexual. Os dados sugerem a existência de diferenças de género e de idade relativamente aos conhecimentos, atitudes e comportamentos sexuais. Pelos resultados encontrados nas análises de regressão logística pode-se verificar que as variáveis “ter iniciado as relações sexuais” e “não ter utilizado o preservativo, na última relação sexual”, se associam significativamente com variáveis individuais de nível sócio-demográfico e pessoal e variáveis relativas ao contexto social que rodeia os jovens (família, pares, escola e comunidade).
Os resultados do estudo qualitativo sublinham que as questões ligadas à sexualidade são complexas e que os conhecimentos, atitudes e comportamentos sexuais adoptados pelos jovens sofrem múltiplas influências que se situam a vários níveis, nomeadamente individual, familiar, interpessoal (pares), escolar e comunitário. Os adolescentes identificaram diversos factores ligados à protecção e ao risco nos diferentes níveis de análise. Os resultados apontam também para que os factores e processos de risco e de protecção interagem entre si através de possíveis relações que reduzem ou aumentam a probabilidade do envolvimento em comportamentos de risco.
Os resultados dos dois estudos sugerem que os adolescentes não podem ser considerados um grupo homogéneo em relação aos conhecimentos, atitudes e comportamentos sexuais e relativos ao VIH/SIDA. Apontam também para a importância das intervenções precoces, que envolvam os jovens como principais intervenientes no processo e os agentes de socialização (pares, pais, escola e comunidade), quer ao nível da redução dos factores ligados ao risco, quer ao nível da promoção dos factores ligados à protecção.
A complementaridade encontrada na utilização de diferentes metodologias parece funcionar como uma estratégia para aumentar o conhecimento e a compreensão das complexidades em que a sexualidade se desenvolve. Os resultados obtidos neste trabalho poderão contribuir para o planeamento e implementação de programas de promoção de Saúde Sexual e prevenção de VIH/SIDA nos jovens, que reflictam as suas necessidades específicas, e consequentemente, permitam efectivos ganhos na saúde juvenil.
The sexual behaviour of young people is an international and national public health concern because they are responsible for negative outcomes, which affect health and well-being of adolescents, such as HIV/AIDS infection, other Sexually Transmitted Infections, and unintended pregnancy. Sexual risk behaviours have been identified as an important cause of the mortality, morbidity and social problems of adolescents. The purpose of this work is to improve the understanding of sexuality and sexual behaviours of adolescents and to identify needs and factors that are relevant for sexual health and HIV/AIDS prevention in adolescents. In order to achieve these goals, two studies, one quantitative, and one qualitative were developed. The quantitative study describe knowledge, attitudes and sexual behaviours that are important to AIDS prevention and examine the relationship between adolescent sexual behaviour and demographic factors, personal characteristics, and social context of young people (parents, peers, school and community). The sample included 3762 Portuguese adolescents on the 8th and 10th grade of high school. Data were collected from the “Health Behaviour in School-Aged Children -2002- (HBSC/ World Health Organization)”,(Currie et al., 2004), that took place in 2002 in Portugal. The qualitative study was used to better identify and understand the protective and risk factors and processes at individual and contextual level, to understand the dynamics of knowledge, attitudes and behaviours in sexuality relevant to AIDS prevention. In this study, 12 focus groups were conducted in a sample of 72 adolescents, 36 girls and 36 boys, from six secondary schools from different geographic areas of Portugal. In the quantitative study the percent of adolescents reporting ever had sexual intercourse was 23.7%. Of these, 48.2% report to have their first sexual experience between 12 and 14 years old, and 17.2%, report the first intercourse at 11 years old or younger. With respect to use of condoms, 29.9% of the adolescents report that they or their partner didn’t use a condom last time they had engage in sexual intercourse. The findings put forward differences in gender and age in knowledge, attitudes and sexual behaviours. The logistic regression analysis show that the variables “have sexual intercourse” and “didn’t used condom last time they engage in sexual intercourse” are associated with socio-demographic characteristics, individual, parents, peers, school and community variables. The qualitative study results underline that issues related to sexuality are complex and that knowledge, attitudes and sexual behaviours are influenced by multiple determinants at different levels: individual, family, peer group, school and community. Adolescents identified a variety of protective and risk factors in different levels of analyze. The findings suggest that protective and risk factors and processes interact with each other within a network of possible relations that either reduce or increase the probability of involvement in risk behaviours. The results of the two studies suggest that adolescents can’t be seen like a homogeneous group concerning knowledge, attitudes and sexual behaviours and HIV/AIDS. They highlight the significance of early interventions that involve young people as prime participants in the process, and also agents of socialization (peers, parents, school and community), in the reduction of risk factors and the promotion of protecting factors. Complementarities found in the use of different methodologies, works like a strategy to increase knowledge and understanding about complex meanings in which sexuality is submersed. This work can be useful to design and implement a comprehensive programme on sexual health promotion and AIDS prevention in young people that better meet their special needs and consequently can have positive impact in youth health.
The sexual behaviour of young people is an international and national public health concern because they are responsible for negative outcomes, which affect health and well-being of adolescents, such as HIV/AIDS infection, other Sexually Transmitted Infections, and unintended pregnancy. Sexual risk behaviours have been identified as an important cause of the mortality, morbidity and social problems of adolescents. The purpose of this work is to improve the understanding of sexuality and sexual behaviours of adolescents and to identify needs and factors that are relevant for sexual health and HIV/AIDS prevention in adolescents. In order to achieve these goals, two studies, one quantitative, and one qualitative were developed. The quantitative study describe knowledge, attitudes and sexual behaviours that are important to AIDS prevention and examine the relationship between adolescent sexual behaviour and demographic factors, personal characteristics, and social context of young people (parents, peers, school and community). The sample included 3762 Portuguese adolescents on the 8th and 10th grade of high school. Data were collected from the “Health Behaviour in School-Aged Children -2002- (HBSC/ World Health Organization)”,(Currie et al., 2004), that took place in 2002 in Portugal. The qualitative study was used to better identify and understand the protective and risk factors and processes at individual and contextual level, to understand the dynamics of knowledge, attitudes and behaviours in sexuality relevant to AIDS prevention. In this study, 12 focus groups were conducted in a sample of 72 adolescents, 36 girls and 36 boys, from six secondary schools from different geographic areas of Portugal. In the quantitative study the percent of adolescents reporting ever had sexual intercourse was 23.7%. Of these, 48.2% report to have their first sexual experience between 12 and 14 years old, and 17.2%, report the first intercourse at 11 years old or younger. With respect to use of condoms, 29.9% of the adolescents report that they or their partner didn’t use a condom last time they had engage in sexual intercourse. The findings put forward differences in gender and age in knowledge, attitudes and sexual behaviours. The logistic regression analysis show that the variables “have sexual intercourse” and “didn’t used condom last time they engage in sexual intercourse” are associated with socio-demographic characteristics, individual, parents, peers, school and community variables. The qualitative study results underline that issues related to sexuality are complex and that knowledge, attitudes and sexual behaviours are influenced by multiple determinants at different levels: individual, family, peer group, school and community. Adolescents identified a variety of protective and risk factors in different levels of analyze. The findings suggest that protective and risk factors and processes interact with each other within a network of possible relations that either reduce or increase the probability of involvement in risk behaviours. The results of the two studies suggest that adolescents can’t be seen like a homogeneous group concerning knowledge, attitudes and sexual behaviours and HIV/AIDS. They highlight the significance of early interventions that involve young people as prime participants in the process, and also agents of socialization (peers, parents, school and community), in the reduction of risk factors and the promotion of protecting factors. Complementarities found in the use of different methodologies, works like a strategy to increase knowledge and understanding about complex meanings in which sexuality is submersed. This work can be useful to design and implement a comprehensive programme on sexual health promotion and AIDS prevention in young people that better meet their special needs and consequently can have positive impact in youth health.
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Palavras-chave
Doenças sexualmente transmitidas Controle e prevenção Doenças infecciosas HIV SIDA Saúde Internacional