HIV/AIDS-related Knowledge, Attitudes And Sexual Behaviors Among Out-of-school Youth In Rural Area Of Hainan Province & How Experiences Of Migration Influence These Behaviors

Background: Youth who do not attend school or who drop out prematurely miss many of the fundamentals of basic education and enter the complex social environment out of the school campus. Meanwhile, there are few programs conducted among out-of-school youth and they lose a valuable opportunity to learn about reproductive health and HIV in a stable and credible environment. Moreover, 60 percent of China's floating population are youth aged 15-24 years and few of them attend school. Several studies have reported a positive association between migration and HIV-related sexual risk behaviors. All of these factors above put out-of-school youth at a disadvantage in regards to HIV prevention compared to their peers who are at school. In china, little is known about out-of-school youth's sexual attitudes and behaviors. Our study will describe HIV/AIDS-related knowledge, attitudes and sexual behaviors of out-of-school youth.Objectives:1. To understand HIV/AIDS-related knowledge, attitudes and sexual behaviors among out-of-school youth aged 16-24 years who are officially registered in a permanent household in two towns of Hainan Province.2. To explore how migration experience influence participants' HIV/AIDS knowledge, sexual attitudes and sexual behaviors.Methods: Cross-sectional data were collected from out-of-school youth aged 16-24 years and who were officially registered in a permanent household in two towns of Hainan province. We recruited 322 out-of-school youth and issued them an interviewer-administered standardized questionnaire. The questionnaire was designed to measure demographic characteristics, migration experience, HIV/AIDS knowledge, attitudes and sexual behaviors. The face-to-face interview was conducted in a separate room by a trained interviewer who was paired with a respondent of the same sex.Findings:The average age of the respondents was 20.6±2.5, nearly 90 percent of whom had at least a middle-school education. Among the respondents who had experience of migrating, 73.9 percent had migrated only once. The median cumulative years spent in migratory towns was 11 months, more than 90 percent of participants had migranted to 1 or 2 towns. When we used the farthest location of migration as the standard to classify the scope of migration, results show that 57.0 percent of youth had experienced cross-city migration, and 30.9 percent of them had experienced cross-province migration.2. The correct answer rates to three transmission routes of HIV ranged from 74.7% to 91.2% .The mean score of AIDS knowledge was 6.4±1.8 points. The findings of multiple linear regression shows that age exerts a positive impact on scoring, and migration experience has no impact on scoring.3. Generally speaking, many respondents were open-minded to multiple sex partners, sex before marriage and pregnancy before marriage. Chi-square test showed that migration experience have no influence on sexual attitude. More males than females held a relatively open attitude towards sex.4. Over half (59.0 percent) of respondents reported having sexual behavior. The average age of their first sexual intercourse was 19.0±1.9. For participants with migration experience, 63.2 percent of them had first sex intercourse during the period of their migration. This figure is higher than that for people who had their first sexual intercourse before or after migration .Premarital sex was reported among 53.7 percent of youth. After ajustment for age, marital status and other demographic variables, multiple logistic regression showed that the greater number of premarital sex among friends, the greater possibility of their own premarital sex. In addition, those youth with migration experience reported premarital sex at a level that was 2 times higher than those without migration experience.Of the 190 youth who reported having sexual behavior, the median of their cumulative namuber of sex partners is 2. If we take two or more sex partners as multiple sex partners, the proportion of participants reported multiple sex partners was 30.4 percent. After ajustment for age, marital status and other demographic variables, multiple logistic regression showed that if the respondents were open-minded to multiple sex partners or many their friends had multiple sex partners, they were more likely to report multiple sex partners. Those youth with migration experience reported more multiple sex partners than these who had never migrated.Twenty youth reported having engaged in commercial sex, accounting for 6.2 percent of all respondents. Chi-square test showed that males and those who were open-minded to sex behaviors were more likely to report commercial sex.5. Several questions about condom knowledge were asked. 78.7% of respondents were aware that condom can prevent pregnancy; 73.7% were aware that condoms can prevent sexually transmitted infections; 60.0% of respondents were aware that condoms can prevent AIDS; and 52% of respondents were aware all of the above. Taking -6 to +6 as score range, 38.2 percent of the respondents' score were above 0 in the condom attitude test. Among people with sexual behavior, the average score of attitudes towards condom was lower for males than females. Moreover there was no difference in scores between the respondents with and without migration experience. Among the respondents with sex behavior, 49.5 percent had never used a condom, 79.8 percent of people did not use condom in their last sexual intercourse, and 55.0 percent had never taken the initiative to use condoms during their sexual experience. Among those who had sex in past six months, 63.2 percent had never used condom. Multiple logistic regression showed that those who correctly answered three questions about condom knowledge were more likely to use condom at least once and use condom in past six months. Migration experience had no influence on the usage of condom.6. The prevalence rate of symptoms of RTIs (Reproductive tract infections)during the previous six months of all respondents was 14.6%. Chi-square test showed that females and those who reported having sex behavior were more likely to report RTIs related symptoms. Further more, the prevalence rate of RTIs related symptoms of the youth who were less educated was higher.Experience of pregnancy was reported among 44.2 percent of females. About 36% of them reported having experienced induced abortion.Conclusion:These findings showed that migration is related to premartial sex and multiple sex partners. The participants' rate of condom use was relatively low. The higher level of condom knowledge is related with higher rate of condom use .