Introduction:
Adolescents and youth constitute 18% of the world population [1] and 23.6% in the western pacific region.[2] In the Philippines, young people (aged 12–24) account or 20.2% of the total population.[3] Given the latter, the health of adolescent therefore is a key element for the social and economic progress of the country. However, adolescents face major challenges like adjusting to sexual developmental demands, protecting reproductive health, and decision making in avoiding risky sexual behavior.
The World Health Organization (WHO) reported that most young people start sexual activity before age 20. Over 30% of girls in developing countries marry before 18 years of age; around 14% do so before the age of 15.[4] Sexually active adolescents are less likely to use contraceptives than adults, even in places where contraceptives are widely available.[5] Girls in many countries are also pressured into having sex, often by family members. In some countries, over a third of girls’ report that their first sexual encounter was coerced.[6] An estimated 3 million unsafe abortions occur globally every year among adolescent girls 15 to 19 years of age.[7]
According to the 2002 Young Adult Fertility and Sexuality Study (YAFSS 3) among Filipino youth aged 15–24, 30% males and 15% females engage in pre-marital sex. Before age 18, 12.85% of females in the 15-24 age range had pre-marital sex (PMS) and half of the very early sex experience for young boys occurred either in the 1st or 2nd year level. Furthermore, 5% of men and 1.7% of women in the 15-24 age range lose their virginity before 15 years. It was also estimated that 40% of first sexual encounters and 70% of most recent sexual encounters among youth were without any protection.[8] Meanwhile, the 2008 National Demographic and Health Survey reported that 13.6% of adolescent women aged 15–19 have ever had sexual intercourse.[9]
Within the local level, majority of the youth still hold conservative notions about sex, yet a significant number engage in premarital sex. The, Waraya Organization noted that among the ethnic group in the province, Samar youth had the highest prevalence of premarital sex with 31.4% with the National Capital Region coming in next with 30.1% rate, 27.8% were unplanned, and only 10.9% used contraceptives during their first premarital sex. [10]
One of the unfortunate consequences of the increase in sexual activity among youth is a high rate of teenage pregnancies and the contraction of sexually transmitted infections (STI’s) including HIV/AIDS. In 2008, Filipino youth between 15 and 24 accounted for 21 percent of new HIV infections from 12% in 2007.[11] According to the United Nations Population Fund's 2011, at 53 births per 1,000 women aged between 15 and 19, the teenage pregnancy rate in the Philippines is the highest among Aseans’ six major economies.[12] Therefore, examining factors that are related to sexual behavior should be assessed in order to address the Adolescent Reproductive Health (ARH) problems of the youth.
Gender-related norms are critical issue to consider when addressing youth reproductive health and sexuality. Gender norms are societal messages concerning appropriate and permissible behaviors for both genders.[13] Traditional gender norms often contribute to unintended pregnancy, STIs, HIV/AIDS, sexual violence and coercion, and other harmful practices. Thus, it is essential and imperative to explore not only the behavioral and environmental factors that are related to sexual behavior but also with the gender-related norms that may shape the sexual attitudes and behaviors among youth. It is in the context that the investigators was motivated to conduct this investigation in order to assess gender-related norms, sexuality and reproductive health among future educators who will soon be entering classroom and in their own way influence the behaviors of their students. The knowledge that could be gained in this investigation would guide school administrators to plan, design and initiate university wide initiatives, programs, and policies relative to reproductive health which could be used to address the ever growing adolescent reproductive health problems.
Research Objective
This investigation explored gender-related norms and knowledge on HIV/AID’s and STI’s among education students in a government university in Samar, Philippines.
Methodology
Design
A descriptive-analytical study was adopted for this investigation among the different types of descriptive studies. This study design is appropriate as the main objective of this investigation was to assess gender-related norms and knowledge on HIV/AID’s and STI’s of the students.
Participants
Data were collected over a period of three (3) months from September to February, 2012. The entire population of five hundred fifty (550) students who were enrolled in the education department of the said university was taken as participants in the investigation. Participants had to be currently enrolled in the education department of university, must be unmarried, and had to be willing to fully participate in the investigation.
Instrumentation
To gather data on the knowledge of the respondents on HIV/AIDS and STI’s, the investigators adopted the questionnaire developed by Cleland in 2010.[14] The questionnaire was developed after a thorough review of the literature and further critical evaluation by experts in gender and sexuality to ensure quality and content validity. The questionnaire was validated for its reliability resulting in statistical value of 0.80. The questionnaire covers 9 items, with possible responses of “agree”, “unsure”, and “disagree”.
Gender-related norms were also determined using the questionnaire developed by Cleland.[14] The questionnaire was validated for its reliability resulting in statistical value of 0.88 (Cronbach’s alpha). There are 24 items with responses of “agree”, “undecided”, and “disagree”.
Questionnaires were drafted in a structured format and they were used in a pilot test before being distributed to the respondents enrolled in this investigation. Refinement and modifications were done on the basis of pretest results. Furthermore, questionnaires were validated through expert validation by five experts in the field of gender and sexuality studies. The questionnaires were handed out and collected by the investigators at the site personally.
Ethical Considerations
The study protocol was reviewed and approved by the Health Ethics Committee of Samar State University. All the participants were fully informed about the purpose of the study and that the discussions would be held confidential. Confidentiality and anonymity of the respondents were maintained by only a code number on the questionnaire.
Data Analysis
The data from the questionnaire were coded and entered into a computerized data base and analyzed using SPSS, version 16. Frequencies and percentages were used for analyzing the selected socio- demographic data while mean and median were used to assess responses of the respondents on the questionnaires. ANOVA was utilized to find out significant differences between the knowledge and gender norms across year level.
Results
The demographic data of the respondents are summarized in Table 1. The mean age of the participants was 18.5 years. There were 426 (77.45%) female and 124 (22.55%) male respondents. About one third (34.36%) of the respondents were first year college student and almost all of them (93.09%) are Roman Catholics.
| Table 1. Demographic Characteristics of the Student- Respondents |
Characteristics |
|
N |
% |
Sex |
Female |
426 |
77.45 |
Male |
124 |
22.55 |
Year Level |
1st Year |
189 |
34.36 |
2nd Year |
139 |
25.27 |
3rd Year |
118 |
21.45 |
4th Year |
104 |
18.91 |
Religion |
Roman Catholic |
512 |
93.09 |
Born Again Christian |
25 |
4.54 |
Iglesia ni Kristo |
3 |
0.54 |
Baptist |
3 |
0.54 |
7th Day Adventist |
3 |
0.54 |
Others |
4 |
0.72 |
Table 2 presents the sexuality profile of the respondents. As reflected on the table, it can be gleaned that out of 550 student-respondents, 81 or 14.73% had already experienced penetrative sexual intercourse. Across the year level, the 4th year students got the highest frequency rate of 35.80%, followed by 2nd year students with 30.86%. As to coital debut, respondents (6.17%) claimed to have engaged in sexual activity as early as 10 years old, and majority of them (76.54%) had it with their boyfriends or girlfriends. With regards to arrangement of first sexual intercourse, 56 or 69.14% had it unplanned and 62 or 82.72% did not use any contraceptives.
| Table 2. Sexuality Profile of the Student- Respondents |
Characteristics |
|
N=81 |
% |
Students who engage in early sexual activity |
1st Year Students |
16 |
19.75 |
2nd Year Students |
25 |
30.86 |
3rd Year Students |
11 |
13.58 |
4th Year Students |
29 |
35.80 |
Self reported penetrative sexual intercourse |
Yes |
81 |
14.73 |
No |
469 |
85.27 |
Coital Debut |
22 – 25 years old |
4 |
4.94 |
18 – 21 years old |
34 |
41.97 |
14 - 17 years old |
38 |
46.91 |
10 – 13 years old |
5 |
6.17 |
First Sexual Relationship |
Boyfriend/Girlfriend |
62 |
76.54 |
One Night Stand |
18 |
22.22 |
Commercial Sex Partner |
1 |
1.23 |
Arrangement of First Sexual Intercourse |
Planned |
25 |
30.86 |
Unplanned |
56 |
69.14 |
Contraceptive Usage on their First Sexual Intercourse |
Yes |
14 |
17.28 |
No |
67 |
82.72 |
Table 3 presents the answers concerning the knowledge of the respondents on HIV/AIDS and other STIs.
As reflected on the table below, 40.18% of the respondents believed that AIDS is curable, while more than half (53.82%) claimed that a person with HIV always looks unhealthy. Nearly half (40.54%) of them agreed that HIV virus can be transmitted through mosquito bites and almost three fourths (72.54%) believed that HIV can be transmitted through sharing of needles.
Majority of the respondents (77.64%) claimed that aside from HIV/AIDS, there are other diseases that both men and women are capable of acquiring during sexual intercourse, while more than half of them (58.73%) (57.27%) were uncertain if man/woman with STI’s can have discharge from penis/vagina and pain during urination.
| Table 3.Responses to questions regarding HIV/AIDS and other STI’s |
Indicators |
Agree (%) |
Unsure (%) |
Disagree (%) |
1. It is possible to cure AIDS |
40.18 |
28.73 |
31.09 |
2. A person with HIV always looks unhealthy |
53.82 |
22 |
24.18 |
3. HIV can be transmitted though kissing and hugging. |
30.91 |
14.73 |
54.36 |
4. Mosquito bite can transmit HIV. |
40.54 |
31.64 |
27.82 |
5. HIV can be transmitted through sharing of needles. |
72.54 |
17.45 |
10 |
6. Apart from HIV/AIDS, there are other diseases that men and women can catch by having sexual intercourse. |
77.64 |
18.18 |
4.18 |
7. A man/woman w/ STI can have discharge from penis/vagina. |
37.27 |
58.73 |
4 |
8. A man/woman w/STI does not experience pain during urination. |
7.82 |
57.27 |
34.91 |
9. Ulcers/sores in genital area can be signs and symptoms of STI in a man/woman. |
27.82 |
61.45 |
10.73 |
Table 4 depicts the comparison of the knowledge towards HIV/AIDS and STI’s and their year level. As gleaned on the table, the computed F-value of 1.74 was lesser than the critical F-value of 2.62 at 0.05 level of significance with 3 and 546 degrees of freedom.
| Table 4. Knowledge on HIV and AIDS and other STIs across Year Levels |
Source of Variation |
SS |
df |
MS |
F |
P-value |
F crit |
Between Groups |
1.390944 |
3 |
0.463648 |
1.736546 |
0.158423 |
2.621227 |
Within Groups |
145.7789 |
546 |
0.266994 |
|
|
|
Total |
147.1699 |
549 |
|
|
|
|
Table 5 shows the responses of the respondents on the different indicators relative to gender-related norms towards pre-marital sex, coercion/violence, and protection mechanism.
As evidenced on the table, dating among unmarried boys and girls is universal (91.45%), however sexual intercourse before marriage (68.36%) and sexual coercion are unacceptable (67.09%). More than half (55.81%) of the respondents think that most girls who have sex before marriage regret it afterwards, and that 77.27% disagreed that boy and girl should have sex before they become engaged to check for their compatibility. Majority (72.36%) of the respondents still uphold the value and essence of virginity. More than half (59.64%) of the respondents thought that boys/girls should be in love with someone before having sex, however 21.09% agreed that it is alright to have sex with each other provided that they use contraception. The idea of abortion was still unacceptable, as 62.18% of the respondents reported they would never contemplate having an abortion; however 54.18% were uncertain if their friends would think the same. Nearly half (46.18%) of the respondents felt that they knew how to use condom properly, however 53.82% were unsure if they could refuse to have sex with someone who is not prepared to use condom. Lastly, vast majority of the respondents (81.45%) were not in favor of one night stand and 72% claimed their friends are not in favor also.
| Table 5. Gender-Related Norms towards pre-marital sex, coercion/violence, and protection mechanism |
Indicators |
Agree/% |
Undecided/% |
Disagree/% |
1. I believe it’s all right for unmarried boys and girls to have dates. |
91.45 |
4.55 |
4 |
2. I believe it’s all right for boys and girls to kiss, hug and touch each other. |
43.64 |
21.82 |
34.54 |
3. I believe there is nothing wrong with unmarried boys and girls having sexual intercourse if they love each other. |
18 |
13.64 |
68.36 |
4. I think that sometimes a boy has to force a girl to have sex if he loves her. |
17.82 |
15.09 |
67.09 |
5. A boy will not respect a girl who agrees to have sex with him. |
38.36 |
29.27 |
32.36 |
6. Most girls who have sex before marriage regret it afterwards. |
55.81 |
33.27 |
10.91 |
7. Most boys who have sex before marriage regret it afterwards. |
26.18 |
38.54 |
35.27 |
8. A boy and a girl should have sex before they become engaged to see whether they suited for each other. |
10.18 |
12.54 |
77.27 |
9. I believe that girls should remain virgins until they marry |
84 |
6.36 |
9.64 |
10. I believe that boys should remain virgins until they marry. |
60.73 |
22 |
12.27 |
11. It is sometimes justifiable for a boy to hit his girlfriend |
10.91 |
25.09 |
64 |
12. Most of my friends think that one night that one night stand is OK. |
8.18 |
19.82 |
72 |
13. It’s all right for boys and girls to have sex with each other provided that they use methods to stop pregnancy. |
21.09 |
18.18 |
60.73 |
14. Most of my friends who have se with someone use condoms regularly. |
8.54 |
63.64 |
27.82 |
15. I am confident that I can insist on condom use every time I have sex. |
9.82 |
40.54 |
49.64 |
16. I would never contemplate having an abortion myself or for my partner |
62.18 |
21.64 |
16.18 |
17. It is mainly the woman’s responsibility to ensure that contraception is used regularly. |
25.09 |
40.18 |
34.73 |
18. I think that you should be in love with someone before having sex with them. |
59.64 |
18.36 |
22 |
19. I feel that I know how to use condom properly. |
15.09 |
46.18 |
38.73 |
20. Most of my friends would never contemplate having an abortion for themselves or their partner. |
30.54 |
54.18 |
15.27 |
21. Men need sex more frequently than do women. |
47.27 |
42 |
10.73 |
22. Most of my friends believe that you should be in love before you have sex with someone. |
56.18 |
29.09 |
14.73 |
23. I would refuse to have sex with someone who is not prepared to use a condom. |
24 |
53.82 |
22.18 |
24. One night stands are OK. |
5.82 |
12.73 |
81.45 |
Table 6 presents the comparison in the gender-related norms of the respondents across year level. The computed F-value resulted from the analysis was 0.58 which was lesser than the critical F-value of 2.62 at 0.05 level of significance with 3 and 546 degrees of freedom.
| Table 6. Gender-Related Norms of Student-Respondents across Year Level |
Source of Variation |
SS |
df |
MS |
F |
F crit |
Decision |
Between Groups |
0.261013 |
3 |
0.087004 |
0.577542 |
2.621227 |
Reject HO |
Within Groups |
82.2527 |
546 |
0.150646 |
|
|
|
Total |
82.51371 |
549 |
|
|
|
|
Table 7 shows the different contraceptive methods used by the students who engaged in sexual intercourse. As presented in the Table, 29.63% who engaged in sexual intercourse used withdrawal method and 20. 98% used condom as a method of contraception. Meanwhile, use of Intrauterine device (IUD) (1.23%) was the least sought method.
| Table 7. Contraceptive Methods used by Student-Respondents who engaged in Penetrative Sexual Intercourse |
Methods |
N |
% |
Ranking |
Natural Method |
Withdrawal |
24 |
29.63 |
1 |
Periodic Abstinence/Rhythm |
14 |
17.28 |
3 |
Calendar Method |
13 |
16.05 |
4 |
Artificial Method |
Condom |
17 |
20.98 |
2 |
Pills |
12 |
14.81 |
5 |
IUD |
1 |
1.23 |
6 |
TOTAL |
81 |
100 |
|
Discussions
This investigation explored gender-related norms and knowledge on HIV/AIDS and STI’s among education students in a government university in Samar, Philippines. It contributes to the growing body of knowledge regarding sexuality and reproductive health among youth.
Findings of the investigation suggest a lower rate of premarital sex (PMS) among respondents compared to the data gathered by the UP Population Institute [8] in 2002 with a rate of 23.2%. This result is an affirmation of the claimed of Raymundo, (1999) that the premarital sex behavior of young Filipinos can still be considered conservative when compared to the levels found in developed countries and some other countries in the Asian region.[15] Low rate of PMS may be attributed to the fact that adolescents and young adults in rural areas have narrower and more restricted ideas on sexuality, because of the family’s and church’s strong influence. In contrasts, youth in highly urbanized places are often exposed to sophisticated life and consequently receive more information on sex and sexuality.
Findings also revealed high percentage of unplanned sexual intercourse and non usage of contraception. Results were similar with that of the local surveys conducted [8] and with international studies conducted among youth sexuality.[4] McCann-Erickson noted that among those who have had sexual intercourse, over half (54%) do not use any contraceptives during sex.[16] YAFSS 2002 results also show that 62% of women reported that they did not use any contraception during their first sexual experience, while 25% of the males reported the same.[8] Furthermore, prominence of withdrawal as a method of contraception poses a great risk among youth for early pregnancy and spread and contraction of STI’s since the method do not offer protection against it.
One of the major findings of this investigation was the persistence of misconceptions regarding HIV/AIDS and STI’s. Findings indicated higher proportion of the respondents who think AIDS is curable. The result was significantly higher compared to the results gathered by the YAFS survey [8] in 2002 where in only 28% agreed that it is indeed curable. It is also worth noting that nearly half (40.54%) of the respondents believed HIV virus can be transmitted through mosquito bites. Although majority (77.64%) of the respondents were aware of other diseases that can be acquired during sexual intercourse, more than half of them were uncertain on what signs and symptoms to be expected if a woman/man has STI’s. And these results were true across year level. This result may be alarming since adequate knowledge on HIV/AIDS and other STI’s is necessary to protect them from acquiring such diseases. This result may be attributed to the fact that sexuality education is poorly incorporated in Philippine education curriculum. Moreover, teachers are still hesitant to introduce the concept of sexuality for the fear that it would just ignite the curiosity of its students towards sex.
Central finding of the study was the varying perceptions on gender norms among respondents across year levels. Result shows that dating among teens was universally accepted. This is in complete agreement with that of the result by the YAFS 2002 [8], where more than half (55.6%) of the respondents had gone out for date. This confirmed that Filipino youth continue to uphold the value of dating as a way to initiate acquaintances with the opposite sex, particularly in urban areas.
Result also affirmed that the idea of abortion among respondents was still unacceptable. Zablan reported that only a few adolescent girls (6.6%) and boys (4.6%) unconditionally approved of abortion.[17] In a study conducted in Baguio, Philippines 78% of students said that abortion was considered wrong regardless of circumstances.[18] This indicates that majority of the respondents still view an act of abortion as sin. The influence of Catholicism may have influenced to their way of thinking regarding abortion. Moreover, sexual coercion was also viewed as unacceptable among respondents. This result coincides with the study conducted by Ramiro where 45% and 29.3% of respondents perceived sexual coercion as “not okay” and “extremely not okay,” respectively. About 16% said that sexual coercion was “acceptable,” whereas 9.5% were noncommittal.[19] Meanwhile, in Wood’s study of young people in a South African township, the use of weapons or physical threats in rape situations, as well as verbal tactics, such as persuasion, blackmail, or verbal threats, was apparent.[20]
Strengths and Weakness of the Study
One of the strengths of this study is the inclusion of the entire population of education student in the university as respondents in the investigation. This ensures that there is no selection bias since respondents were not selected purposively. However, this investigation was conducted among education students from one university only. Exclusion of education students from other university in other provinces may limit the generalizability of this investigation.
Conclusions
Despite of the limitations posed by this investigation, our findings show that Filipino adolescents still hold conservative views regarding gender and sexuality. However, they face challenges such as greater access to correct and meaningful information on sexual and reproductive issues.
In view of the above findings, schools play critical roles in teaching and reinforcing the values of the culture and this holds especially true in areas of gender and sexuality. Every school should therefore provide adolescents with a non-stereotyped environment where they can mature and begin to adopt positive notions of gender and sexuality roles. School administrators must provide a range of information, skills and support relative to gender and sexuality to all students enabling them to deal with concerns and issues effectively. A curriculum of courses that would include age – appropriate gender and sexuality education maybe proposed in order to promote the sexual health of its students. The result also calls for a greater need for reviewing the existing policies and programs relative to reproductive health among its students for further improvement and enhancement.
Government entities and other non-government organizations (NGOs) should provide reproductive health (RH) information and education through counseling, training and dissemination of information, education and communication (IEC) materials in schools and other places of work in order to address the problems of accessibility and availability of adolescent reproductive health (ARH) services in most areas especially in rural areas.
This study focuses only on education students, thus, university wide study such as like this maybe done every one to two years in order to assess how the sexuality and gender norms of the students change. Furthermore, studies identifying other factors which may be related to gender and sexuality may be investigated.
Acknowledgement
Investigators would like to thank all the participants for their time and effort in responding to the questionnaires.
References
- United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2008 Revision, Available at www.esa.un.org/unpd/wpp2008/index.htm. Accessed October 2010.
- National Adolescent Health Factsheet for the Western Pacific Region. Manila. WHO Regional Office for the Western Pacific, 2011
- Index of population projection statistics. Republic of the Philippines: National Statistics Office. [Cited 26 September 2010.] Available from: http://www.census.gov.ph/data/sectordata/datapopproj.html
- Women and health: Today’s evidence, tomorrow’s agenda. Geneva, World Health Organization, 2009.
- How universal is access to reproductive health? A review of the evidence. New York, United Nations Population Fund, 2010.
- Multi-country study on women’s health and domestic violence against women. Geneva, World Health Organization, 2005.
- Ahman E, Shah I. New estimates and trends regarding unsafe abortion mortality. International Journal of Gynecology and Obstetrics. 2011;115:121-126.
- Young Adult Fertility and Sexuality Study (YAFSS3), National Datasheet 2002. Republic of the Philippines: Population Institute, University of the Philippines. [Cited 14 October 2010.] Available from: http://www.drdf-uppi.net/projYAFS3.htm
- Philippines National Demographic and Health Survey 2008. Republic of the Philippines and Calverton, Maryland: National Statistics Office and ICF Macro, 2009.
- Family Planning Organization of the Philippines. WarayWaray Youth Advocate Organization (WARAYA). 2007
- Department of Health National Epidemiology Center. Philippine HIV and AIDS Registry. May 2009
- United Nations Population Fund's 2011 Annual Report. Available at www.unfpa.org
- Paludi M, ed. Praeger Guide to the Psychology of Gender. Greenwood Publishing Group. 2004
- Cleland J. Illustrative Questionnaire for interview-Surveys with Young People. 2001. Available at http://www.who.int/reproductivehealth/topics/adolescence/core_instruments/en/index.html
- Raymundo CM, Xenos P, Domingo LJ. Adolescent Sexuality in the Philippines. Quezon City: UP Office of the Vice Chancellor for Research and Development. 1999
- McCann Erickson Philippines. The McCann Youth Study 2000 Edition: A Synopsis. (A media release). 2001
- Zablan ZC. The 2000 IEC Impact Survey in Apayao, Kalinga and Ifugao Provinces: A Project Final Report. DRDF, Inc., Quezon City. 2000. pp. 1-109.
- Cruz G, Diaz M. Baseline Survey on the Knowledge, Attitudes, and Practices of Adolescents and Adults on Reproductive Health. University of the Philippines-Baguio. 2001, June.
- Ramiro L. Physical Intimacy and Sexual Coercion Among Adolescent Intimate Partners in the Philippines. Journal of Adolescent Research. 2005;20(4):476-496 DOI: 10.1177/0743558405275170
- Wood K. Defining “forced sex, rape, streamline and gang-rape”: Notes from an African township. Paper presented at the Fourth Meeting of the International Research Network on Violence Against Women, Johannesburg, South Africa. 2001, January.
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