Aids-related knowledge, beliefs, sexual practices, community perceptions and selected enablers of young adults in eastern rural Jamaica PDF
Preview Aids-related knowledge, beliefs, sexual practices, community perceptions and selected enablers of young adults in eastern rural Jamaica
AIDS-RELATEDKNOWLEDGE,BELffiFS,SEXUALPRACTICES,COMMUNITY PERCEPTIONSANDSELECTEDENABLERSOFYOUNGADULTSINEASTERN RURALJAMAICA By SHAROND.MORRISON ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL OFTHEUNIVERSITYOFFLORIDAINPARTIALFULFILMENT OFTHEREQUIREMENTSFORTHEDEGREEOF DOCTOROFPHILOSOPHY UNIVERSITYOFFLORIDA 1998 Complexity,simplicity,allrolledintoone Playfijl,fulloflaughter,ourMarketMan Ken,Canute,Ken-Root,Rootisimus alwaysplantingseeds helovedthelandandhisfamilyindeed! Inlovingmemory CanuteHenryMorrison September25,1939-October26,1997 ACKNOWLEDGMENTS MygratitudeandthankstomyheavenlyFatherforinnerpeaceandstrength. My deepestappreciationforunfailinglove,supportandadmirationfrommyparents,Canute andSybil,andmysiblings,Lorraine,Paul,ColinandMaxine. ThankstoNadineA. Brown,whosevoiceandexampleoffriendshipwillalwayslingeron.Warmestthanksto thewomenof"LaPandilla"fortheirsenseofcomradery,emotionalsupport,simplebut fillingmealsandendlesscupsofcoffee. Muchthanksforthewordsofwisdomhanded downtomebythosesistersandbrotherswhohavegonebeforemeandfromthosewho arecontinuingonafterme. IextendmythankstotheyoungpeopleandcommunityleadersofSt.Thomas, Jamaica.Withouttheirgenerousinputandfeedback,thisprojectwouldnothavebeen realized. IespeciallythanktheManagerandEasternRegionalCoordinatorofthe NationalYouthServiceProgram,Jamaica,fortheirroleinallowingmetopursuethis venture. IthanktheCenterforLatinAmericanandCaribbeanStudiesforfundingthis project. IalsothanktheFloridaEducationFundforprovidingthefinancialsupportand motivationformydoctoralstudies. ManythankstoDr.CynthiaGarvanforherstatistical expertiseandencouragement. Also,manythankstoMrs.JoyNicholsonforherassistance withthetedioustaskoftranscribing. Finally,Iwishtothankmychair.Dr.Wei.William Chen,andmembersofmycommittee.Dr.SteveDorman,Dr.BarbaraRienzo,Dr. DeloresJamesandDr.AllanBums,fortheirguidanceduringthedissertationprocess. iii TABLEOFCONTENTS cage ACKNOWLEDGMENTS iii LISTOFTABLES vii LISTOFFIGURES ix ABSTRACT x CHAPTERS 1 INTRODUCTION 1 BackgroundoftheProblem 1 StatementofResearchProblem 3 ConceptualFramework 5 ApplicationoftheModel 9 PurposeoftheStudy 12 ResearchQuestions 12 ConceptualDefinitions 13 SignificanceoftheStudy 14 Delimitations 16 Limitations 17 Assumptions 18 2 REVIEWOFLITERATURE 19 Introduction 19 SocioculturalSetting 19 EpidemiologicalAspectsofAIDSinJamaica 23 Health,SexualityandHIV/AIDS 25 YoungAdultsandtheAIDSPandemic 29 PatternsofSexualBehavior 30 Knowledge,Attitudes,BeliefsandPractices(KABP)Studies 32 HIV/AIDSInterventionInitiatives 36 UtilityofthePEN-3Model 38 Summary 41 iv 3 DESIGNANDMETHODS 43 Introduction 43 Setting 43 ResearchDesign 45 Survey 45 Subjects 48 DataCollectionProcedures 48 DataAnalysis 50 RapidEthnographicAssessment 51 DataCollectionProcedures 52 DataAnalysis 55 EthicalConsiderations 56 4 RESULTSANDDISCUSSION 57 SurveyResults 57 SampleCharacteristics 57 ResultsofIndividualResearchQuestions 59 Discussion 72 Summary 78 RapidEthnographicAssessmentResults 78 KeyInformantCharacteristics 79 EthnosemanticAnalysis;PEN-3DomainsandThemes 79 CulturalTerms 81 ThematicAnalysis;LocalExplanations 93 CulturalAppropriatenessofThemes 102 Discussion 105 Summary 115 5 SUMMARY,CONCLUSIONSANDRECOMMENDATIONS 117 Summary 117 Conclusions 123 Recommendations 128 APPENDICES A AIDS-RELATEDKNOWLEDGE,BELIEFSANDSEXUAL PRACTICESPILOTSURVEYFORYOUNGADULTS 132 B INFORMEDCONSENT 142 C AIDSRAPINTERVIEWGUIDES 145 V REFERENCES BIOGRAPHICALSKETCH LISTOFTABLES Table 4-L Agedistributionofsurveysample 58 4-2. Characteristicsofsurveyparticipants 58 4-3. KnowledgeaboutHIVtransmission 60 4-4. KnowledgeaboutAIDSdisease 60 4-5. BeliefsaboutAIDSself-protectiveactions 62 4-6. BeliefsabouttheimportanceofAIDS 62 4-7. BeliefsaboutpersonalvulnerabilitytoHIV/AIDS 63 4-8. Typesofsex 63 4-9. Vaginalsexoverthepastyear 64 4-10.Vaginalsexoverthepastyearwithoutusingacondom 64 4-11.Vaginalsexoverthepastmonth 65 4-12.Vaginalsexoverthepastmonthwithoutusingacondom 65 4-13.ScoresforknowledgeaboutHIVtransmission,AIDSdisease,self-protection andbeliefsaboutAIDSimportance 66 4-14.Knowledgescoresbysexualpracticeoverthepastyear 67 4-15.Knowledgescoresbysexualpracticeoverthepastmonth 68 4-16.BeliefaboutAIDSimportancebysexualpracticeoverthepastyear 68 4-17. BeliefaboutAIDSimportancebysexualpracticeoverthepastmonth 68 4-18.Beliefaboutpersonalvulnerabilitybysexualpracticeoverthepastyear 69 vii 4-19.Beliefaboutpersonalvulnerabilitybysexualpracticeoverthepastmonth 69 4-20.Knowledgescoresbygender 4-21.BeliefabouttheimportanceofAIDSbygender 70 4-22.Beliefaboutpersonalvulnerabilitybygender 70 4-23.STDexperiencebysexualpracticeoverthepastyear 71 4-24.STDexperiencebysexualpracticeoverthepastmonth 71 4-25.Pearson'scorrelationmatrixforknowledgescoresoftransmission,AIDSself- protectionandbeliefscoresaboutimportance 71 4-26.ExamplesofaDomain 79 4-27 Localtermsandtheirusage 81 4-28.YoungadultperceptionsaboutAIDSasdisease 82 4-29.Youngadultperceptionsaboutsexualactivityandcondoms 83 4-30.Youngadultperceptionsaboutcondomavailabilityandaccessibility 84 4-31.YoungadultperceptionsaboutHIV/AIDSprevention 87 4-32.CommunityperceptionsaboutyoungadultsandAIDS 89 4-33.Communityperceptionsaboutyoungadults,sexandcondoms 90 4-34.Communityperceptionsaboutcondomavailabilityandaccessibility 91 4-35.CommunityperceptionsaboutHIV/AIDSprevention 92 4-36.PositiveAIDS-relatedthemes 103 4-37.ExistentialAIDS-relatedthemes 103 4-38 NegativeAIDS-relatedthemes .' 104 viii LISTOFFIGURES Figure Eage 1. ThePEN-3Model 7 2. MapofJamaica 20 ix AbstractofDissertationPresentedtotheGraduateSchool oftheUniversityofFloridainPartialFulfillmentofthe RequirementsfortheDegreeofDoctorofPhilosophy AIDS-RELATEDKNOWLEDGE,BELffiFS,SEXUALPRACTICES,COMMUNITY PERCEPTIONSANDSELECTEDENABLERSOFYOUNGADULTSINEASTERN RURALJAMAICA By SharonD.Morrison August1998 Chairperson:Dr.W.WilliamChen MajorDepartment;HealthandHumanPerformance YoungadultsinruralEasternJamaicaareatriskforHIVandAIDSwhenthey engageinunsafesex. Despiteuniversalknowledgeandawarenessabouttransmissionand protection,youngaduhsstillfosterHIV/AIDS-relatedmisconceptions,continueto underestimatetheirownvulnerabilityandtendnottoalterunsafepractices. Usingthe PEN-3modelasaconceptualframework,thepurposesofthisstudyweretodescribethe AIDS-relatedknowledge,beliefsandsexualpracticesofyoungaduhs;todetermine relationshipsbetweenknowledge,beliefsandsexualpractices;andtoassessthenatureand contextofknowledge,beliefsandpracticesbyexploringAIDS-relatedcommunity perceptionsandselectedcommunityenablers. Thisdescriptiveandexploratorystudyutilizedbothsurveyandethnographicfield methods. Thesurveysampleconsistedof58youngaduhsbetween18and24yearsold X
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