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SEXUALITY AND SEXUAL BEHAVIOUR IN MALE ADOLESCENT SCHOOL STUDENTS
SHARMILA S PATIL***, RAMESH CHATURVEDI**, MANISH B MALKAR*
***Lecturer; **Professor; *Intern, Department of Preventive and Social Medicine, Seth Gowardhandas Sunderdas Medical College and KEM Hospital, Parel, Mumbai 400 012.
A cross-sectional community based study was conducted on 120 male adolescents in June-July 2001 in an Urban slum community in Mumbai.
87.5% of the respondents had received information about sex and sexuality from their peers and older friends. Nocturnal emissions and masturbation were the major health concerns for 40% of those interviewed; 7.5% were sexually active.
INTRODUCTION
Adolescents comprise 20 per cent of the global population, 85 per cent of whom live in the developing countries. Further more the adolescent population in developing countries is expanding, with the number of urban youth growing to a projected 600 per cent between 1970 and 2025. Twenty one per cent (210 million) of India's population is in the age group of 10-19 years.[1]
"Adolescence" refers to the development period between the age group of 10-19 years.[6] Adolescence is a period of deep emotional changes. These changes unsettle a number of adolescents leading an adolescent becoming unduly self conscious or somewhat imbalanced in responses which occasionally can last throughout life.[6] Adolescence is also the period of experimentation which exposes the youth to health risks through drugs, alcohol, tobacco use, irresponsible sexual behaviour etc.[5]
"Sexuality" refers to the total sexual make up of an individual, covering the physical aspects, attitude, values, experience and preferences.[3] Frequently, sexuality presents, the first challenge to healthy growth and development during adolescence. Often unplanned and sometimes forced, adolescent sexual relations occur before young people acquire adequate knowledge about contraception, sexually transmitted disease or health services available to them.[2] During their development from boyhood to man adolescent males are often expected to prove their "masculinity" to their peers to elders. The behavioural expression of "musculinity" is not determined by biology; it is largely acquired through socialization leading to the internalization of a set pattern of "male" attitudes and values. Adolescent boys learn their societies interpretation of "masculinity" from their parents, peers, the mass media and by observing the behaviour of adults. The developmental processes of the childhood and adolescent years, combined with the traditional requirements with masculinity define the sexual scripts for many young males.[2]
Several studies conducted on Indian adolescent have found that many adolescents particularly males are sexually active and are likely to indulge in unsafe sexual activities making them vulnerable to STD's including HIV infection.[4]
According to estimate by UNAIDS, by the end of 1999, there were already 33.6 million people worldwide with HIV infection altogether more than four million children under the age of 15 years and more than 10 million young people (15-24 years) have been infected with HIV since the epidemic began.[5]
Unfortunately the needs of adolescents have not been addressed by the health system. Only recently the reproductive child health programme has included all males and adolescent females as target groups.
Hence efforts were taken to conduct a study on sexual behaviour and sexuality among young adolescent boys. The study also aims to throw light on their awareness regarding STD, HIV and AIDS.
MATERIAL AND METHODS
A cross-sectional study was conducted in secondary Municipal School in Malvani, an Urban slum in western Mumbai during June - July 2001, Male adolescent students were selected by the method of systemic random sampling from class IX Students were selected both from Marathi as well as Urdu Medium.
The objectives of the study were to study sexual behaviour and sexuality among adolescent boys and also to identify awareness regarding STD, HIV and AIDS.
A pretested proforma was used for conducting individual interviews to document pattern of sexual behaviours and awareness related to STD, HIV and AIDS. A descriptive study design was planned.
Before commencing the study, a brief explanation of the purpose of the study was given by the investigators, to the school students. Participation in the study was entirely voluntary. A large room was selected for personal interviews and seating was arranged in such a manner that each participant had privacy in responding to the itneviewers.
The interview were conducted in Hindi/Urdu or Marathi language.
The adolescents aged between 13-17 years were selected. There were four IXth standard division each in Urdu and Marathi medium. There were total 158 male students in IXth standard class. The schools were visited three times to contact those students who were absent. Due to exclusion of students above 17 years of age and absenteeism only 120 students could be interviewed. The study was conducted between June and July 2001.
RESULTS AND DISCUSSION
The demographic characteristics are presented in Table 1
Parameters Age (yrs) 13-14
15-17
72 (60.0)Type of family : Nuclear
Joint
32 (26.66)Working after school : Yes
No
88 (73.34)Figures in Parentheses indicate percentage.
60 per cent of the students were between the ages of 15-17 years and the rest 40 per cent were between 13-14 years. Majority (76.66%) belonged to nuclear families while 23.34 per cent were residing in joint families, 32 (26.66%) were working after school hours in small-scale industries (like embroidery and zari units) and were financially independent.
Communication between parents and adolescents
Regarding interaction between male adolescents and their parents about issues related to reproductions and sexuality 98.33 per cent replied in the negative only 1.67 per cent said that they discussed the issues with their parents.
Source of information
Respondents were asked about the sources of information for sexuality and sex related issues. 105 boys (87.5%) replied that they received such information from peers, elderly friends, 27 (22.5%) were aware because of television, films and video parlour shows, whereas 8 (6.7%) sought information from roadside book vendors.
Verma Ravi Kumar on his reproductive health issues on men mentions films and television as media channels through which boys were enlightened about reproduction. He mentions streets becoming libraries of knowledge of sex and some times even laboratories.[2]
Reproductive health and sexuality concerns
Majority of the boys 72 (60%) stated that there were no concerns, whereas 48 (40%) mentioned nocturnal ejaculation i.e. 'wet dreams', masturbation and concerns because of excessive masturbation in order of priority.
Awareness about 'Virginity' and 'Homosexuality'
114 (95%) respondents were not aware about the concept of virginity whereas 6 (5%) adolescents were aware of the meaning to the satisfaction of the interviewer. Approximately equal number 112 (93.4%) were not aware about homosexuality but 8 (6.6%) did confess about the meaning and certain boys practising in the community.
MASTURBATION AND NOCTURNAL EMISSION
Nearly 111 (92.5%) respondents were aware of masturbation. Only 9 (7.5%) showed ignorance. Out of the 111 adolescents who were aware, 20 (18.01%) were regularly masturbating whereas 91 (81.98%) said they never practised it till date.
108 (90%) out of the total respondents opined that masturbation was not a healthy practice. The reasons furnished for the same were varied, but majority (70%) of them said that it causes weakness in the body, makes one's body weak because of which one may not be able to perform the sexual act successfully in future. Some of them (9.2%) believed that the growth of the penis would become stunted whereas 7 (5.8%) respondents said that the penis would grow excessively large. A few (4.2%) also mentioned that masturbation would make the penis "diseased" but were unsure of the type of "disease" that would occur.
Nearly 77 (64.16%) adolescents accepted they were aware of the entity which is termed "swapna dosh" wet dreams in the vernacular language. But out of the 77 respondents who were aware only 22 (18.33%) confided that they had experienced nocturnal emissions. The rest 43 (38.33%) respondents were totally unaware of this practice, even when probed, by using various colloquial terms.
A study on adolescent males in rural Maharashtra also has reported nearly one third i.e. 84 (33.6%) of the males (150 married and 100 unmarried) accepted indulging in masturbation and had several notions about the same. Over half (58%) of the married males and 51 per cent of unmarried males admitted having experienced 'wet-dreams'.4 Another study by Tripathy et al mentions that boys often have misconceptions related to potency, masturbation and other sexuality related issues, nor do they have reliable sources of information to depend on.[3]
SEXUAL EXPERIENCES
About 9 (7.5%) students admitted to indulging in sexual intercourse.
Out of those who practised the sexual act, only one respondent always used condom as a protective measure. Another student had also used condom but only during sexual act with commercial sex workers.
One interesting finding in the present study was, out of the 9 boys who admitted to indulging in sexual acts, 2 (22.22%) of them had indulged with commercial sex workers whereas the rest of the 7 (73.78%) boys had physical relations with neighbourhood girls or their school mates. The protected intercourse was practised only by those two who indulged in sexual act with commercial sex workers whereas the rest seven boys who practised sex with their neighbourhood girl friends did not use any protective method. The reasons stated for this behaviour was that the neighbourhood girls were not "Kharab" i.e. were considered free from disease affliction and not indulging in sex with other men.
A NARI study in Pune aimed at understanding sexual behaviour and possible risks to AIDS/HIV among college youths, reported sexual experience with those of the same and opposite gender, more so by boys including having sex with commercial sex workers. One third reported condom use, only a fifth its consistent use. Knowledge of sexually transmitted diseases was also limited.[5]
Table 2 shows that none of the respondents knew about the abbreviation "HIV" or its full form; whereas 115 (95.84%) stated that they were aware about "AIDS" though none of them ware able to tell the full form of the abbreviation in the vernacular language also. 7 (5.83%) students were aware about "STDs" which is known as "Guptarog" in Hindi/Marathi and about their mode of transmission.
Parameters Disease Awareness Awareness about routes of Transmission 1) MSP/CSW 2) Infected blood and needles 3) MSP/CSW/Infected blood and needles 4) "Don't know" Awareness about prevention 1) Avoiding MSP/CSW 2) Avoiding MSP/CSW/ Infected blood and needles 3) Using condoms 4) "Don't know" Figures in parentheses indicate percentage MSP = Multiple sexual partners; CSW = Commercial sex workers; STDs = Sexually transmitted disease.
Regarding awareness about routes of transmission 55 (45.84%) students stated multiple sexual partners as the cause of transmission of HIV/AIDS. 46 (38.33%) of the respondents were aware about both the routes i.e. multiple sexual partners and infected blood, needles, whereas only 2 students said that infected blood, needles were the only route of transmission. None of the students stated mother to foetus transmission. 18 (50%) students were unaware about any route of transmission.
These findings indicated that without any intervention like health education or special awareness programmes, knowledge about AIDS and its major routes of transmission among the school going adolescents is quite high. This may be attributed to exposure to mass media.
On awareness about prevention of HIV/AIDS, 45 (37.5%) students said that HIV/AIDS could be prevented if one avoids multiple sexual partners and commercial sex workers 22 (17.9%) respondents opined that HIV/AIDS could be prevented by not having multiple sexual partners as well as by using disposable needles, or properly sterilized needles along with avoiding infected "Kharab" blood. Another 25 (20.8%) knew about use of condoms during sexual act as a mode of protection. 23 (19.2%) were totally unaware about any preventive measure.
CONCLUSION
The findings of the present study indicate the urgent need for educational interventions. Correct scientific information should be disseminated to adolescents both in formal and informal settings so that they do not pick up sexual myths and misconceptions from their peers.
This study revealed that 7.5 per cent of the respondents were sexually active. It is possible that the others may not have been very frank in replying to queries. Though this was community based study, the sample size is rather small, sexual activity and sexuality related misconceptions among adolescents may be the proverbial "tip of the ice - berg".
REFERENCES
1.Man power Profile India, Institute of Applied Manpower Research IV Edition, Manak Publications New Delhi, Year Boo 1996.
2.Verma Ravikumar. Reproductive Health Issues, Focus on Men. IASSI Quarterly. 1997; 16 (3 and 4) : 172-82.
3.Mawar N, Tripathy SP, John JK, Sinha SK, Quiraishi SY, Bagul R, Gadkari DA. Youth sexuality study for behaviour change interventions for AIDS/HIV in college youth", Pune, India XII International AIDS conference, Geneva, 1998; Abstract No. 14333.
4.Mutakar RK, Apte Hemant. Sexual behaviour amongst adolescents in rural western Maharashtra. AIDS Research and Review. 1999; 12 (2) : 89-94.
5.ICMR, Bulletin. 1999; 29 : 12.
6.RCH Newsletter 2001; 2.
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