Exploration of Knowledge, Attitudes and Percepions regarding Sexually Transmitted Infections among Patients Attending a Primary Health Care Clinic in Gauteng Part 1

Curationis 30(4): 21-30 Sexually transmitted infections are a major public health problem in South Africa. The high incidence and prevalence of sexually transmitted infections in South Africa pose a serious threat to public health for tw o m ain reasons. Firstly, the long-term consequences o f these infections are a major cause o f loss o f health or life, and secondly, sexually transmitted infections are important co-factors in driving the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. The control and prevention o f sexually transmitted infections has become an urgent priority. At a primary health care clinic, the nursing personnel experienced an increasing num ber of persons daily seeking treatment for sexually transmitted infections. The purpose o f the study was therefore to investigate the know ledge, attitudes and perceptions o f people seeking treatment at Stanza Bopape Clinic regarding sexually transmitted infections. The study was a contextual, quantitative survey. The population was all patients (15 years and older) who visited the clinic for a health-related problem during November 2004 to January 2005. The sampling method was convenient. The data gathering method was self-report using a structured questionnaire basic on current knowledge. The data analysis was done with descriptive statistics.


Background, rationale and research problem
Sexually transmitted infections are a major public health problem in South Africa (B allard et al., 2000:1).It has been estim ated that over three and a h a lf m illion patients in South A frica alone seek treatment for sexually transmitted in fections each year at public sector facilities.Many more are seen in private p ra c tic e an d o c c u p a tio n a l h e a lth s e rv ic e s .T h e h ig h in c id e n c e and p re v a le n c e o f se x u a lly tra n sm itte d infections in South Africa poses a serious threat to public health for tw o m ain reasons.Firstly, because the long-term consequences o f these infections are a m a jo r c a u se o f h e a lth y life lo st, particularly for w om en and children.Secondly, because sexually transmitted infections are im portant co-factors in driving the HIV epidemic (W ilkinson et al., 1997:1).
Though high rates of sexually transmitted infections are com m on globally, Landry an d T u rn b u ll (1 9 9 8 :1 ) re p o rt th a t h is to ric a lly , s e x u a lly tra n s m itte d infections have been overlooked in the global fight against infectious diseases.The result is a high mortality rate with premature loss of life, especially in the developing world.It is estimated that 333 million new cases of treatable sexually transm itted infections (excluding HIV/ AIDS and other viral sexually transmitted infections) occur every year, globally (Mulick etal., 2001:37).
The control and prevention o f sexually transm itted infections has becom e an urgent priority.Sexually transm itted in fectio n s spread rap id ly and if not promptly treated, can result in long-term complications.Since its detection in the West early in the 1980s, HIV/AIDS has become and rem ained a priority public health issue.In addition, HIV/AIDS has also directed attention away from other sexually transm itted infections and their consequences to the health and the well being o f the community.
At the prim ary health care clinic, the nursing personnel have experienced an increasing num ber o f persons seeking tre a tm e n t fo r s e x u a lly tra n s m itte d in fe c tio n s .T h e c l i n i c 's s ta tis tic s indicated that the incidence o f sexually transm itted infections, excluding HIV/ AIDS, for the period from June 2003 to May 2004 was 3782 compared to less than 2000 in the p rev io u s co rresp o n d in g period.The increased rate and increased number o f repeat diagnoses of sexually transmitted infections at the clinic were a concern to the registered professional nurses especially with the possibility of coexistence o f HIV.The incidence of other sexually transmitted infections and their possible consequences m akes it im perative that registered professional nurses working in prim ary health care develop specific prevention strategies to prevent sexually transm itted infections.
One strategy com m only em ployed to com bat infectious d iseases, is health education.W hilst health education is inadequate by itself, it is a key discipline th a t m u st be h a rn e s s e d in any com prehensive m anagem ent o f primary health care concerns.Naude, M eyer & van Niekerk, 2000:127) state that health education should move from its current d isease-p rev en tio n focus and should focus more on the prom otion of health.W ith the changed focus, the purpose would be to promote healthy behaviour before the onset o f the disease.Health education to promote a healthy sexual lifestyle is central to primary prevention.T h e h e a lth e d u c a tio n p ro g ra m m e s sh o u ld be b u ilt a ro u n d a fu lly participatory basis with key local leaders, inform ants and families.Clients often m obilise them selves only if they are reached w here they are on an equal footing (UNESCO, 2001:26).
The focus of the research was therefore to formally investigate the incidence of sexually transmitted infections at Stanza Bopape clinic and to develop community s p e c ific g u id e lin e s to re d u c e the in c id e n c e o f s e x u a lly tra n s m itte d infections the primary health care clinic.The focus of the current article (Part I) is to report one specific aspect of the study, nam ely the know ledge, attitudes and p e rc e p tio n s re g a rd in g se x u a lly transm itted infections in the community surrounding the prim ary health care clinic.Part II of this research will describe th e g u id e lin e s g e n e ra te d fro m the research.
The research problem reported on in this a rtic le w as as fo llow s: W hat is the knowledge, attitudes and perceptions of p eo p le se ek in g tre a tm e n t at S tan za B o p a p e C lin ic re g a rd in g s e x u a lly transmitted infections?The purpose was to gain an understanding o f the current knowledge, attitudes and perceptions of the specific com m unity to be able to develop community specific guidelines to im prove the knowledge, attitudes and perceptions of the community.

Theoretical framework of the study
The theoretical basis o f the study is the Health Promotion Model as described by P e n d e r, M u rd a u g h a n d P a rso n s

Context
T he study w as co ntextual in nature.B urns an d G ro v e (2 0 0 3 :1 4 ) d efin e contextual as a study that is done within a specific area and that the results of the stu d y w o u ld o n ly be v a lid fo r the s itu a tio n in w h ic h th e stu d y w as conducted.The study was conducted at Stanza Bopape Clinic.The clinic offers services for primary health care and is lo c a te d in M a m e lo d i, a to w n s h ip northeast o f Tshwane.

Design
The design chosen for the study problem is a quantitative survey.Bums and Grove (1999:56) define a quantitative survey design as the collection, integration and analysis of numerical data.The design was suitable for the research problem as numerical data was required to solve the research problem.

Population
According to Bums and Grove (1999:80), a population is the entire group o f person or objects that m eets the criteria the researcher is interested in studying.The target population for study problem are all patients (15 years and older) who visited the clinic for a health-related problem.However, the total population that attended Stanza Bopape clinic could not be included in the study due to time and financial constraints.To be able to reduce the target population, a specific p e rio d w as c h o se n , n a m e ly fro m November 2004 to January 2005 to serve as the sample for the study problem (Polit & Beck, 2004:731).
The sampling method was convenient.Brink (2002:39) refers to the convenience method as an accidental or availability sampling that involves choosing readily available people for the study.All clients, 15 years of age and older, who visited th e S ta n z a B o p a p e c lin ic d u rin g November 2004 to January 2005, and were w illing to partake in the study w ere invited to participate in the study.The sample size realised as 1694 (n=1694).

Data gathering
The data gathering method selected was self-report (B rink, 2006:146) using a structured interview (Burns & G rove, 2003:396).A structured interview was chosen due to the possibility of illiterate participants as well as participants who could possibly not read English.
The data gathering instrum ent w as a q u e s tio n n a ire .
T h e a im o f the questionnaire was to collect information on th e k n o w le d g e , a ttitu d e s and perceptions o f participants regarding sexually tran sm itted infections.The questionnaire was constructed based on previous instrum ents (D iale & Roos, 2000:138;Reddy etal., 2004:265;Khoza, 2004:39) and the theoretical basis o f the study.
A s p e c ts c o v e re d in th e q u e s tio n n a ire w as p rio r re la te d behaviour, perceived benefits o f action, p e rc e iv e d b a rrie rs to a c tio n , in te rp e rso n a l in flu en ces, situ atio n al in flu e n c e s , im m e d ia te c o m p e tin g demands and a com m itm ent to a plan of action.
The procedure for data gathering was as follows: •

Data analysis
A ccording to Brink (2006:170), data analysis is the ordering, categorizing, m a n ip u la tin g , s u m m a riz in g and describing o f data in meaningful terms.D e s c rip tiv e s ta tis tic s w ere u sed to describe and summarise information.As the questionnaire w as pre-coded, the data were entered directly in a prepared spreadsheet.The stored data in the Excel form at were then analysed using a SPSS 14.0 software programme.

Ethical considerations
The Validity and reliability was ensured by applying the following aspects: • Researcher.The researcher was employed at the Stanza Bopape Clinic.A trust relationship existed between the researcher, management and participants.

•
The proposal.The proposal was peer-reviewed and presented an in-depth description o f how the research would be conducted.
The questionnaire was also pre tested on a small num ber of participants from another clinic before the main data gathering.Two changes were made to the questionnaire after the pre-test.
• F ieldw orkers.Trained fieldworkers conducted structured interviews aim ed at assisting the participants in completing the questionnaire.
• Period.Data were only gathered during the planned period.
• Im proved truth value o f data.
Anonymity and confidentiality was maintained by numbering the questionnaires sequentially.The fieldworkers were also known to the p artic ip an ts and a tru st re latio n sh ip already existed between the two groups.As the participants were addressed in a

Results
The results will be described in term s o f the demographic profile of the sample and th e ir k n o w le d g e , a ttitu d e s an d p e rc e p tio n s o f se x u a lly tra n sm itte d infections.

Demographic profile
The    The perception of risk o f contracting HIV was investigated.W hen cross tabulated with the num ber o f sexual partners, the majority of the group (n = l 158) indicated that the risk o f HIV/AIDS affected them.O f this g ro u p , 78.3% had only one partner.There were however, still 8.5% that adm itted to having multiple sexual partners and 11.2% abstained from sex.O f the group (n = 5 10) who indicated that HIV/AIDS did not affect them, 88.8% of the group indicated having one partner and 5.1% had multiple sexual partners.
The influence o f the num ber o f sexual partners on the frequency o f condom use was also investigated and 36.6% o f the group (n=1369) who indicated having one p a rtn e r did not use co n d o m s w hen having sex.Infrequent use o f condoms was indicated by 36.2% and only 25.9% in d ic a te d th a t th e y a lw a y s u se d condom s.O f the group (n=124) who indicated having two partners, 51.6% used condoms sometimes, 26.65% used the condom s alw ays and 19.4% had n ev er used condom s.O f the group (n=27) who indicated having more than three p artners, 48.1% used condom s sometimes, 29.6% did not use condoms and 22.2% used condoms always.The results o f the study therefore provide evidence that approximately 25% of males never w ear condoms, regardless of the num ber o f sexual partners.

Knowledge about sexually transmitted infections
The participants were asked if they were k n o w le d g e a b le a b o u t s e x u a lly tra n s m itte d in fe c tio n s , an d 9 2 .6 % (n=1568) responded positively.A small group (6.9%; n -1 16) reported having no k n o w le d g e o f se x u a lly tra n sm itte d infections.The group who did not know about sexually transm itted infections consisted o f 32.8% females compared to 67.2% males and 80.2% of this group were single.
W hen age w as investigated w ith the p a rtic ip a n ts' k n o w ledge o f sexually tran sm itte d in fec tio n s, o f the group (n=1568) who indicated knowledge of sexually transm itted infections, 45.3% were from 21-30 age group.The age group 31-40 ranked second (24.6% ) followed by the 15-20 age group (18.6%).Investigating the group who professed no knowledge o f sexually transm itted infections, most participants were in the 15-20 age g ro u p .In th is g ro u p , a significant difference existed between male (8.3%) and female (23.0%).The results indicate that one in five young w om en betw een 15-20 years o f age ad m itte d an a b se n c e o f k n o w led g e regarding sexually transmitted infections.
To in v e s tig a te th e v a lid ity o f th e participants' claim to be knowledgeable, sev eral co n te n t q u estio n s reg ard in g sexually transm itted in fections w ere asked.H igh correct percentages for these questions would corroborate the level o f know ledge professed by the particip an ts.T he co n ten t q u estio n s T h e m a jo rity o f the particip an ts (87.4% ) knew only one m ethod for transm issions o f sexually transm itted infections.A small group (3.7% , n = 62) c o u ld not a n sw e r the question correctly.

Knowledge regarding various sexually transmitted infections
The respondents were asked to list three different sexually transmitted infections.A ny o f th e s e x u a lly tra n s m itte d infections were accepted as correct, for example HIV/AIDS, gonorrhoea, syphilis or Chlamydia.It was not expected o f the participants to know the proper scientific name o f the infection.
As indicated in the Figure 2, only 12.4% of the males and 9.1 % of the females knew at le a s t th re e se x u a lly tra n s m itte d infections.There were varying levels of knowledge between male and female.A group of participants could not name any sexually transmitted infections.Though the group was small (4.6% males and 9.1 % of the females) the group translates to 122 individuals.
W ith re g a rd s to th e in d e p e n d e n t variables, no clear trend was obtained in terms o f educational level.Regarding the age groups (Figure 3), important trends did appear.The 15-20 age group had the highest percentage in terms o f no correct answ er (12.5%) and one correct answer (52.3%) and the lowest for two and three correct responses (29.7% and 5.5%).

Knowledge of signs and symptoms of sexually transmitted infection
To be able to determ ine if w hat the respondent considered as knowledge was valid, a question was asked on what are the signs and sym ptom s o f sexually transm itted infections.T rends becam e clear w hen the k n ow ledge re g a rd in g sig n s and sym ptom s o f sexually transm itted infections and num ber o f sexual partners w ere cross tabulated.Almost half (47.8%) of the group who abstained from sexual relationships, did not know any signs and sym ptom s of sexually transmitted infections (Figure 4).T he group w ho had m ultiple sexual p a rtn e rs sh o w ed an in c re a s e in knowledge, with 37.7% knowing at least tw o signs and sym ptom s o f sexually transmitted infections.

Knowledge regarding complications of sexually transmitted infections
Knowledge regarding complications due to sexually transmitted infections were also investigated.Again, the majority of participants (54.7% m ales and 63.6% females) demonstrated lack of knowledge regarding the complications of sexually transm itted infections.Participants were asked to indicate if they had a previous diagnostic test for HIV, syphilis or a Pap sm ear for cervical infections.The overall reported level of diagnostic testing was low.The highest was testing for HIV (23%), followed by a Pap sm ear (10% ) and lastly Syphilis (5.8% ).Investigating the group who reported having had a HIV diagnostic test, 28.7% o f the participants were in the 41 and older age group, 25.8% in the 21-30 age groups 24.9% in the 31-40 age groups.

Knowledge of availability and location of condoms
The im portant role condom s play in p re v e n tin g s e x u a lly tra n s m itte d in fe c tio n s is c ru c ia l and ca n n o t be overemphasized.Therefore the ability to identify areas of condom distribution was included to examine whether condoms and condom use were a priority.The p a r tic ip a n ts w ere ask e d se v e ra l q u e s tio n s re g a rd in g c o n d o m s, the availability o f condoms, locations and frequency o f use.W hen asked about a c c e s s to c o n d o m s, 9 5 .5 % o f the p a rtic ip an ts in d icated th at they had access to condoms and 95.2% reported that the condoms were readily available.In term s o f the location o f condom s, 79.3% o f participants reported getting condom s from the clinic and 8.1% of participants indicated buying condoms from the shops.Some people indicated that they received condom s from the phone shops (7.1%).

Condom use
The participants were asked to indicate the frequency o f condom use (Figure 6).T h e r e g u la r an d c o n s is te n t use o f condom s is an indicator o f an action taken to prevent sexually transm itted infections.Across all four age groups, so m e p a rtic ip a n ts w e re n o t u sin g condoms.The highest percentage was in the 40+ age group (63.4%).Three in ten participants (32.1 %) in the 15-20 age g ro u p did not use condom s.If the som etim es and never ca teg o ries are com bined, betw een 63.0% (15-20 age group) and 83.3% (40+ age group) are in d a n g e r o f c o n tra c tin g a se x u a lly tran sm itted infection.In v estig atin g se x u a l p re fe re n c e in te rm s o f the frequency o f condom use, 38.9% o f the heterosexual group and 69.6% o f the homosexual group indicated not using condom s.In term s o f gender, m ore fem ales than m ales reported not ever u sin g a co n d o m (4 0 .4% fe m a le s compared to 35.0% males).In addition, the availability o f a personal condom was reportedly important to only a minority o f the sam ple.The m ajority o f the participants (76.7% ) did not carry a condom 'just in case'.Only 18% o f the p a rticip an ts stated that th ey alw ays carried a condom.

Recommendations
Several recommendations emanate from the study:

•
Different ways of intercultural communication with ethnic m inorities should also include the handicapped using non verbal communication, so that they can be informed about early detection and treatment of sexually transmitted infections.• M ethods to improve a culture of testing for sexually transmitted infections must be investigated.
• Curricula should focus on health education with health promotion as a primary strategy to empower the community to be in control of their own health.
• Age specific strategies must be explored and practiced to ensure that the registered professional nurse is proficient in teaching all age groups.
• The use of the syndromic m anagement in the clinic for educating the community regarding sexually transmitted infections should be evaluated and adapted to ensure success.

Conclusion
(2002:Chapter 3).The Health Promotion M odel is an integrated perspective that d e p ic ts th e ra n g e o f b e h a v io u ra l influences to be addressed in nursing interventions in order to increase healthp ro m o tin g b e h a v io u rs (P e n d e r, M urdaugh & Parsons, 2002:75).
ethical standards proposed in the position paper o f the Democratic Nursing Organization o f South Africa (1991) for n u rsin g re se a rc h e rs w ere follo w ed .C o n s e n t to c o n d u c t the stu d y w as obtained from the Faculty Research and Innovation Committee o f the Faculty of S c ie n c e , th e E th ic s C o m m itte e o f Tshwane University of Technology, and the management of Stanza Bopape clinic.All the participants were requested to c o m p le te th e c o n s e n t fo rm b e fo re participating in the research.Sufficient in fo rm a tio n in an u n d e rs ta n d a b le language about the study was provided to all participants, and they were informed that they could withdraw from the study at any tim e for any reason.A n o n y m ity and c o n fid e n tia lity w as ensured by numbering the questionnaires sequentially.A ccording to Polit and Hungler (1999:35) participants have the rig h t to fa ir and equitable treatm ent b e fo re , d u rin g , and a fte r th e ir participation in the study.Fair treatment was ensured by including all participants w ho w ere w illing in the study in the predeterm ined period.The p riv acy o f the p articip an ts was m aintained at all times.The self-respect and d ig n ity o f the p a rtic ip a n ts w as e n s u re d (P a ra h o o , 1 9 9 7 :2 7 6 ), and participants had access to the researcher at any point during the study to clarify in fo rm a tio n a n d p re v e n t misunderstandings.No harm was caused to p a rtic ip a n ts in th e study.T he fieldworkers were registered professional nurses working at Stanza Bopape clinic and were thus known to the participants.Validity and reliability A c c o rd in g to L o B io n d o -W o o d and H a b e r (2 0 0 2 :5 0 2 ), v a lid ity is the determination of whether a measurement instrument actually measures what it is purported to m easure.R eliability is concerned with consistency, stability and r e p e a ta b ility o f th e in f o r m a tio n 's accounts as well as the investigator's ability to collect and record information accurately (Bums & Grove, 2003:374).

FIGURE 1 :
FIGURE 1: Age and multiple sexual partners or abstinence (n=1693) k n o w le d g e , a ttitu d e s and p e rc e p tio n s re g a rd in g se x u a lly transmitted infections will be presented in terms o f the num ber o f partners and the knowledge regarding various aspects o f sexually transmitted infections.Number of partners T he n u m b er o f sexual p artn ers w as in v e stig a te d as it w as co n sid e red a practice-based question bearing light on knowledge, attitudes and perceptions.As knowledge, attitudes or perceptions do not necessarily tran slate into action, determ ining the num bers o f partners would provide a suggestion o f the study sample's sexual behaviour.An increased number o f sexual partners would suggest an increased risk to acquire a sexually transmitted infection and possibly HIV.The majority of the participants (81.5%) reported having one sexual partner.In terms o f gender, more females (86.6%) than males (73.3%) indicated one partner.If all categories that indicate m ultiple sexual partners are com bined, 16.4% of the m ales and 4.5% o f th e fem ales in d ic a te d m o re th a n o n e p a rtn e r.Approximately one in ten (10.1 % males and 8.6% fem ales) o f the respondents abstained from sexual intercourse.

FIGURE 2 :
FIGURE 2: Percentage of correct responses regarding different sexually transmitted infections (n=1695) FIGURE 3: Age and correct responses regarding various sexually transmitted infections (n=1695)

W
hen sexual preference was investigated w ith th e k n o w le d g e re g a rd in g the com plications o f sexually transm itted infections, o f the heterosexual group (n=1589), the m ajority (61% ) o f the p a rtic ip a n ts d e m o n s tra te d la c k o f knowledge.O f the homosexual group (n = 6 6 ), a m a jo rity (6 8 .2% ) o f the participants indicated know ledge.In terms of educational level, 82.0% of the group who indicated knowledge had a secondary education compared to 73.8%

FIGURE 4 :FIGURE 5 :
FIGURE 4: Knowledge regarding signs and symptoms of sexually transmitted infections and number of current partners (n=1686)

FIGURE
FIGURE 6: Age groups and frequency of condom use (n=1693) transm itted infections is an essential com ponent in guiding individuals and communities to engage in protective and preventive actions against infections.It can be noted from the research that g e n e ra lly , th e re is a low le v e l o f k n o w le d g e a m o n g st th e p a tie n ts .Though 92.6% reported that they are k n o w le d g e a b le a b o u t se x u a lly transmitted infections, the results o f the Curationis December 2007 study indicate the opposite.Evidence for the statement is as follows:

A
possible reason for the low level of k n o w le d g e re g a rd in g s e x u a lly transm itted infections is suggested by Houts et al. (2005:3).The authors state that health education provided by health w o rk e rs is o fte n p ro b le m a tic .Professionals com m unicate with clients using technical jarg o n because o f its familiarity, precision and because of a lack of non-technical words to address health issu e s.T h e re fo re th e in fo rm a tio n provided by health w orkers becom es useless as patients did not understand much about it.The current methods used at Stanza Bopape clinic include public lectures, distribution of condoms and the operations of the Love Life Centre.Very little o n e -to -o n e e d u c a tio n a b o u t a person's specific needs occur due to lack o f tim e. T he p erso n n el rely on the syndromic care m anagem ent to manage sexually transm itted infections.These m e th o d s sh o u ld be in v e s tig a te d to g e n e ra te e v id e n c e re g a rd in g th e ir efficacy in reducing the incidence of sex u a lly tra n sm itte d in fe c tio n s.In a d d itio n , N e e d h a m e t al. (2 0 0 6 :1 ) indicated that low health literacy may contribute to the high rates o f sexually tra n s m itte d in fe c tio n s in p e o p le .However, the level of health literacy in the com m unity being served by Stanza Bopape clinic is not known and has not been researched.S everal other im plications for future interventions became apparent from the results o f the study.Evidence revealed specific risks for the 15-20 age group.These risks include 15.6% of the males having multiple sexual partners.Their ro le m o d els a lso e x h ib it th e sam e behaviour.Also, the results indicate that 72.5% o f the m ales and 83.3% o f the females in the 15-20 age group are sexually a c tiv e .T h o u g h se x u a lly a c tiv e , a significant group o f fem ales (23.0% ) p ro fessed no know ledge o f sexually transm itted infections.The reality is an increased risk of being infected.Also, a h ig h p e rc e n ta g e (4 5 .3% ) had no knowledge o f the signs and symptoms o f sexually transmitted infections.An even higher percentage (82.6%)could not lis t tw o c o m p lic a tio n s o f se x u a lly transmitted infections.In addition, there is a lack o f c o n siste n t co n d o m use (63.0%).

S
ex u ally tra n sm itte d in fe c tio n s are com m on and are the cau se o f high morbidity and mortality in South Africa.F u rth e rm o re , th e re d u c tio n o f th e in c id e n c e o f se x u a lly tra n s m itte d infections is an im portant tool in the prevention of HIV/AIDS.The knowledge g e n e ra te d in th e c u rre n t stu d y is important in terms o f the age groups of infected individuals and the knowledge o f the com m unity served by Stanza B o p a p e c lin ic .T h e c u rre n t h e a lth e d u c a tio n p ra c tic e s o f re g is te re d professional nurses in the primary health care clinic must be investigated as the desired outcome, namely knowledgeable clients with a low sexually transmitted infection rate is far from the current reality.Based on these findings, guidelines for reducing sexually transmitted infections will be discussed in Part 2 of this research.B U R N S , N & G R O V E , S K 1999: Understanding nursing research.2nded.Philadelphia: WB Saunders.B U R N S , N & G R O V E , S K 2 0 0 3 : Understanding nursing research.3rd ed.Philadelphia: WB Saunders.D EN O SA 1991: Ethical standards for n u rse r e s e a r c h e r s , p o s itio n p a p e r.Pretoria: SANA.D IA L E , D M & R O O S , SD 2 0 0 0 : P ercep tio n s o f sex u ally tra n sm itte d diseases among teenagers.C urationis.23(4), Dec.:136-141.HOUTS, PS; DOAK, CC; DOAK, LG & L O S C A L Z O , L 2005: T he role o f p ic tu re s in im p ro v in g h e a lth communication: a review o f research on attention, com preh en sio n , recall and adherence [Online].Available from: file:/ / w w w .s c i e n c e d i r e c .c o m / s c i e n c e [Accessed: 25/04/2006], K H O Z A , L B 2 0 0 4 : A d o le s c e n ts ' kno w led g e, b e lie fs and e x p erien ces regarding sexual practices.Health SA Gesondheid.9(3):34-41.LANDRY D J & TU R N B U L L W 1998: Issues in b rie f issu e no 2: sex u ally tra n s m itte d d is e a s e s h a m p e r developm ent efforts.New York: Alan Guttm acher Institute.L oB IO N D O -W O O D G & H A B E R J 2002: Nursing research: methods, critical appraisal and utilization.5th ed.St Louis: Mosby.M U LICK , S; M CCOY, D; BEKSINKA, M & M O Y S, A 2001: Evaluating the quality o f care for sexually transm itted in fe c tio n s u sin g d is tric t S T I c lin ic assessment.Durban: Gang.N A U D E , M ; M E Y E R , S & VAN N IE K E R K , S 2000: The nursing unit m a n a g e r: a c o m p re h e n s iv e g u id e .Sandton: Heinemann.N E E D H A M , H E ; W IE M A N N , C M ; T O R T O L E R O , SR & C H A C K O , M R 2 0 0 6 : H e a lth lite ra c y , re a d in g com prehension and risk for sexually transmitted infections in young women.Journal of Adolescent Health.38 (2), Feb: 105-110.professionals.2nded.Cape Town: Juta.P A R A H O O , P 1997: Nursing research: principles, process and issues.London: M acmillan Press.P E N D E R , N J; M A U D A U G H , C L & PARSONS, MA 2002: Health promotion in nursing practice, 4lh ed., New Jersey: Prentice Hall.P O L IT , D & H U N G L E R , B P 1999: N u rs in g re s e a rc h : p rin c ip le s and m e th o d s. 4 th ed.P h ila d e lp h ia : Lippincott.PO LIT, DF & BECK , C T 2004: Nursing research: principles and methods.7th ed.Philadelphia: Lippincott.REDDY, P; M E Y E R -W E IT Z , A; VAN DEN BORNE, B; KOK , G & W EITJTS, W 1999: The learning curve: health education in STI in South Africa [Online].A v a ila b le fro m : f ile :// E :\S T I% 2 0 h e a lth 2 0 e d u c a tio n .htm [Accessed: 10/05/2005], U N ITED NATIONS ED U C A TIO N A L S C I E N T I F I C A N D C U L T U R A L O R G A N IS A T IO N 2001: A cultural approach to HIV /AIDS prevention and care, culturally appropriate information Education/Communication elaboration & delivery.UNESCO.WILKINSON, D; RAM JEE, G; STURM, AW & K A R IM , SA 1997: Reducing S o u th A fric a n h id d e n e p id e m ic o f sexually transmitted infections.South Africa: Medical Research Council.
group until 40 years o f age (15.6%, 17.0%, and 17.1%).The highest num ber o f abstinent males (27.5%) is also in the 15-20 age group.In the female group, approximately two in ten females (21.9%) in the 40+.age group reported abstinence.In the 15-20 age group, only 14.7% were abstinent compared to 27.5% in the equivalent male group.Stated in opposite term s, the results indicate that 72.5% of the males and 83.3% o f the females in the 15-20 age group were sexually active.