Physical And Psychological Health Investigation And Educational Intervention Among AIDS Orphans, And AIDS-related Knowledge, Attitude, Behavior Of Adolescents In China

Background:AIDS epidemic in the world has brought about a tremendous impact on children and adolescents especially AIDS orphans. AIDS orphans in China still have not been attached enough concern. Their vulnerabilities of living situation, physical/psychological health and life quality have not been fully revealed. Exploringappropriate health intervention mode to them is very necessary. Meanwhile, it is also important to investigate their HIV-related knowledge, attitude and behavior to provide scientific suggestions for the further formulation of relevant policies and eliminate the negative impact of HIV/AIDS on young people.Objectives:1. To evaluate AIDS orphans'physical/psychological health and quality of life, confirm their health needs, and provide basis for coping strategy of AIDS orphans crisis.2. To explore health intervention mode to children affected by HIV/AIDS which is suitable to the actual situation of the areas with high AIDS epidemic level.3. To investigate HIV-related knowledge, attitude and behavior status in quo of China's adolescents, primarily evaluate the special school education of HIV prevention project, and provide basis for further amendatory of relevant strategies.Methods:1. Adopting 1∶1 matching design according to gender and age, we selected 93 pairs of AIDS orphans and non-orphans aged 8~15 years from Zhecheng county of Henan Province. The orphans'vulnerabilities and heath needs were evaluated by comparing the living conditions, growth and nutrition level, psycological health and life quality.2. We designed the"life skills-based health education plans for children affected by HIV/AIDS ", and provided this health intervention to 104 students of No.2 middle school of Zhecheng country. Another 105 students were enrolled as control group to evaluate the educational effect.3. We designed"HIV-related knowledge, attitude and behavior questionnaire for middle school students ", using which, we investigated 6487 middle school students aged 10~20 years from 24 middle schools of Beijing, Zhengzhou and Tangshan.Results:1. No significant differences in morphological indicators between orphans and non-orphans except BMIZ and subscapular skinfold thickness. However, the vulnerabilities in psychological health and life quality of AIDS orphans were notable and lower self-esteem, higher depression level were found in them, which mainly existed in boy orphans. Lower self-esteem level and depression were proved to be inevitable consequences of AIDS orphanhood which played an important role of lower life quality.2. The participatory life skills education mainly focusing on HIV-related knowledge, care attitude, self-esteem and self-confidence was proved to have ideal acceptability, feasibility and effectiveness. The students'knowledge, attitude, self-esteem and self-confidence level increased significantly after the intervention. The boys'self-esteem and self-confidence level were both lower than girls before and after the intervention.3. China's adolescents had a relatively low level of HIV-related knowledge. Avoidance and discriminatory attitudes towards PLWHAs were obvious."Super-ego attitude" which established under the pressure of social approval should arouse special concerns because it could lead to disjunction between attitude and actual behavior. Sexual intercourse behavior and substance abuse in the adolescents were fewer than abroad similar studies, but the growth rates of premarital sex and its adverse consequences could not be ignored, such as unintended pregnant and forced sex.Students of Tangshan had significantly higher knowledge and attitude level than Beijing and Zhengzhou, but the proportions of risk behaviors were also higher. Boys had higher knowledge level, equal attitude level and more risk behaviors than girls, suggesting that the association among KAB in boys was weaker than girls.Conclusion:1. Being orphaned by AIDS would cause a series of negative impacts on children especially to boy orphans. The primary thing is to comprehensively improve the overall living standards of the children in poverty-stricken areas and explore the appropriate foster mode which can meet the children's needs of the normal physical and psychological development. Meanwhile, school-based HIV prevention education and psychological health intervention would be appropriate strategy.2. Participatory life skills education mainly focusing on HIV-related knowledge, care attitude, self-esteem and self-confidence could be spread among children affected by HIV/AIDS. More attention should be attached on boys in design and implementation of the intervention.3. HIV prevention school education in China should definitely be more deepin and systematic to provide comprehensive and convincing knowledge to the students. In key areas of HIV prevention, short-term programs can not replace the systematic classroom education and repeatability of objects and contents should also be avoided. In the areas with low epidemic level, more education activities which mainly focus on attitude and behavior should be implemented. Gender differences should also be seriously considered in the education.