INTRODUCTION

All young people worldwide are under risk of sexually-transmitted diseases (STD). STD consists of diseases such as syphillis, hepatitis B and C, gonorrhea, HIV and trichomoniasis. The risk increases due to lower age of contacting sexual issues, early starting age of sexual activities and increasing age of marriage. Lack of information and skills about STD and prevention in young people and difficulties in access to preventive measures cause higher incidence of these diseases (1). Adolescence and youth are periods which people discover sexuality and become sexually active but not having adequate experience and information. This confronts them with undesired pregnancies, complications of these pregnancies and various problems like STD. For this reason, increasing information of this age group about sexuality and family planning (FP) is important for general public health (2).

Substance abuse which is a widespread social problem can cause several complications which may threaten life. STD come first among these complications. It was reported that intravenous substance use which is an important risk factor for STD is increasing in our country (3,4). It was also shown that STD are increasing in Turkey as well (5). When HIV/AIDS cases in Turkey are examined according to transmission routes, it was shown that etiological causes were heterosexual sexual contact in 50.8, homosexual sexual contact in 8.1%, intravenous substance dependence in 5.88%, transfusion in 2.27%, mother-to-child transmission in 1.66%, hemophilia in 0.5% and unknown causes in 30% (6).

Research and sexual health training experiences showed that young people do not have adequate information about reproductive physiology, prevention from pregnancy and basic sexuality such as HIV/AIDS and reproductive health (7). In a study done in United States, correct respond rate of young people between the ages of 13–15 to questions asked about reproduction, STD and FP was 40% aproximately and reproductive physiology was found to be the subject that they had the least information (8). To our knowledge, there is not any study that investigated information of substance dependent young people on STD and FP and impact of training on level of information. In this study, we aimed to inform young people under treatment for substance dependence about STD and FP and evaluate the efficacy of the training.

METHODS

This is a descriptive and cross-sectional study done between March 1st and March 31st, 2010 in Akdeniz University Alcohol and Substance Dependence Research and Implementation Center (AMBAUM). Forty-two young people between the ages of 15 and 25 who was defined as young according to WHO criteria, diagnosed as “Substance Dependent” according to DSM-IV diagnostic criteria, getting treatment in- or outpatient basis and volunteered to participate in the study were included in the study. A questionnaire which was prepared by the investigators according to literature containing pre- and post-tests was administered to the participants. In the questionnaire, questions 1, 2, 3, 4, 5, 7-18 were on STD and questions 6, 19, 20 were on FP. Questions consisted of definition of STD, in whom STD are seen, symptoms, complications, routes of contamination, and concerning the FP, issues such as importance of condom and preventive methods. One point was given to each correct answer and maximum score was determined as 20 points corresponding to total 20 questions. An audio-visual standard training was given to participants by one of the investigators (ward nurse) then. The subjects covered in the training were: in whom STD are seen, symptoms, complications, routes of contamination and risky conditions in substance dependence and concerning FP, issues such as importance of condom and preventive methods. Pre-test was required to be answered in 20 minutes and training of 30 minutes duration was given after pre-tests were collected. Non-formal method was followed during training and question and answer method was used. Answers were not given directly. Same questionnaire was administered as post-test just after training ended.

Statistical Analysis

Statistical analyses were done by Statistical Package for Social Sciences (SPSS v16.00). Numbers and percents were given for data analyses and paired t-test and McNemar tests were used for statistical analyses. p<0.05 was taken as statistically significant.

RESULTS

Among participants included in the study, 85.7% (n=36) were men and 14.3% (n=6) were women. Mean age was 20.40±2.49 (between 17 and 25) and 69% were primary school graduates, 54.8% were unemployed and 97.6% were single. It was found that 21.4% of participants used alcohol, 100% used cigarette, 54.8% used hashish, 16.7% used ecstasy, 7.1% used cocaine, 97.6% used heroine before treatment at some period in their lives.

Pre-test mean score was 11.28±2.52 (between 5 and 17), post-test mean score was 16.85±2.28 (between 10 and 20) (t=-14.792, p<0.001).

When correct answers to different questions by participants were examined, highest proportion of correct answer in pre-test was to question “Except for sexual intercourse are AIDS, Hepatitis B and syphilis transmitted by blood?” (90.5%). Lowest proportion of correct answer in pre-test was to question “Is birth control pill an effective prevention method?” (33.3%). In the pre-test, participants responded to the statements “Seven thousand young people are infected by HIV everyday” and “Half of HIV cases are seen between 15 and 24 age group”, the definition of STD and answered the question of “In what conditions are STD seen more often?” correctly by 71%, 69%, 76.2% and 64.3%, consecutively.

When correct answers to post-test given to participants after training were examined, highest proportion of correct answer was given to question “Seven thousand young people are infected by HIV everyday” (97.6%) and lowest proportion of correct answer was given to question “Is birth control pill an effective prevention method?” (45.2%). Participants correctly responded STD definition by 92.9%, statement of “Half of HIV cases are seen between 15 and 24 age group” by 95.2% and “In what conditions are STD seen more often?” by 73.8%. Between pre- and post-test, when each question was compared one-by-one, correct answers to all questions about STD and FP issues were increased and in 15 of these questions (75%), this increase was statistically significant (Table 1).

DISCUSSION

Excessive risk taking behaviors in substance-dependent young people, impairment of judgement under substance influence, increased impulsive behaviors, erroneous thoughts and negative behaviors during sexual intercourse increase risk of CTD. Moreover, individual under substance influence does not use FP and this may lead to serious health problems such as undesired pregnancies and abortion. Impulsive behavioral temperament characteristic was comprehensively defined as an important risk factor for alcohol and substance abuse disorders (9).

In substance abuse which can be related to several physical and social problems, several transmittable diseases such as AIDS can be observed due to syringe exchange between people using intravenous substances and sexual intercourse with substance abusers with STD (10). STD is an important health problem widely seen in Turkey as well as worldwide (11). Prevalence of pre-marital sexual relationship is increasing in many places of the world. In some African countries 43% of young people under the age of 20 had sexual contact and this figure was reported 20% in Latin America. When developed countries are viewed, it was reported that in US 68% and in France 72% of young people under the age of 20 had sexual activity (12). Factors such as social groups, media, disruption of traditional family structure, increasing immigration and urbanization accelerate sexual activity. Parallel to rapid urbanization, late marriage, increased economical status and increasing educational possibilities, prevalence of pre-marital sexual activities are increasing among young people compared to previous years albeit not as much as in developed countries (13). Excessive risk taking behaviors in young people with substance abuse, impairment of judgement under substance influence, sharing syringes, impulsive behaviors, changing sexual partners frequently, lack of using condoms in both vaginal and anal intercourse, common toothbrush use increase transmission of STD. Increasing prevalence of sexual experience compared to previous years and increasing substance dependence in Turkey which has young population show the importance of sexual training and consultancy about STD and FP young people.

In the study of Topbaş et al. (14), although it was found that 95% of young people know the name of at least one FP method, when knowledge level of FP methods were examined, it was found to be lower than it should be in both males and females. In the study of Tekbaş et al. done in 3309 young men in Ankara (15), they were found to have low knowledge scores about STD and FP. In another study, 91.2% of students stated that sexual training was not given properly during school education and they need a systematic training program about sexuality (16). When young people were asked what kind of information they need about sexual health, they wanted to become conscious about STD first. The group called “young” is especially under risk of STD due to their physical, social and economic characteristics (17). High prevalence of STD, difficulties in clinical and laboratory diagnosis, serious complications if untreated show that these diseases are highly important for human health (18). For these reasons, informing young people who are one of the most sensitive groups about STD is very important.

In the study of Uzun and Kişioğlu (19), prevalence of adequate knowledge score about STD in young people was found 35.9% and mean knowledge score was found 4.8±2.3 over 10 full score. In another study, it was found that although most of the young people know about prevention methods from STD, knowledge level about symptoms of STD was found to be quite low (1). Similarly, it is noteworthy that proportion of participants knowing symptoms of STD was found low (38.1%) in our study as well. In the study of Özcebe and Dam (1), when knowledge level of young people about family planning was evaluated, majority were found to have moderate level of knowledge. Proportion of knowing FP methods before being informed was found similar (59.5%) in our study.

Nearly all of the studies were done in healthy adults and there is no study investigating STD and FP among young people with substance dependence. Results of our study showed that knowledge level is also low in young people with substance dependence who are under higher risk when STD and uncontrolled sexual activation are considered and this may be reversed by even short-term trainings.

CONCLUSION

Results of our study showed that STD and FP should especially be a part of similarly designed studies and training programs organized for young people. Consultancy for STD and FP is an important opportunity for training people. Training makes prevention from STD and treatment more effective; moreover, young people adhere to treatment better when they understand the importance of the issue (1).

It is noteworthy that young people with substance dependence both have inadequate level of information and do not care about birth control methods. It will be beneficial to add trainings about STD and FP to rehabilitation programs in alcohol and substance dependence treatment centers. Causes of STD in substance abusers should be understood carefully and preventive and therapeutic methods should be developed, patients should be evaluated with care individually and society and young people should be informed adequately.



REFERENCES

1. Özcebe H, Dam AV. Gençlik Danışmanlık ve Sağlık Hizmet Merkezleri CSÜS Eğitimi Modülü - Katılımcı Rehberi. Ankara, Buluş Tasarım ve Matbaacılık Hizmetleri, 2007, 4,173 (Article in Turkish).

2. Biri A, Korucuoğlu Ü, Yılmaz E. Adölesan kızların cinsel bilgi gereksinim durumlarının belirlenmesi. Türk Jinekoloji ve Obstetrik Derneği Dergisi 2007; 4:104-107 (Article in Turkish).

3. Öğel K. Madde Bağımlılarına Yaklaşım ve Tedavi. 2 Baskı, IQ Kültür Sanat Yayıncılık, İstanbul, 2002, 219 (Article in Turkish).

4. Öğel K. Türkiye’de Madde Bağımlılığı. 2 Baskı, IQ Kültür Sanat Yayıncılık , İstanbul. 2002, 174-175 (Article in Turkish).

5. Topçuoğlu V, Bez Y. Madde kullanımına bağlı enfeksiyonlar. Bağımlılık Dergisi 2005; 6:2 (Article in Turkish).

6. Ağaçfidan A, Akın L. Türkiye’de cinsel yolla bulaşan enfeksiyonlar (CYBE) ve HIV/AIDS’in sürveyans sistemine ilişkin durum analizi. İlerleme Raporu, Buluş Tasarım ve Matbaacılık Hizmetleri, Ankara, 2007 (Article in Turkish).

7. Nalbant H, Bulut A. Gençler ve üreme sağlığı. Aktüel Tıp Dergisi 2001; 6:30-36 (Article in Turkish).

8. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States - results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2007; 64:830-842.

9. Ohlmeier MD, Peters K, Wildt BTT, Zedler M, Ziegenbein M, Wiese B, Emrich HM, Schneider U. Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD). Alcohol 2008; 43:300-304.

10. Yüncü Z, Kabukçu B. Madde kullanım bozukluğu olan ergenlerde HBV: yaygınlık, riskler, aşılama. Anatolian Journal of Psychiatry 2008; 9:208-216 (Article in Turkish).

11. Aras Ş, Orçın E, Özan S, Şemin S. Dokuz Eylül Üniversitesi öğrencilerinin cinsel bilgi, tutum ve davranışları. Sağlık ve Toplum Dergisi 2004; 4:23-28 (Article in Turkish).

12. Häggström-Nordin E, Hanson U, Tydén T. Sex behavior among high school students in Sweden: improvement in contraceptive use over time. J Adolesc Health 2002; 30:288-295.

13. Orçın E, Aras Ş, Açık R. Üniversiteli gençlerin cinsel tutum ve davranışları. Jinekoloji ve Obstetrik Dergisi 2003; 17:169-174 (Article in Turkish).

14. Topbaş M, Çan G, Kapucu M. Trabzon’da bazı liselerdeki adolesanların aile planlaması ve cinsel yolla bulaşan hastalıklar hakkındaki bilgi düzeyleri. Gülhane Tıp Dergisi 2003; 45:331-337 (Article in Turkish).

15. Tekbaş F, Ceylan S, Hamzaoğlu H. Genç erkeklerin AP konusundaki bilgi düzeyleri. 6. Ulusal Halk Sağlığı Kongresi Kitabı, 1998, 379 (Article in Turkish).

16. Özkan H. Üniversite gençliğinin aile planlaması ve cinsel yolla bulaşan hastalıklardan korunmaya ilişkin yaklaşımları. Yüksek Lisans Tezi, İ.Ü. Sağlık Bilimleri Enstitüsü, Halk Sağlığı Hemşireliği Anabilim Dalı,, İstanbul,1994 (Article in Turkish).

17. Pınar G, Doğan N, Ökdem Ş. Özel bir üniversitede okuyan öğrencilerin cinsel sağlıkla ilgili bilgi tutum ve davranışları. Tıp Araştırmaları Dergisi 2009; 7:105-113 (Article in Turkish).

18. Özdemir L, Ayvaz A, Poyraz Ö. Cumhuriyet Üniversitesi öğrencilerinin cinsel yolla bulaşan hastalıklar konusundaki bilgi düzeyleri. Cumhuriyet Üniversitesi Tıp Fakültesi Dergisi 2003; 25:10-14 (Article in Turkish).

19. Uzun E, Kişioğlu M. SDU Tıp Fakültesi Halk Sağlığı Anabilim Dalı Keçiborlu Eğitim Ve Araştırma Bölgesi Çalışmaları: Bir meslek yüksek okulunda okuyan öğrencilerin cinsel yolla bulaşan hastalıklarla ilgili bilgi durumları: Süleyman Demirel Tıp Fakültesi Dergisi 2007; 14:7-12 (Article in Turkish).