Statistique, Dveloppement et Droits de lHomme

Session C-Pa 7a

The Relation between Source of Information and the Knowledge about HIV / AIDS for Adolescent Street Children in Bandung, Indonesia, 1999 Ahyani RAKSANAGARA

The Relation between Source of Information and the Knowledge about HIV / AIDS for Adolescent Street Children in Bandung, Indonesia, 1999
Ahyani RAKSANAGARA Health Office, Bandung Municipality Jl. Supratman No. 73 40235 Bandung, West Java, Indonesia T. + 6222 720 2210 F.+ 6222 522 3517 grafist@indosat.net.id

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ABSTRACT The Relation between Source of Information and the Knowledge about HIV / AIDS for Adolescent Street Children in Bandung, Indonesia, 1999 Economic development is not always make prosperity which is evenly distributed, some people become a border community. Specially in big cities, they usually live in border of city or live between the famous and big buildings in the centre of the city. The children from these families become street children. They must work for the family, because they dont have any capability for working another job so they work in the street. They sale newspapers, candy or beg while singing plating musical instruments. The economic crisis in Indonesia make the number of poor families increase so the number of street children become increasing. Bandung is the capital city of West Java Province, one province in Indonesia with 40 million people. We can see the street children almost at every traffic light in the street or in the quarter of streets in Bandung. The street children dont have a healthy life style, street culture often encourages and reinforces risky behaviors. They report of being forced to have sexual intercourse. Adolescent street children are a high risk group for HIV/AIDS because of their risky behavior. In Indonesia 82.8 % of HIV/AIDS cases are from productive age (15-35 years) and 83.3% transmission come from sexual transmission. Because of that, we want to know the knowledge about HIV/AIDS from adolescent street children and from what kind of source they get the information about HIV/AIDS. The sample of this research is 77 adolescent street children, taken from five stop in home for street children; we collected the data with questionnaire. The result of this research is: 88.3% are male, only 10.8% still go to school, 52% are between 10 to 15 years old, the level of education 78% are passed elementary school or below, only 57.1% have good level of knowledge about HIV/AIDS, 74% know about HIV/AIDS from mass media (tv, radio, newspaper). We get a significant relation between source information from mass media and level of knowledge about HIV/AIDS. Increasingly the knowledge about HIV/AIDS for adolescent street children is very important, we have to increase the health education for them. After we give them information we have to continue with another activity like counseling or support them with recruitment the buddies for them. RESUME Lien entre les sources d'informations et les connaissances sur le HIV / SIDA des enfants des rues de Bandung, Indonsie, 1999

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Le dveloppement conomique n'engendre pas toujours des richesses, qui sont rparties de faon ingale, certaines personnes sont marginalises. Dans les grandes mtropoles notamment, ces dernires vivent souvent aux frontires de la ville ou entre les grands buildings chics du centre ville. Les enfants de ces familles deviennent des enfants des rues. Ils doivent travailler pour subvenir aux besoins de leur famille et nayant aucune aptitude pour faire un autre travail, ils se retrouvent dans les rues. Ils vendent des journaux, des sucreries ou mendient en chantant et en jouant dun instrument. La crise conomique en Indonsie accrot le nombre de familles pauvres, ce qui entrane une augmentation du nombre d'enfants dans les rues. Bandung est la capitale de la province de Java ouest, une province d'Indonsie qui compte 40 millions d'habitants. A Bandung, il y a des enfants des rues chaque feu tricolore et chaque intersection de rues. Ils n'ont pas un mode de vie sain et la culture de la rue encourage et renforce les comportements risque. Ils ont affirm tre contraints avoir des rapports sexuels. Les enfants des rues constituent un groupe haut risque pour le HIV / SIDA en raison de leur comportement risque. En Indonsie, les individus tant en ge de procrer (15-35 ans) reprsentent 82,8 % des cas de HIV / SIDA et 83,3 % des transmissions du virus se font par voie sexuelle. Cest pourquoi, nous souhaitons nous rendre compte du degr de connaissances des enfants de la rue sur le virus HIV / SIDA et connatre leurs sources d'informations. Dans le cadre de cette recherche, 77 adolescents des rues, rencontrs dans 5 refuges, ont t questionns afin d'obtenir des donnes. Voici ce qui est ressorti de cette enqute : 88,3 % des enfants sont de sexe masculin, seuls 10,8 % sont toujours scolariss, 52 % sont gs de 10 15 ans, quant leur niveau d'ducation, 78 %, ou moins, sont alls l'cole primaire, seulement 57,1 % ont un niveau de connaissance suffisant concernant le HIV / SIDA, 74 % tirent leur connaissance des mdias (tlvision, radio, journaux). Un lien significatif s'tablit entre les sources d'information provenant des mdias et le degr de connaissance des virus HIV / SIDA. Il est trs important de dvelopper les connaissances des enfants des rues sur le HIV / SIDA ainsi que leur hygine. Une fois les informations transmises, nous devrons poursuivre par une autre activit, telle que lassistance socio-psychologique ou le soutien dans leurs frquentations. 1. Background Information The aim of the national development in Indonesia is to increase the standard of living and prosperity for the community. The effort to increase the prosperity of Indonesian community is pointed to all social class, including children. Children are source of nation potency and they are the future generation to catch the aim. Because of that they need the chance to growth and development. Children have the strategic position to continue the development, they are hoped to be a qualified human resources. In the other position they have a special character, so to guarantee their growth and development they need founding and protection. The fact is very different, there are so many children live without having opportunity to get the right, specially the children come from poor family. In this condition the children must help their parents to give the income for the family. They must work, go out from the family and live at the street to be the street children. The street children will growth and develop, without control and protection from the parents or other older people. Living in the street is very sensitive to get the accident, violence and to be a person with high-risk behaviour for HIV/AIDS transmission. There are three types of street children: children of the street are the children that live in the street, children on the street are the children that work and spent the time at the street, and vulnerable to be street children, they are the children that come from the poor family with high-risk to be street children. The economic crisis and social crisis give the effect to increase the poor
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family, this condition increasing the number of street children. In 1999 there are 1804 street children in Bandung. And 66.6% from them are the children with age more than 14 years old. If we can not handle this problem, they will loose the opportunity to be the productive and qualified generation. The convention on the rights of child mention the rights for the children such as: to get the information, live in the circle of family, children caring, get the health services, get the education. The street children are far away from the rights, they are living with more implementation the duties than the rights. In the circle of life, the adolescent period is the very sensitive period that the children must pass away. The reproductive organ is already mature for reproductive function, but at the other side the adolescents still find the identity. This period is very important, because adolescent period like a bridge that cross from children period to adult period with responsibility. They need the parents or the person who has a role like their parents, to care and protect them. The adolescent street children is the high risk behavior group for HIV/AIDS transmission, we can see the data from the research in 1998. This research is worked by Unicef, Statistical Center Office of Indonesia and Medicine faculty of University in Bandung. The result is 2.3% from street children that get the medical examination are diagnosed GO (gonorhoe) positive. This condition indicate that the sexual transmitted disease is already occurred there. The impact of HIV/AIDS is very broad, it will touch the social, economic and culture aspect. For example the economic aspect, to give treatment and caring the people with HIV/AIDS will need very high cost. Usually the people with HIV/AIDS come from productive group, this condition will inflict a financial lost for the country. The country with economic crisis will get the double jeopardy. In Indonesia, the first case is reported on 1987, after that the number of case increase every year. 85.6% for the HIV/AIDS cases come from young people for 15 to 49 years old. 82% from the model of transmission is sexual transmission. In December 1999 Indonesia Health Department is reported 1014 cases HIV/AIDS, 9 cases come from Bandung. Prevention action is one of the strategic to fight HIV/AIDS, this strategic is more effective and efficient. People will keep away from the risk behavior for HIV/AIDS transmission, if they know about HIV/AIDS. Generally the growth and development problem in adolescent street children is the same as other the adolescent. But there is a different between them, the difference is social contact. Street children have a limit social contact. Usually they contact just with their friends at the street, for some of them contact with parents and school circle just only a little time. In fact some of them never touch with their family and never go to school anymore. This situation make them have a limit source of information, including about HIV/AIDS. From that condition bring out some questions: How far the adolescent street children know about HIV/ AIDS What kind of source of information existence in the circle of street children, that give the information about HIV/AIDS How is the characteristic of adolescent street children How is the relation between source of information and the knowledge about HIV/AIDS at adolescent street children 2. Objective The general objective from this research is to find the image of adolescent street children about the level of knowledge about HIV/AIDS, kind of source of information in the circle of street children, and the relation between source of information and the knowledge about HIV/AIDS at adolescent street children.
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The specific objectives are: To study the level of knowledge about HIV/AIDS in adolescent street children To study kinds of source of information that existence in the circle of street children To study the characteristic of adolescent street children To study the relation between characteristic of adolescent street children and the source of information and the knowledge about HIV/AIDS To study the relation between source of information and the knowledge about HIV/AIDS at adolescent street children 3. The Concept of Study
SOURCE OF INFORMATION : LEVEL OF KOWLEDGE ABOUT HIV/AIDS

Mass media Leaflet/poster Formal educator (teacher, health worker) Close circles (parent, friends, volunteer that assistance street children) Religion Leader

CHARACTERISTIC OF ADOLESCENT STREET CHILDREN :

Sex Age Religion Status of schooling Level of education

The level of knowledge about HIV/AIDS is the dependent variable, from the answer of questioner is grouped to be good and less. Source of information is the independent variable, and the characteristic of adolescent street children is the confounding variable. 4. Design and Methodology The design of this research is quantitative and qualitative approach. The quantitative approach by giving the questionnaire, and the qualitative approach by doing focus group discussion. The population of this research is the street children in Bandung, there are 1804 street children (data from NGO, 1999). The inclusion criteria for sample are age 10 to 19 years old, registered at open house from street children (NGO).The exclusion criteria is married. This quantitative research is cross sectional surveys method using questioner as the instrument of survey. The qualitative data did by making focus group discussion with two groups adolescent street children, each group consist of 7 (seven) adolescent street children. Data analysis by using univariate, bivariate and multivariate analysis. To get the sample size we use the Proportional Stratified Random Sampling formula from Adequacy of Sample Size in Health Studies (Lemeshow): Z 2 1/2 L h=1 --------------------------------------------------------------------2 2 N d

{N2 h Ph (1 - Ph ) } / W h

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Level of confidence 95% and precision 10%, we get the sample size: 77,03. There are 5 open houses in Bandung, the sample distribution for each open house is: Table 1. The Sample Distribution For Each Open House
NO 1 2 3 4 5 Name of Open House (NGO) Ar Rufi Bahtera Mesra Masyarakat Sehat Saman TOTAL Number of Street Children 436 563 389 286 130 1804 Number of Sample 19 24 17 12 5 77

The location of this research is in Bandung City, the capital of West Java Province Indonesia. The research started from November 1999 to December 1999 for quantitative. And at May 2000 for qualitative research. Collecting the quantitative data was done by using questionnaire, that have been filled in by the repondents. SPPS is used to analysis the data. 5. Results and Discussion 5.1 Univariate Analysis a) Level of Knowledge

From 22 questions, we give 0 for wrong answer and 1 for correct answer. The distribution of score is shown in graphic 1. Graphic 1. Adolescent Street Children Distribution by Score of HIV/AIDS Knowledge Bandung 1999
Scoring of Knowledge about HIV/AIDS
20

10

Frequency

Std. Dev = 3,65 Mean = 15,1 0 4,0 6,0 8,0 10,0 12,0 14,0 16,0 18,0 20,0 22,0 N = 77,00

Scoring of Knowledge about HIV/AIDS

We make categorization for the level of knowledge, with cut off point 15. The score 15 or more is grouped good knowledge, and the score above 15 is grouped less knowledge. The distribution of street children by level of knowledge about HIV/AIDS is shown by table 2:
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Table 2. Adolescent Street Children Distribution by Level of HIV/AIDS Knowledge, Bandung 1999
Level of Knowledge Less Good Total Number 33 44 77 % 42,9 57,1 100

From table 2 we can see only 57.1% adolescent street children are grouped in good classification. On the other side, we know that street children have risk bevahiour for HIV/AIDS transmission. Because of that its better if more adolescent street children know about HIV/AIDS. b) Source of Information The source of information that exist for street children circles is showed in table 3: Table 3. Distribution of Source Information at Adolescent Street Children, Bandung 1999
Source of Information 1. Mass Media 2. Leaflet/Poster 3. Formal Educator 4. Close Circles 5. Religion Leader n 57 25 25 59 13 Yes % 74 32,5 32,5 76,6 16,9 N 20 52 52 18 64 No % 26 67,5 67,5 23,4 83,1 n 77 77 77 77 77 Total % 100 100 100 100 100

The highest percentage about source of information is close circle (76.6%). Street children spent hole time at the street with people who live at the street, like their friends, volunteer that assistance street children. The relation between them are very close like a best friend. With this source information we can give the information for the street children. Mass media has a high percentage (74%). Newspaper, radio and television have a strength can give the information to many people in the short time, entertain and attractive. c) Respondent Characteristics

The respondent characteristic that can give the influence to source of information and to level of knowledge about HIV/AIDS are showed in table 4. Table 4. Distribution of Adolescent Street Children According to Characteristics, Bandung 1999
Characteristics Sex : Male Female Age : 10 15 years old 16 19 years old Religion : Islam
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Number 68 9 77 40 37 77 77

% 88,3 11,7 100 51,9 48,1 100 100

Statistique, Dveloppement et Droits de lHomme

Status of Schooling: Still go to school Dont go to school Level of education : Never/drop out from elementary Graduated from elementary Graduated from high school

8 69 77 33 27 17 77

10,4 89,6 100 42,8 35,1 22,1 100

The important thing is 89.6% from respondents can not go to school anymore, besides they are the children in school age. They live at the street for working, is hard to involve the street children to the school, because in their mind just only to get the money today. They do not have a motivation to go to school. 5.2 Bivariate Analysis The result of bivariate analysis using Chi-Square Statistic analysis is shown in table 5: Table 5. Result of Bivariate Analysis
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 VARIABLE Mass media and level of knowledge Leaflet/poster and level of knowledge Formal educator and level of knowledge Close circles and level of knowledge Religion leader and level of knowledge Age and level of knowledge Status of schooling and level of knowledge Level of education and level of knowledge Age and mass media Status of schooling and mass media Level of education and mass media Age and leaflet/poster Status of schooling and leaflet/poster Level of education and leaflet/poster Age and formal educator Status of schooling and formal educator Level of education and formal educator Age and close circles Status of schooling and close circles Level of education and close circles Age and religion leader Status of schooling and religion leader Level of education and religion leader P Value 0.202 0.068 0.725 0.484 0.792 0.025 0.746 0.189 0.402 0.077 0.059 0.995 0.748 0.348 0.622 0.748 0.605 0.071 0,909 0.066 0.286 0.727 0.298 RESULT Odds Ratio 0.54 0.389 0.841 0.686 1.175 2.889 0.780 1.014 & 3.059 0.644 1.408 0.350 & 0.205 1.003 1.282 1.225 & 2.450 1.273 1.282 2.337 & 0.990 2.720 0.906 2.537 & 5.075 0.518 0.679 0.967 & 0.381

There are not relation between source of information and level of knowledge, characteristic of adolescent street children and the level of knowledge, characteristic and source of information. But
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the variables with p value < 0.25 are included to be a candidate variables that will continue analysis with multivariate. 5.3 Multivariate Analysis The multivariate analysis for independent variable and dependent variable, controlled by confounding variable is shown below:
POSTER MASS MEDIA AGE LEVEL OF EDU EDU(1) EDU(2) Constant B -,965 -,521 1,067 -,169 ,799 ,932 S.E. ,565 ,578 ,514 ,583 ,719 1,431 Wald 2,916 ,813 4,313 1,856 ,084 1,235 ,424 df 1 1 1 2 1 1 1 Sig. ,088 ,367 ,038 ,395 ,772 ,267 ,515 Exp(B) ,381 ,594 2,906 ,845 2,223 2,539

The result from multivariate analysis is no relation between source of information and the level of knowledge about HIV/AIDS at adolescent street children after was controlled by the characteristic of the adolescent street children. 5.4 Qualitative Analysis To know the answer why there is no relation between source of information and the level of knowledge about HIV/AIDS at adolescent street children, but in the other side 57.1% are good level of knowledge we did focus group discussion (FGD). From FGD they said that they know HIV/AIDS from: books in the open house, poster (at the street, store, health facility), newspapers, writing at the street, the volunteer, television, leaflet and magazine. They said information with poster is interesting, but the picture must be attractive. Not all the children can understand the message in the poster, the picture must easy to understand. From radio is very rare, because the radio at the open house is rare available. From television is very interesting, specially if giving information by using a story. By news paper is very rare, they said is more interesting if giving information by using picture and is placed in first page. The source information that very interesting for street children is using comic. They said if something are not understand, they will ask to the volunteer that assistance them at the street. 6. Conclusion The level of knowledge about HIV/AIDS at adolescent street children is still low Source of information that already existence in the circle of street children still have not a role to increase the knowledge about HIV/AIDS There is no relation between source of information and level of knowledge about HIV/AIDS There is no relation between adolescent street children characteristic and level of knowledge about HIV/AIDS, except age There is no relation between source of information and the level of knowledge about HIV/AIDS at adolescent street children after was controlled by the characteristic of the adolescent street children.

7. Suggestions
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The intervention for increasing the knowledge about HIV/AIDS for adolescent street children is still needed Increasing the knowledge about HIV/AIDS for adolescent street children must use all the source information that existence in the circle of street children The information must be attractive, simple and easy to understand The knowledge about HIV/AIDS of the volunteer must be increased by training The monitoring program for prevention transmission of HIV/AIDS at street children is needed, we can observe the STD case, make a behavior survey or to do HIV/AIDS screening if its possible Giving the information must do simultaneously by socialization using condom The level of education of the street children must be increased by giving them fellowship, training and open the opening school for them

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