Original Article

Singapore Med J 2009; 50 (2) : 173

A randomised controlled trial of peeradult-led intervention on improvement

of knowledge, attitudes and behaviour
of university students regarding
HIV/AIDS in Malaysia
Jahanfar S, Lye M S, Rampal L
in
knowledge
Introduction: The aim of this study was to
investigate the knowledge, attitudes and
behaviour of university students regarding
acquired immunodeficiency syndrome (AIDS)
and the human immunodeficiency virus (HIV).
Methods: A randomised controlled trial of 530
university students was done using peeradult facilitators. Participants completed a
questionnaire

before

and

after

the

intervention, which was a four-hour group

A

prevention

programme

was

developed by local experts, health educators

and

peer

facilitators.

The

peer-adult-led

programme was designed to provide a

conceptual model of HIV risk reduction
through

and

improving attitudes

ABSTRACT

session.

increasing

information,

motivational

and

behavioural skills, a harm reduction module

and health promotion theme.

towards AIDS

and

HIV. However, it did

not

improve

taking

risk-

behaviour.

Peer-adult-led

studies
on the
programmes
for level
youth using various of
knowle
interactional
dge of
activities, such as
these
small
group
cluster
discussions, poster s
activity and empathy suggest
exercises, can be that
successful
in althoug
changing
the h the
prevailing
youth level
of
perceptions
of
(13)
knowle
AIDS
and
HIV.
dge is
high,
educational

Keywords:

acquired

immunodeficiency
Results: The main outcome measured was the
level of knowledge, attitudes and behaviour
scores. The results suggest that relative to the
control group, participants in the intervention
group had higher levels of knowledge (30.37 vs.
25.40; p-value is 0.001) and a better attitude
(12.27 vs. 10.84; p-value is 0.001). However,

syndrome,

health

education,

human

immunodeficiency
virus,

sexually-

transmitted disease
Singapore Med J 2009;
50(2): 173-180

there was no difference in the behavioural score

(46)

unprot
ected
sex
and
needle
sharing
remain
prevale
nt.
The

(9.47 vs. 9.41; p-value is 0.530). The correlation

Introduction

between the level of knowledge and age and the

The

level of education was found in the intervention

immunodeficiency virus

group, but not in the control group (p-value is

(HIV) epidemic in

0.01). Attitude and gender were found to be

Malaysiaiscurrentlyina

correlated in the intervention group only (p-

concentrated epidemic

value is 0.01).

stage with a cluster of

data
human

intravenous (IV) drug

Conclusion: Our programme was successful

and
adolescent
sbeingat
ahigher
risk.
Cross
sectional

users,sexworkers

suggest
s thata
high
levelof
knowle
dge
does
not

necessarily lead to safe behaviour. Zulkifli and Wong

havereportedthatthelevelofknowledgeforadolescents
whoattendedschoolwas90%morethanforthosewho
did not. However, the depth of knowledge is
questionable as not much information is introduced in
school regarding sexual intercourse or HIV/acquired
immunodeficiency syndrome (AIDS) transmission. (4)
Narimah et al have shown serious gaps and
misconceptions about HIV/AIDS.(7) Reid et al have
suggested that subjects were aware that needles are a
sourceofinfectionbutdidnotknowthatsharingother
injectingequipmentcanalsotransferthevirus. (8) These
gapsandmisconceptionsneedtoberectifiedforgroups
atrisk,specificallyforyouthwhoarethebuildingblocks
ofthefutureforeverynation,havetheabilitytolearn
andtheflexibilitytochange.

Department of
Public Health,
Royal College of
Medicine Perak,
Universiti Kuala
Lumpur,
3 Greentown Street,
Ipoh 30450,
Malaysia
Jahanfar S, MSc, PhD
Fellow
Department of
Public Health,
Faculty of Medicine
and Health Sciences,
Universiti Putra
Malaysia,
Serdang 43400,
Malaysia
Lye MS, MD, MPH,
PhD
Professor
Rampal L, MD, MPH,
PhD
Professor

Corresp
ondence
to:
Dr
Shayeste
h
Jahanfar
Tel: (60)
12 436
4230
Fax: (60)
5 243
2636
Email:
jahanfar2
000@
yahoo.co
m

Singapore Med J 2009; 50 (2) : 174

Table I. Sociodemographic characteristics of UTP students in the intervention and control groups.
Sociodemographics
Gender
Male
Female
Race
Malay
Chinese
Indian
Others
Education level
Foundation
Undergraduate
Postgraduate
Course of study
Civil engineering
Electrical engineering
Mechanical engineering
Chemical engineering
Information technology
Information system
Petroleum engineering

No. (%) of intervention group (n = 292)

No. (%) of control group (n = 238)

160(54.8)
132(45.2)

133 (55.9)
105 (44.1)

239(81.8)
23(7.9)
1(0.3)
29 (9.9)

200 (84.0)
9 (3.8)
6 (2.5)
23 (9.7)

76(26)
215(73.6)
1(0.3)

182 (76.5)
56 (23.5)

32 (11.0)
54 (18.5)
54 (18.5)
88 (30.1)
16 (5.5)
36 (12.3)
12 (4.1)

37 (15.5)
43 (18.1)
40 (16.8)
68 (28.6)
14 (5.9)
23 (9.7)
13 (5.5)

p-value
0.436

0.293*

0.28#

0.699

*Race was divided into two categories (Malay and non-Malay) as the number of subjects was less than 5 in each cell
when computing chi-square using cross-tabulation.
#
One record (postgraduate student) was deleted before cross-tabulation was computed.

safer behaviour, such as

SexeducationisconductedinMalaysianschoolsona
small scale through nongovernmental organisations
(NGOs)andithasnotbeenformallyintroducedasapart
of the curriculum. A recent study by the first author
suggests that even smallscale studies in schools can
greatly enhance students knowledge of risk factors
relevant to HIV/AIDS.(9) Policymakers believe that
introducing sexual health issues in schools may lead to
negativeperspectivesandmayencouragestudentstostart
engaging in sexual activities outside of marriage.
Similarly, university students who are not exposed to
sexual health education in a broad spectrum are left
vulnerabletoriskybehaviours.Moreover,themediasends
confusing messages to our youth, encouraging them to
adoptafashionablelifestyleoffreedominsex.Atthe
same time, the strong family structure of Malaysian
culturesandbeliefsteachesthemtodressproperlyandact
responsibly. Outofmarriage sex is considered a sin.
Universitystudentswhooftenhavetolivefarawayfrom
theirfamilies,experiencingfortheveryfirsttimethetaste
ofindependence,maynotfindthechallengeaneasytask.
Peerpressuremayentrapthemandleadtoundesirableand
riskysituations.
Sinceneitheracurenoraneffectivevaccinationhas
yetbeendeveloped,primarypreventionremainsthekeyto
curbingtheHIVepidemicamongadolescents.Preventive

abstinence or consistent

that

condom use. Although

interventions can reduce

behavioural

severalstudiessuggest

adolescents selfreported
HIV riskassociated sexual
behaviour, it is not clear
which

behavioural

intervention is the most

effective.(10,11) Intervention
should engage peer
facilitators to enhance its
effectiveness and employ
professional adults to
convey the correct
information. An effective
intervention should be
tailored according to the
sociodemographical
characteristicsofthetarget
group,suchasage,religion
and culture. The objective
ofthisstudywastotestthe
effectiveness of a peer
adult programme with the
abovementioned
characteristics.

programmes should focus not only on knowledge

Methods
This studys hypothesis

enhancementbutalsoonbehaviouralchangetoencourage

was

that

students

randomised to the intervention would show improved participants completing the

square

knowledge, as well as safer attitudes and behaviour. trialwasprojectedtoprovide

sociodemographical

EthicalapprovalwasobtainedfromtheUniversitiPutra apowerof80%todetecta

characteristics and baseline

Malaysia(UPM)EthicalCommittee. Thefieldofstudy 1.67standarddeviation(SD)

measureswereconductedto

was Universiti Teknologi Petronas (UTP) in Perak, difference in the level of

ensure

Malaysia.Permissiontoconductthestudywasgrantedby knowledge between the

allocation was successful.

theMinistryofHealth,IpohBranchandUTPauthorities. intervention group and the

The effectiveness of the

With = 0.05, twotailed, a total sample of 530

control group. A series of

tests

that

on

random

intervention

analysesofvarianceandchi
after an extensive literature review, brainstorming and
gettingideasfromexperts.Allquestionshadbeenpilot
testedtoensuretheirclarityandsimplicity.Thecompleted
questionnaire was checked for consistency and
completenessbeforeitwasused.Itwasdividedintothree

Mean scores

35

Pre-test

Post-test

broad sections: knowledge concerning AIDS/ HIV (36

items) (including its symptoms, sources and modes of

30

transmission); beliefs and attitudes (20 items) (origin,

25

people,roleofsociety,etc);andrisktakingbehaviours(18

20

items)(druguseandsexualbehaviour).

15
10
5
0
Knowledge

Attitudes

Behaviour

Fig. 1 Bar chart shows the comparison between the means of

knowledge, attitudes and behaviour scores before and after
the intervention in the intervention group (n = 292).

was assessed by comparing the knowledge, attitudes and

behaviouroftheinterventiongroupwiththatofthecontrol
groupusingthepairedttest.Differencesbetweenthepre
testandposttestoftheinterventiongroupandthoseofthe
controlgroupwerealsocomparedusingthepaired ttest.
Correlations were computed between the quantitative
variablesusingthePearsonstest.

The sampling technique for this study was a

combined one inclusive of proportional sampling for
each department and simple random sampling. A
sampling frame of six departments in UTP was
obtained. Subjects were randomly selected for each
groupproportionaltotheregisterednumberofstudents
in each department. Allocation into either the
interventionorcontrolgroupwasdoneviaacomputer
generatedrandomnumbersequence.Randomsampling
and allocation were doubleblinded. Students were
invitedbypeerfacilitatorsviaaninvitationlettersentto
their hostels. They were encouraged to attend the
interventionthroughvariousmedia,viz.intranet,student
services,lecturersandcampaign.
Datawascollectedusinga74itemquestionnaire,once
before intervention and another immediately after
intervention.Thequestionnairewasdesignedbytheauthors

Singapore Med J 2009; 50 (2) : 175

conceptual foundations, viz. informationmotivation

behavioural skills models of AIDS riskreduction,
motivational enhancement approach, harm reduction
models and a health promotion theme. The designed

Sociodemographic characteristics (ten items) were

interventionwasdesensitisedaccordingtothecultural

recordedatthepreteststage.Levelofknowledgeand

and religious backgrounds of Malaysians. Religious

score of behaviour were respectively categorised into

teachings were emphasised to encourage abstinence.

three categories: low, medium and high level of

However,asitisacknowledgedthatabstinencemaynot

knowledge,andnorisk,lowriskandhighriskbehaviour,

alwaysbefeasible,harmreductionprinciplestoreduce

using mean one and two SDs, while the score of

therisksofHIVinfection,suchascondomuse,were

attitudewascategorisedintotwomajorgroupsofbador

also promoted. Intervention was designed to enhance

good attitude using the mean as a cutoff point.

knowledgeofHIV/AIDS,strengthenbehaviouralbeliefs

Participantswererequiredtoreadafactsheetaboutthe

supporting abstinence and increase selfmanagement

studyandsignanagreementtoparticipateinthestudy.

skills regarding the ability to identify dangerous

Duringthetests,theywereseatedapartfromoneanother

situations, negotiate abstinence or practise safe sex,

toensuretheconfidentialityoftheiranswers.Theywere

resistpeerpressuretohavesexualintercourseorabuse

remindedtorespondhonestlyastheinformationwould

drugs. The safersex interventionpromotes abstinence

beusedforthedevelopmentofeducationalmaterialsfor

beforemarriageasthefirst(andbest)choice,inkeeping

theadolescentsbenefit.Confidentialitywasassuredas

withreligiousbeliefs;however,ifthestudentdecidesto

thestudentsdidnothavetorecordtheirnamesonthe

engageinsexualactivities,theimportanceofcondom

questionnaire;rather,thesameuniquecodenumberfor

usewasemphasisedtoreducetherisksofHIVinfection,

eachstudentwasusedforthepreandposttestssothat

pregnancyandothersexuallytransmitteddiseases.

thedatacouldbelinked.Thequestionnairewascollected
bythepeerfacilitatorsratherthantheadultinstructors.

Interventionwaspilottestedbybothadultandpeer
facilitatorsonagroupofstudentleadersandfacilitators

A modified intervention was used, after obtaining

fromthestudypopulationwhowerenotinvolvedinthe

permissionfromtheauthoroftheHealthImprovement

actualstudy.Eachinterventionconsistedoffourhours

Project Intervention Manual.(12) It consisted of four

oflectureandotheractivitiesconductedona

Singapore Med J 2009; 50 (2) : 176

Table II. Comparison between pre-test and post-test results of the intervention and control groups for level of
knowledge, attitude and behaviour scores.

Variable
Level of knowledge
Attitude score
Behaviour score

Pre-test (n = 238)
Intervention gp
Control gp
24.74 4.79
10.95 2.63
9.42 1.24

24.39 4.582
10.81 2.81
9.28 1.27

p-value
0.405
0.561
0.229

Post-test (n = 238)
Intervention gp
Control gp
30.70 2.65
12.27 2.71
9.47 1.29

p-value

25.40 4.29
10.84 3.22
9.41 1.22

0.000
0.000
0.530

Table III. Mean and standard deviation of differences between pre- and post-tests of the intervention and control
groups for knowledge, attitude and behaviour scores.
Variable
Difference between knowledge levels
Difference between attitude scores
Difference between behaviour scores

Mean SD intervention group

Mean SD control group

p-value

5.96 4.49
1.30 2.51
0.12 1.17

1.01 2.60
0.01 2.8
1.25 1.01

0.000
0.000
0.933

Saturday morning or afternoon with a 20minute break in

between. Thesessions were designed to be educational but
entertainingaswellasculturallyrelevant.Activitiesincluded
smallgroupdiscussions,games,brainstorming,experimental
exercises, skillbuilding activities and role play. Each
interventionwashighlystructuredandwasimplementedby

Results
530 subjects attended the
programme, 292 in the
intervention group and 238
in the control group. The
mean and SD age of
participants

in

the

adulteducators(n=8)withmedicaldegreesoraspecialtyin

interventiongroupwas19.96

publichealthaswellaspeerfacilitators(n=6)whooperated

1.69 (range 1727) years.

insmallergroups,providingadviceoransweringqueries.Peer

Using Students ttest, there

facilitators were also responsible for conducting comedy

wasnosignificantdifference

pantomimes, empathy exercises and poster activities. The

betweenthemeanagesofthe

themefortheinterventionworkshopwashealthylifestyle.

twogroups(p=0.966).The

ThepeereducatorswererecentgraduatesofUTPorUPMand

meanandSDpocketmoney

hadtheexperienceofbeingstudentleadersorfacilitators.The

for the intervention group

selection of peer educators was based on recommendations

was453.86

from university authorities and interviews. Both adults and

115.42 Malaysian Ringgit

peer facilitators attended three series of intensive training

(RM)(1USDwasequivalent

workshops over two days. The objectives of these training

toRM3.5atthetimeofthe

workshops were to familiarise trainers with the programme

study), while that for the

andtoteachthemthebasicskillsoffacilitatingsmallgroups

control group was RM

and conducting brainstorming and role playing sessions. A

440.04109.46.Therewas

trainingmanualwaspreparedtoassistbothadultsandpeer

no statistically significant

facilitatorswiththeinterventionimplementation.Facilitators

difference between the two

weremonitoredduringeachinterventiontoensurethatthey

groups in terms of average

delivered the same information to all the groups. The

pocket money (p = 0.176),

facilitatorsofthecontrolgroupalsoreceivedfourhoursof

cigarettesmoking(p=0.256)

trainingintwosessionswitha20minutebreakatthesame

oralcoholconsumption(p=

time and location, but the training was on career

0.347). Table I compares

improvement,whichcomprisedfourlecturesonhowtobuild

other

up ones skills for job hunting, how to write a curriculum

aspects of the intervention

vitae, how to look for a job and how to prepare for an

andcontrolgroups.

interview.

sociodemographic

The results show that

57.4%ofsubjectshadahighlevelofknowledge,whileonly drug use while no needle

(23.9%).

Risktaking

17.2%hadalowlevel.53.6%ofsubjectshadabadattitude sharing was reported. 0.6%

behaviour was rare among

towards HIV/AIDS and 46% showed a good attitude. The reported having been

UTP students. 91.9%

majority (91.9%) exhibited lowrisk behaviour (one out of overdosed before or having

(475/517) of students

five risky behaviours), while only 1% exhibited highrisk seen someone with the

exhibited no risky sexual

behaviour. 2% claimed to have tested positive for HIV. condition.Themostcommon

behaviour, 7.2% (37) of

Tobaccousewas21.2%,alcoholconsumptionwas9.7%and reasons given for taking

studentswereatlowriskand

the use of other drugs, such as ecstasy, cannabis and drugs were peer pressure

1%(5)wasathighrisk.The

amphetamine,wasrare.1.7%reportedexperimentingwithIV (63.9%)andlackofguidance

majority(97.7%,

Singapore Med J 2009; 50 (2) : 177

Table IV. Comparison of the responses to two open-ended questions about HIV/AIDS between the intervention
and control groups.
Question and categorised answers

No. (%) intervention group

No. (%) control group

When did you hear about HIV/AIDS?

During:
Childhood
Primary/secondary school
High school
Total

27 (15.3)
88 (50.0)
61 (34.7)
176 (100)

30 (17.4)
109 (63.4)
33 (19.2)
172 (100)

How did you hear about HIV/AIDS?

From:
School/university
TV/Internet/video
Healthcare services
Parents
Family and friends
Books/newspapers/advertisements
Total

31 (12.1)
156 (60.7)
29 (11.3)
9 (3.5)
10 (3.9)
22 (8.6)
257 (100)

21 (10.4)
130 (64.4)
22 (10.9)
5 (2.5)
4 (2.0)
20 (9.9)
202 (100)

p-value
0.005

0.766

gender were found to be

511/523)ofthestudentsdidnotreportanysexualactivity
duringthelast12months,whiletheremaining2.3%of
studentsreportedsexualactivityduringthisperiod.Eight
outof12ofthesestudentsweremale.
Inordertoensurethatrandomisationandallocationwere
donecorrectly,acomparisonwasmadebetweenthelevelof
knowledge,attitudesandbehaviourofbothgroupsbeforethe
intervention.TableIIshowsnosignificantdifferencebetween
the pretest results of the intervention and control groups,
mostlikelyduetotherandomisedselectionofthestudents.

correlated(p

= 0.01). No significant
correlation was found for
any two other quantitative
variables between the
intervention or control
groups.
Two newlycreated
variables were: the
differencebetweenthepre
testandposttestscoresof
theinterventiongroup,and

Aftertheinterventionprogramme,posttestresultsshoweda

the difference between the

significant difference between the two groups for the

pretestandposttestscores

knowledge(p=0.000)andattitudes(p=0.000)scores,while

ofthecontrolgroup.Paired

no difference was found between the two groups for the

ttest was then performed

behaviourscore(p=0.530)(TableII).Thisshowedthatthe

between these two

intervention had been successful in increasing the level of

variables. There was a

knowledge and had resulted in a better attitude towards

significant

HIV/AIDS, while there was no observable change in the

between these two

studentsbehaviour.Comparingthemeanoftheknowledge

variables (p = 0.000),

levelwithintheinterventiongroupbefore(25.034.63)and

where the mean SD of

after(30.902.57)theintervention,asignificantdifference

thefirstvariablewas5.96

wasobserved(p=0.000).Similarly,usingthepaired ttest,

4.49andthatofthesecond

thetotalscoreforattitudewassignificantlyincreasedafterthe

variable was 1.01 2.60.

interventionfrom11.112.59beforeto12.382.62after

The same comparisons

theintervention(p=0.000).Ontheotherhand,acomparison

weremadefortheattitude

betweenpre(9.431.25)andposttest(9.531.19)scores

and behaviour scores

of behaviour did not show any significant difference (p =

(Table III), where the

0.111),usingtheWilcoxonsignedranktest.

attitude scores were

difference

significantly higher in the

Within the intervention group, the mean level of

intervention group than in

knowledge for undergraduate students was found to be

the control group (p =

significantlyhigher(25.464.30)thanthatofthefoundation

0.000).Thisdifferencewas

group(23.885.31)(p=0.01).Studentswithahigherlevel

not seen in the behaviour

ofknowledgewerealsoolder(p=0.01).Attitudescoresand

scores.

98.7% of students responded positively to thequestion, there was no

clinics and educational

question, Have you heard of HIV/AIDS? Only fivesignificantdifferencefound

activitiesconductedbythe

students(0.9%) had not encountered these terms. Therebetweenthetwogroups(p

Ministry of Health, as a

weretwoopenendedquestionsonthequestionnaire;viz.=0.766).Themedia,such

source. Having heard of

WhendidyouhearofHIV/AIDS?andHowdidyou as television, the Internet

HIV/ AIDS via parents

hearofHIV/AIDS?Forthefirstquestion,asignificant and video, was the most

(3.1%) and family and

difference between the control and intervention groupscommon

of

friends (3.1%) were found

wasobserved(p=0.005);63.4%(109/172)ofsubjectsin information transfer for

tobenegligible(TableIV).

form

thecontrolgrouphadheardofHIV/AIDSintheirprimary UTP students (62.3%).

or secondary school as opposed to 50% (88/176) of11.3% quoted healthcare
students in the intervention group. For the secondcentres,includinghospitals,
population.(31)ForasensitivetopicsuchasHIV,thisisnota
surprisingfinding.

Successfulinterventionshaveusedhealtheducators,
(29)

Discussion
This study examined the impact of the HIV/AIDS
prevention programme through peeradult education
among university students. The effectiveness of this
programmewasassessedbymeasuringtheknowledge,
attitudes and intention to practise abstinence or safer
behaviourswithregardtosexualactivitiesanddruguse.
Greaterchangeswereobservedintheinterventiongroup
comparedtothecontrolgroup.Changeswereobserved
in the level of knowledge and attitudes but not in
behaviour. Comparing the posttest results of the two
groupsshowedasignificantlyhigherlevelofknowledge
(30.37 vs. 25.40)(2529) (p=0.000)andbetterattitude
(12.27 vs. 10.84) for the intervention group, but no
significantdifferenceforbehaviour(9.47vs.9.41)(p=
0.530). Many studies evaluating sex education
programmesindevelopedcountriesvariouslyfoundthe
programmestobeeffective,(1115)partiallyeffective,(1619)
ineffective, (20,21) unclear(22,23) or even harmful.(24)
Comparison of our data with that of the developed
countries might not be feasible as sociodemographic
characteristicsindevelopedcountriesaredifferent.
In developing countries, a positive effect of
interventionalprogrammeshasbeenreportedbythe
majorityofstudies.Abolfotouh,however,reported

a failure in the change of subject knowledge after a 45

minute lectureformatted module was conducted. (30) The
failureoftheeducationalinterventiontoenhancestudents
knowledgeaboutAIDSmayreflecttheinsufficiencyofa
onesession lecture provided in isolation from a
comprehensive AIDS curriculum. Although a controlled
studyofthepreventiveeffectofpeereducationwasdonein
Turkey using a singlesession educational lecture on
HIV/AIDS, the knowledge and attitudes showed a
significant change among university students. (29) Perhaps
addingtheelementofpeereducationwasthekeytosuccess
inthisstudy.Themajorityoftheabovementionedstudies
agreethateveryinterventionhastobetailoredaccordingto
the sociodemographic characteristics of the target

teachers(30)aswellaspeers(27)todesignaneffective

module.Ourstudybenefitedfromthecontributionsofall
these subgroups to design a culturally and religious
sensitive module targeted towards Malaysian students.
Klepp et als study, as an example of a successful
programme, is similar to ours in terms of adopting
variousactivities,suchasmakingposters,smallgroup
discussions,performingsongsand

Singapore Med J 2009; 50 (2) : 178

thenext.Thisraisesthequestionoftherighttimetostart
sexual education. Siegel et al have suggested that the
mostappropriatetimeforinterventionimplementationis
during early adolescence, before the onset of risky

otherfeasibleactivities.

(26)

Itseemsthatusingactivities

behaviours.(32)Thisquasiexperimentalstudy,whichwas

and concentrating on small groups can enhance the

doneonalargegroupofmiddleschoolandhighschool

effectiveness of the intervention. It was therefore our

students(n=4,001),foundthatsubjectswhoarealready

intention to create an interesting and attractive

sexually active at pretest were less likely to show a

programmeoutoftheusualframeworkofboringlectures

positiveinterventionaleffect.Theriskybehaviourscore

to draw students attention and participation. Unlike

Fitzgerald et als study, our results did not show any
significantchangeinbehaviour.(24)Itisworthnotingthat

waslowinourstudypopulation,makingitsuitablefor
engagingstudentsinaneffectivepreventiveprogramme.
Sexual activity was found to be low among our

Fitzgeraldetalconcentratedoncondomuse,whilerisk

study population. In 1986, Low conducted a study

takingbehaviourinourstudyincludedacombinationof

among1,20015to21yearoldunmarriedMalaysiansin

sexualactivityanddruguse.

Kuala Lumpur, the capital of Malaysia, using faceto

This study showed a positive correlation between

face interviews on sexual knowledge, attitudes and

theageandlevelofknowledge(p=0.01).Themean

behaviour.(33) The result suggested that 20% of

levelofknowledgeforundergraduatestudentswasfound
tobesignificantlyhigher(25.464.30)comparedtothat
ofthefoundationgroup(23.885.31)(p=0.01).This
findingsuggeststhatfoundationstudents(freshmen)do
not knowmuch aboutHIV butgradually pickup this
knowledgefromtheirpeersorthroughothermodalities.
However,itisnotcleariftheinformationiscorrectly
andaccuratelygivenandreceivedandifbadjudgments
andwrongdecisionmakingregardingsexualbehaviour
arealsopassedalongfromonegenerationofstudentsto

adolescentshadhadsexualintercourse,where93%were
boysand7%weregirls.Comparingtherateofsexual
activitybetweenUTPstudentsandstudentsfromother
neighbouringcountriesrevealedinterestingresults.11%
of 804 students from four public high schools in the
Philippines reported having had intercourse, with a
higher rate among males (p = 0.001).(27) The rate of
sexualactivityamongourtargetpopulationisquitelow
comparedtootherdevelopedcountries,suchastheUSA,
wheresexualactivitywasreportedtobe89%among
communitybased sample of 1,083 1317yearold
teenagers.(35)Heconcludedthatparentshavetheopportunity
andabilitytoinfluence theirchildrensdecisionsontheir
sexualbehaviour.Inhisstudy,youthsweremuchlesslikely

college students.(31) As for studies conducted on other

to have initiated sexual intercourse if their parents taught

continents,astudyinZimbabweonsexualbehaviourfound

themtosayno,setclearrules,talkedaboutwhatisrightand

thatoutof511malestudentsbetweentheagesof11and19

wrong,andaboutdelayingsexualactivity;iftheseyouths

years,37%hadexperiencedsexualintercourse,ofwhichup

were sexually active, they were more likely to use birth

to 63% had had more than one partner.

(34)

Teenagers in

control.

Gambiaweremoresexuallyactive(73%ofthemarriedboys

Inconclusion, our study module was found to be an

and28%oftheunmarriedgirls),aswerethoseinthe17

effective one in enhancing the level of knowledge and

yearsagegroupinNigeria(60%ofboysand38%ofgirls).

improving the attitude of youths. However, it did not

In Taiwan, however, the figures were more conservative,

improve their risktaking behaviour. Comparing various

with only 4% having experienced sexual intercourse

modulesofinterventionsuggeststhataneffectivemodule

betweentheagesof15and21years.

shouldstart inearly adolescence before sexual activity is

Anotherfindinginthisstudysuggeststhatsexualrisk

experienced.Peereducatorsandadulthealthcarespecialists

taking behaviour was higher among boys than girls (p =

should be involved in the facilitation and design of the

0.01).Onthewhole,adolescentgirlsengageinmuchless

modules. More interactive activities, such as small group

sexualactivitythanadolescentboys.Onereasonforthisis

discussions,posteractivitiesandempathyexercises,heldfor

undoubtedlythedoublestandardofmoralitythatthreatens

a longer period of time, may produce more successful

females with much harsher consequences for sexual

results. Our study module included most of the above

infractions than males. Parents role in teaching sexual

characteristics,whichmaybethereasonforitssuccess.One

behaviourcanbeofimmeasurablevalue,yetmoststudies
including this one verify that parents play almost a
negligibleroleinthesexualeducationoftheiradolescents.
Aspyetalstudiedtheroleofparentalcommunicationand
instructionstotheiryouthsconcerningsexualbehaviourina

limitationofourstudywasthatwedidnotfollowuponthe
subjectstomeasurethelongtermeffectsofthismoduleon
their level of knowledge, attitudes and behaviour. Future
studiesshouldbeconductedtocheckontheeffectivenessof

Singapore Med J 2009; 50 (2) : 179

anddeputiesatUniversitiTeknologiPetronasforgiving
us the permission and support to carry out this study.
Finally,wewouldliketothankthestudentsofUTPwho
participatedinthestudy.

thisinterventionoveralongerperiodoftime.Another
limitationwasthestudydesignofhavingonelongsingle

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