Elsevier

Child Abuse & Neglect

Volume 31, Issue 2, February 2007, Pages 143-159
Child Abuse & Neglect

Child abuse and AIDS-related knowledge, attitudes and behavior among adolescents in Zambia

https://doi.org/10.1016/j.chiabu.2006.08.006Get rights and content

Abstract

Objective

To research the correlation between physical and sexual abuse by family members and AIDS-related knowledge, attitudes, self-efficacy and behavior among urban and rural adolescents in Zambia.

Sample

The sample comprises 3,360 adolescents, aged 10–19, from urban and rural Zambia; 2,160 of them attended school, while 1,200 of them did not.

Measures

Standardized scales were utilized to assess AIDS-related knowledge, attitudes, and self-efficacy. In addition, the adolescents reported the extent of their engagement in various high-risk behaviors and their lifetime experience of being sexually or physically abused.

Results

As the level of abuse experienced by the adolescents increased, their level of knowledge about HIV/AIDS, tendency to hold positive attitudes toward prevention, and level of self-efficacy regarding HIV/AIDS prevention decreased. Most importantly, when controlling for socio-demographic variables, findings indicate that past abuse was a key factor predicting participation in high-risk behaviors associated with HIV infection.

Conclusion

Physical and sexual abuse of adolescents in Zambia is significantly related to HIV risk behaviors. Future studies should investigate which factors mediate between the experience of abuse and the tendency to engage in risky behaviors.

Résumé/Resumen

French- and Spanish-language abstracts not available at time of publication.

Section snippets

Child abuse and AIDS-related knowledge, attitude and behavior

Studies in the West suggest the existence of a strong connection between having had an experience of child abuse and the tendency to engage in high-risk sexual behaviors. Such studies, to the best of out knowledge, have not been conducted among African adolescents. However, more than 70% of the world's HIV-infected people live in Sub-Saharan Africa, where Zambia is geographically located. This statistic is particularly alarming considering that only 10% of the world's population resides in

Sample

The sample comprised 3,360 adolescents aged 10–19. Adolescence is usually defined as 15–19 years of age. We included in this study younger participants because previous studies suggested that in Zambia youths tend to initiate sexual activities at a much younger age (Slonim-Nevo et al., 2001). In order to obtain a representative sample of adolescents, the following eight groups were created: females, urban in school—females, urban out-of-school; females, rural in school—females, rural

Sexual and physical abuse by a family member

Table 2 presents the frequency of each of the 9 offenses of sexual and physical abuse that form the scale “family abuse.” Physical abuse was more common than sexual abuse: less than 10% of the adolescents reported that they had been sexually abused, but 23% reported that a family member had physically abused them.

Out-of-school participants were at a higher risk of sexual and physical child abuse, including reporting that a family member had touched their breasts or genitals or had intercourse

Discussion

This paper examined the impact of sexual and physical abuse by a family member on the AIDS-related knowledge, attitudes, self-efficacy and behavior of urban and rural adolescents in Zambia. The results indicate that as the level of abuse experienced by the adolescents increased—their level of knowledge about HIV/AIDS, tendency to hold positive attitudes toward prevention, and level of self-efficacy regarding HIV/AIDS prevention decreased. Additionally, when controlling for socio-demographic

References (50)

  • Chela, M. F. (1992). A study on knowledge, attitude and sexual practices concerning AIDS among street adolescents in...
  • S.J. Collings

    The prevalence and characteristics of child sexual abuse among South African university students: Comments on S.N. Madu

    South African Journal of Psychology

    (2002)
  • R.J. DiClemente et al.

    Minorities and AIDS: Knowledge, attitudes and misconceptions among Black and Latino adolescents

    American Journal of Public Health

    (1988)
  • D.E. Elze et al.

    Untangling the impact of sexual abuse on HIV risk behaviors among youths in foster care

    AIDS Education and Prevention

    (2001)
  • M. Essex et al.

    AIDS in Africa

    (2002)
  • Feldman, D. A. (1995). High-risk sexual behavior among some female Zambian out-of-school adolescents: A possible future...
  • D. Finkelhor et al.

    The traumatic impact of child sexual abuse: A conceptualization

    American Journal of Orthopsychiatry

    (1985)
  • Fylkesnes, K. (1995). Overview of the HIV/AIDS situation in Zambia: Patterns and trends. A paper presented at the 5th...
  • Gaisie, K., Cross, A. R., & Nsemukila, G. (1993). Demographic and health survey, 1992. UNZA, CSO: Macro...
  • C. Gore-Felton et al.

    Relationships of sexual, physical, and emotional abuse to emotional and behavioral problems among incarcerated adolescents

    Journal of Child Sexual Abuse

    (2001)
  • Haworth, A. (1988). Knowledge, attitudes, beliefs and practice (KABP) survey on AIDS. UNZA Medical Library, Family...
  • J.T. Hernandez et al.

    The effects of child abuse and race on risk-taking in male adolescents

    Journal of the National Medical Association

    (1993)
  • H. Klein et al.

    Sexual abuse during childhood and adolescence as predictors of HIV-related sexual risk during adulthood among female sexual partners of injection drug users

    Violence Against Women

    (1995)
  • C. Koopman et al.

    Assessment of knowledge of AIDS and beliefs about AIDS prevention among adolescents

    AIDS Education and Prevention

    (1990)
  • M.A. Lodico et al.

    The association between childhood sexual abuse and prevalence of HIV-related risk behaviors

    Clinical Pediatrics

    (1994)
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    The study reported in this paper was supported by a grant from The Netherlands-Israel Development Research Program (NIRP) No: 95-8.

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