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Procedia Environmental Sciences 23 (2015) 99 – 104

International Conference on Tropical and Coastal Region Eco-Development 2014

(ICTCRED 2014)

The Role of Sexual Behavior In The Transmission Of HIV and AIDS


In Adolescent In Coastal Area

Dewi Rokhmaha, Khoironb


a,b
Lecturer at School of Public Health, University of Jember, East Java, Indonesia

Abstract
This study aims to analyze the role of sexual behavior in the transmission of HIV/AIDS in adolescents in coastal areas.
This study is quantitative research with observational methods using crossectional approach. The study population was
adolescents in high school aged 15-18 years. The sample of the research was chosen by random sampling at 200 students. Data
collected is analized by quantitative methodes with univariat analysis and narative explanation. Results showed that the
adolescents knowledge related to HIV / AIDS in the coastal areas is high and the attitudes of HIV / AIDS is in the category
adequate, it was not guarantee that they have save behaviour, which 15% of students had sexual intercourse, 6% of them using
condom, only 7% of students had sexual intercourse with a girlfriend/boyfriend, 2% of students had sexual intercourse with
prostitutes, and there are 5% of students had sexual intercourse with more than one person, there are 47% of students had
masturbation, and 5% of students had STIs symptoms.

©2015
© 2014TheTheAuthors.
Authors. Published
Published by Elsevier
by Elsevier B.V. B.V.
This is an open access article under the CC BY-NC-ND license
Peer-review under responsibility of scientific committee of the ICTCRED 2014.
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of scientific committee of the ICTCRED 2014

Keywords: risky sexual behavior, adolescents, STI and HIV/AIDS, coastal area

1. Introduction
One of the objectives of the Millennium Development Goals 2015, the 6th goal there are several indicators
to be achieved, one of which is the percentage of people aged 15-24 who have comprehensive knowledge of HIV /
AIDS to 95%. At the time of HIV & AIDS is a concern because of the increased number of events that continue to
grow over time, especially in the adolescent age group. The fact that 57.8% of the AIDS cases that occurred in 2006
involving adolescent and young people aged 15-29 years were significantly shows that this group is specifically very
vulnerable to HIV [1]

1878-0296 © 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of scientific committee of the ICTCRED 2014
doi:10.1016/j.proenv.2015.01.015
100 Dewi Rokhmah and Khoiron / Procedia Environmental Sciences 23 (2015) 99 – 104

Adolescents or young people according to the United Nation are all people aged 10 to 24 years.
Adolescents or young people are always want to know, quickly bored with the routine, enjoy group activities, and
tend to follow their peers. Santrock (2007) revealed that adolescents (adolescene) is defined as a transitional
developmental period between childhood and adulthood that include changes in biological, cognitive, and social-
emotional. This resulted in teenager's easy to fall to promiscuity, drug abuse, fights and even criminal acts. These
conditions can not be denied is closely related to the impact of technology flows among adolescents which is getting
easy to access to pornography accompanied by an increase in unsafe sex behavior (free-sex) and injecting drug use
that getting widespread. [2]
In the spread of HIV / AIDS there is an interesting phenomenon associated with the high cases in the
coastal zone. The coastal zone has the potential to be used as a transit point for shipping, marine products trading,
and other business activities, including commercial sexual transactions. So the mobility in the area is high, including
in the context of transmission and spread of HIV / AIDS. In Indonesia, amount of the society in coastal area as
traditional fisherman is included as low income population.This is the same result with the research which the title
is The Epidemiology of Herpes Simplex Virus Type 2 Infection in Low-Income Urban Populations in Coastal Peru
showed that In the socially marginalized population, Herpes Simplex Virus Type 2 (HSV-2) prevalence was 72.3%
in men who have sex only with men (MSOM), 42.5% in women, and 20.7% in men. In the general population,
HSV-2 prevalence was 20.5% in women and 7.1% in men. In all groups except the male general population, HSV-2
prevalence increased with age or number of sexually active years. HSV-2 infection was associated with HIV
infection in MSOM and other socially marginalized men [3]. Puger subdistrict Jember District is a region in the
southern area which is a coastal areas. The same with another place in developing country, the coastal area has
amount of community in low income. Worldwide, societal shifts and behavioural patterns exacerbated by unique
developmental vulnerabilities create a confluence of factors that place today’s adolescents at heightened risks for
poor health outcomes [4]. Unsafe sex is the second most important risk factor for disability and death in the world’s
poorest communities and the ninth most important in developed countries [5].
In Puger subdistrict there is a limestone mountain that supply the main materials for Puger Cement Factory.
Beside that Puger has marine potential in form of fish and tourism. For fish potential, Puger is the only subdistricts
in Jember that become the center of marine fisheries. While there are 2 beach tourism potential that is managed by
the district government and the PT. Perkebunan Nusantara X region. As the center of economic activity and tourism,
Puger region has become a destination for migrants from outside the region and from abroad. The workers in Puger
Cement many originating from Korea and Thailand. On the other hand, the flow of information technologies
through media such as television, mobile phones and the Internet also have an impact on people's behavior patterns
in Puger, including adolescents. Permissive lifestyle that allows promiscuity can lead to increase the risk behaviors
that lead to the spread of sexually transmitted diseases including HIV and AIDS. Meanwhile "taboo" cultural to
discuss issues of sexuality and reproductive health in the family and society is still very attached. This is reinforced
by the presence of the biggest ex-localization in Jember was in the Puger subdistrict. Although the Jember
government has closed the Puger localization since 2007, but the practice of illegal prostitution still mostly found in
the ex localization and some found in dimly lit stalls adjacent to residential areas.
The southern region of Jember District is the red zone of the spread of HIV / AIDS. This means that in the
south there is a 5 subdistricts as the largest contributor to the discovery of cases of HIV and AIDS, which includes:
the Puger, Gumukmas, Kencong Wuluhan and Ambulu subdistrict. Recent data reported by KPAD Jember Month
December 2013 states that the number of HIV and AIDS in Jember reach 1115, where Puger subdistrict ranked first
with HIV and AIDS cases reached 161, with the highest risk factor of heterosexual. By age group, that is included in
the adolescent category at the age of 14-24 people reached 213 cases [6].
According to the conditions mentioned above, the researcher is interested in conducting research on how
the sexual behavior of adolescents in the coastal areas of Puger subdistrict that have risk of HIV and AIDS infection.

2. Method
This study is quantitative research with observational methods using crossectional approach. This research
aimed to analyze how risky sexual behavior in transmission of HIV/AIDS in adolescents in coastal areas in the
Dewi Rokhmah and Khoiron / Procedia Environmental Sciences 23 (2015) 99 – 104 101

Puger subdistrict Jember district. Independent variable of the research are individual charactaristic, and dependent
variable is behaviour in the transmission of HIV/AIDS in adolescent in coastal area in Puger subdistrict in Jember
district. The place of the research is in the coastal area in Jember district at September-Desember 2013. The study
population was adolescents in high school in the region of Puger subdistrict aged 15-18 years. The sample of the
research was chosen by random sampling at 200 students. Based on the gender of the respondents there are 137 male
students (68.5%), and 63 female students (31.5%). The data collected is analized by quantitative methodes with
univariat analysis and narative explanation.

3. Results and Discussion


3.1.Overview of Study Sites
The area of Puger sub district Jember district area located on the southern region which is directly adjacent
to the south coast. There are 2 areas, Watu Ulo beach and Papuma beach, that become a tourist destination. Since
2010, Puger cement factory has established. In addition Puger subdistricts also have a limestone mountain that
become the source of livelihood of the local population. Currently 24 companies are engaged in the processing of
lime. Related to the exploitation of nature in the Puger subdistrict it is not surprising that there are so many
immigrants coming into the Puger area. They not only aim to work but also in order to travel. In connection with
these conditions, there are ex-localization in Puger. This localization has been closed by the local government, based
on the SK Bupati Jember number 188.45/39/012/2007 on the closure of Social Services Transition for Commercial
Sex Workers and Prostitution Closure In Jember. But in reality it is still found illegal prostitution in the area of
Puger. These conditions directly affect the lives of local people, including adolescents. Because of the many
migrants who earn a living, localization and the beach destinations, it make adolescents exposed to circumstances
that are not ideal to support their growth and development, both physically and socially. As a result, adolescents get
used by adults environment that is permissive to risk behaviors such as: free sex, drugs, and others.
According to Santrock (2004) adolescence is a time of sexual exploration and integrate sexuality into one's
identity. Since HIV / AIDS cases are found in Jember, Puger subdistrict always ranked highest in case of discovery.
Both from heterosexual adult age group who are married and from unmarried adolescents age with risk factors for
heterosexual and homosexual. Intercourse that occur among teenagers is an extension of a general trend that leads to
a permissive attitude toward sexual life that occur in the adult culture [2].
3.2.Sexual Behavior In The Transmission Of HIV/AIDS In Adolescent In Coastal Area

The results showed that adolescents knowledge related to HIV / AIDS in the coastal areas is high at an
average of 85%. While knowledge of the symptoms of HIV / AIDS is in the category adequate with an average of
65%. At the research which the title is A Controlled-Study of Preventive Effects of Peer Education and Single-
Session Lectures on HIV/AIDS Knowledge and Attitudes among University Students in Turkey showed that
Statistical analyses reveal significant differences in knowledge and attitudes, personal behavior, and awareness of
HIV/AIDS [7]. Knowledge is an important part in the formation of behavior. Behavior that is based on knowledge
will be more lasting than the behavior that is not based on knowledge [8]. Knowledge is the antecedent of the
behavior that provides the primary reason or motivation for the behavior [9]. Knowledge about HIV / AIDS of the
respondents is quite high because they get information from electronic media such as the Internet. Because most of
the students already have a mobile phone. Parents who have children in adolescents age are considered adults and
were given mobile phones as a means of communication.
High level of knowledge about HIV and AIDS is very important for the respondent to have a positive
attitude to prevent risky behaviors that can transmit HIV & AIDS. The attitude is the willingness or readiness to
behave [8]. In terms of attitude, average of adolescents has a positive attitude towards prevention and testing for
HIV / AIDS from an early age by 60%. With the high adolescents knowledge about HIV / AIDS and how to prevent
it, will improve behavior of adolescents to avoid behaviors that lead to HIV infection and AIDS. Knowledge and
attitudes of adolescents towards HIV & AIDS and its prevention is an important part in the lives of adolescents in
taking the decision to behave safely (no risk of being infected with HIV and AIDS). It is like Widyastari research
which states that media exposure is not influential, but an adolescents attitude that encourages a more permissive
102 Dewi Rokhmah and Khoiron / Procedia Environmental Sciences 23 (2015) 99 – 104

attitude toward sexuality [10].


In terms of actions that lead to risky behavior in the transmission of STI and HIV / AIDS are: 15% of
students had sexual intercourse. 6% of students had sexual intercourse using a condom, only 7% of students had
sexual intercourse with a girlfriend, 2% of students had sexual intercourse with prostitutes, and there are 5% of
students had sexual intercourse with more than one person, there are 47% of students have ever masturbation, and
there are 5% of students who experienced symptoms of Sexual Transmited Infection (STI). STI is caused by unsafe
sexual behaviour likes : sexual intercourse with multipartners and without condoms.
STI is the entrance to the spread of HIV and AIDS. Because a person suffering from STI are very easy to
wound and bleeding in the genital area, so the risk of transmission of HIV through blood contact is likely to occur.
Approximately 80% of HIV cases are transmitted sexually and further 10% perinatally or during breastfeeding [11].
The infection of HIV by sexually is happened at man who buy sex ang his partners, sexual workers, Man Who Have
Sex with Man (MSM) and his woman partner [12]. Epidemic of HIV/AIDS raised as the increasing of high risk
behaviour likes : Injecting Drugs User (IDU) unsterilized, heterosexual behaviour without condoms and in small
community at man who have sex with man without condoms [13]. The result of study on adolescent sexual behavior
of high school students in the city of Denpasar, revealed that exposure to pornography, direct and indirect behaviors
were significantly associated with the initiation of sexual intercourse before marriage [14]. Another study about the
factors that influence sexual behavior Premarital Pekalongan Students 2009-2010 also stated the same thing that
11.9% of respondents do risky premarital sexual behaviour [15].
The results showed that risky behaviour is done by the respondents, most of them were men, amounting to
68.5%. This condition is in line with the investigations reported there was an association between sex with
adolescents attitudes toward premarital sexual relations. Men tend to be more permissive toward premarital sexual
intercourse than women [16]. This condition does away with the results of the study which states that adolescent
males seem to do a lot more sexual activity than female adolescents [14]. This is consistent with studies in Factors
associated with risk behaviors of Adolescent in Semarang in 2009 which states that adolescent males tend to behave
at risk than females [17]. Another study also revealed the same facts to students at several universities in three cities
in Central Java, Semarang, Solo and Purwokerto showed that 22% of male respondents and 6% of female
respondents had had sexual intercourse [18]. Indonesian society in general, applying double standards in sexual
behavior between men and women. Men are allowed to seek sexual experiences before and outside of marriage,
while women should avoid such behavior. The norms of sexuality that is dominated by the norms of masculinity that
emphasize sexual pleasure (sexual pleasure) of men, sexual ability (sexual powerness) and encourage men to have
more than one sex partner (multiple partners) [19].
This study showed that the sexual behaviour of the adolescent in coastal area has big role in the
transmission of HIV and AIDS. Althought the adolescents knowledge related to HIV / AIDS in the coastal areas is
high at an average of 85%, and the knowledge of the symptoms of HIV / AIDS is in the category adequate with an
average of 65%, it was not guarantee that they have save behaviour in sexual intercourse. It is because of the
reproductive health programmes on adolescent is not optimally. Sexual and reproductive health programmes can
make an important contribution on HIV prevention and treatment, and that STI control is important both for sexual
and reproductive health and HIV/AIDS control (Askew & Berer, 2003). Adolescents’views of and preverences for
sexual and reproductive health services highlight promising direction and persisten challenges in preventing
pregnancy and HIV and treating sexually –transmitted infections (STI) in this population [20].
According to the result of the research showed that behaviour of adolescents have potention to transmite
HIV is possible to happen from sexual intercourse with their partner. The Health Minister of Indonesia reported that
until the end of 2010, the proportion of AIDS cases is most happened at youth at aged 15-39 year (81,8%). It
indicated that youth is risky population and important to be the target of the AIDS prevention programmes in
Indonesia [21]. But the programmes of sexuality and health reproductive for adolescent is still limited and unpopular
at the youth community, both of boys and girls, especially in coastal area at the Puger subdistrict that including as
the low-income population. This condition is the same with the research showed that thirty-eight percent of
adolescents had a previous 12 months. Low-income and full-year uninsured status were associated with higher risk
for not receiving this visit [22]. After adjusting for STD/HIV risk behaviours, dating violence remains significantly
associated with STD/HIV testing and diagnosis among sexually active adolescent girls [23]. The reproductive and
sexual health education does not match the reality of sexual behaviour and sexual risk faced by teenagers because :
(1) reproductive health and sexuality education that given to the high school level is more focused on the biological
Dewi Rokhmah and Khoiron / Procedia Environmental Sciences 23 (2015) 99 – 104 103

aspects aloner, (2) there is still a notion that sexuality is a taboo to be given at school, (3) the sexuality education has
not looked at the importance of aspects of gender relations and rights of adolescents in adolescent reproductive and
sexual health [24]. Research indicates that current programs often do not match the needs and health-seeking
behaviours of young people. Behavioral theories and expert opinion agree that adolescents must be taught generic
and health-specific skill necessary for adopting healthy behaviors. Constraints on financial and human resources,
coupled with the great size of the youth population, highlight the need to find less costly ways to reach young people
[25].

4. Conclusion and Sugession


The results of study about the role of risky sexual behavior in the transmission of HIV/AIDS among
adolescents in coastal areas in the Puger subdistrict Jember district indicate that the role of adolescents risky sexual
behavior that includes adolescents knowledge of HIV/AIDS, the symptoms of HIV/AIDS are at a high enough
category, then the positive attitude to the prevention and investigation of HIV/AIDS since the early adolescents in
coastal areas Puger is also high enough. In terms of actions that lead to risky behavior in the transmission of STI and
HIV/AIDS are: some students had sexual intercourse, had sexual intercourse using a condom. A few of respondents
had sexual intercourse with a girlfriend, a few of students who have ever had sexual intercourse with prostitutes, and
there are a few of students had sexual intercourse more than one person, there are a few of students have ever had
sexual intercourse with masturbation, and there are some students who experienced symptoms of STI. Althought the
adolescents knowledge related to HIV/AIDS in the coastal areas is high and the attitudes of HIV/AIDS is in the
category adequate, it was not guarantee that they have save behaviour in sexual intercourse. It is because of the
reproductive health programmes on adolescent is not optimally. So the role of risky sexual behavior was
instrumental in the spread of HIV/AIDS among adolescents in coastal areas in the Puger sub district Jember District.
Comprehensive effort is needed in the form of cooperation between the government through the schools
and the community in this case teachers and student’s parents in providing health education about the dangers and
prevention of HIV / AIDS through the media that attract students such as: film and music performance.

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