Introduction

This ground-breaking study was carried out in order to examine several aspects in the lives of youth which were thought to be closely related to the AIDS epidemic that was not only spreading rapidly in Malaysia but also all over the world. The World Health Organisation estimated that in the year 2000, there would be 40 million people infected with HIV and that 12 million would die from AIDS. In Malaysia , up to March 1996, there were 15,471 people who had been infected with HIV and there were 388 confirmed AIDS sufferers.

As there is still no known cure for AIDS, the best way to counter this disease is through prevention. Among the methods of prevention carried out was educating the public about AIDS. Present AIDS education, whether in Malaysia or overseas, focuses primarily on proper sexual behaviour like the use of condoms, safe sex, avoiding changing partners, or avoiding sex workers.

AIDS education also emphasises avoiding syringe sharing among drug addicts, encouraging the use of clean syringes and the provision of facilities to obtain clean syringes.

This study showed that better results could be obtained by ascertaining the factors which drove the youth to activities which could expose them to the dangers of AIDS infection. With this in mind, the approach taken by this study was to ascertain how far youth's personal traits such as knowledge, values and personalities could contribute to behaviours that would expose them to the danger of AIDS infection. AIDS was also regarded as a behavioural aberration that was closely related to smoking, drug use and experimentation with pre-marital sex.

It is hoped that the information obtained on the above matters will be used to formulate a strategy of AIDS education which differs from the conventional approach. The type of AIDS education that will be proposed focuses more on the development of personal values and the worthiness and fortitude of youth, which will ultimately serve as a bulwark against the assault of the AIDS epidemic in Malaysia .

Respondents

A total of 4,347 youth aged between 13 and 25 years from various races were interviewed. This thorough study took two months to complete, i.e. from March 15 to May 15, 1996 , and was conducted throughout the country.

Two groups of youth were chosen for this study: a group of 3,462 youth who were still at school or who were employed (normal youth), and another group comprising 885 youth who were undergoing rehabilitation in Serenti rehabilitation centres (trainees). The trainees acted as a control group in order to observe the differences in knowledge, values, personalities and behaviours among the youth studied.

To ensure that the youth selected represented a fair sample, efforts were made to choose youth from various age, family income, sex and ethnic groups. The places where the youth resided were also considered, whether in town, on the outskirts, in the countryside, in land development schemes, or in squatter areas.

Results of the Study

The focus of this study was on four types of youth behaviours which were considered contributory towards AIDS infection. These were smoking, drug use, pre-marital sex and an unhealthy lifestyle. Smoking and drug use were especially taken into account in this study because a large part of AIDS infections in this country was caused by the sharing of syringes by drug addicts. Smoking, on the other hand, had a connection to AIDS in that youth who took drugs usually started with smoking cigarettes.

Youth Behaviour

Among normal youth, the percentage that had tried or often took drugs was only five percent when compared to 95 percent for trainees. Looking at those who smoked however, 34 percent of normal youth and 99 percent of trainees smoked.

This study also clearly showed a significant positive relationship between smoking and drug use (r = 0.27 among normal youth and r = 0.32 among trainees). The result of this correlative test indicated that youth who smoked often were more inclined to use drugs. This tendency was more pronounced among the trainees.

In connection with pre-marital sex, six percent of the normal youth admitted to having tried or often practising it. The percentage among the trainees was higher – 54 percent. On being questioned as to whether their lifestyles made it easier for them to become infected with AIDS, 45 percent of the trainees and 32 percent of the normal youth admitted that that was the case.

The correlative test done in this study showed a significant relationship between pre-marital sexual behaviour and a lifestyle that made it easier for a person to be infected with AIDS (r = 0.18 among trainees and r = 0.12 among normal youth). This finding indicated that youth who often practised pre-marital sex were more inclined to unhealthy lifestyles that made them more likely to be infected with AIDS.

The correlative test also showed that there was a positive relationship between the behaviours of drug using and pre-marital sex (r = 0.19 among trainees and r = 0.23 among normal youth). This showed that heavy drug users were also probably often practising pre-marital sex. Drug use also contributed positively towards a lifestyle that made youth more likely to be infected with AIDS (r = 0.14 among trainees and r = 0.09 among normal youth).

Based on the above findings, it is clear that the four behaviours which were the focus of this study were closely related to each another. Smoking contributed towards drug use. Similarly, drug use contributed towards pre-marital sex and also towards an unhealthy lifestyle that made possible AIDS infection. Whether the influence of these behaviours was big or small was irrelevant, because it had been proven that they made a significant contribution towards the AIDS phenomenon.

The Media and AIDS knowledge

Media information contributed only moderately towards the acquisition of information on AIDS (average score of media information was 18.5 compared to a maximum score of 27). This was similar to the knowledge youth had about AIDS. In general, youth were more knowledgeable on the causes of AIDS (knowledge score of 2.0 for normal youth and 1.6 for trainees, from a maximum score of 3.0). Knowledge on prevention of AIDS was lower (a score of 1.6 for normal youth and of 1.5 for trainees from a maximum score of 3.0).

Looking at the above from the educational aspect, it was found that youth with a low level of education had the least knowledge about AIDS. Knowledge increased with the increase in the ages of the youth studied.

The information that youth often obtained from information sources was that AIDS led to death; AIDS was dangerous; AIDS was difficult to cure; the methods of infection, and the methods of prevention. Such important information directly obtained influenced the perception of youth about AIDS. When questioned as to how they viewed the disease, the majority of youth stated that AIDS was death; AIDS was incurable; AIDS was a dangerous disease; and caused fear.

With respect to the kind of information about AIDS that youth needed the most, the results of the study indicated that it was firstly, methods of prevention, and secondly, information on how AIDS was transmitted. Youth stated that this information was important for it would cause them to be more careful in the future. They also stated that such information would be useful because they believed it would help them avoid AIDS infection.

This study showed that youth received a lot of information about AIDS through the mass media, such as television, newspapers and pamphlets/posters/exhibitions. When questioned about what kind of further information they required, and what sources they would refer to, the majority replied that they would refer to doctors and medical personnel, teachers and their parents, or pamphlets/posters/exhibitions. It was clear that the sources used to disseminate information about AIDS differed from the sources which the youth wanted to refer to.

On the question of why youth preferred personal sources when seeking further information about AIDS, this study found that among the main criteria that youth looked for when seeking information about AIDS were sources that were to them learned and knowledgeable, information that was complete, and information that was easily obtainable.

This study also investigated the extent to which youth were involved in activities dealing with AIDS education that were taking place in the country. Only 22 percent of normal youth and 25 percent of trainees admitted to being involved. Their involvement was limited to listening to talks on AIDS, taking part in sports and AIDS campaigns, giving advice to others, putting up posters, and taking part in essay-writing competitions.

A matter that was possibly beyond the expectations of AIDS educationists was that knowledge about AIDS did not assist much in changing behaviour. This study shows that knowledge about AIDS did not reduce the negative behaviours that could lead to AIDS infection.

Youth Values

This study assumed that youth values directly or indirectly influenced their behaviour. Youth values towards lack of education, religion and loitering was studied. As expected, youth involved in activities like smoking, drug use, pre-marital sex and living a lifestyle that could lead to AIDS infection showed a relatively low level of values. Youth who were involved with loitering behaviour placed a high value on this behaviour.

The highest deficiency in values was among normal youth aged between 13 and 16 years. The lowest values were among trainees also aged between 13 and 16 years. As to education and family income, trainees who had a low level of education and who came from families with incomes of more than RM 1, 000 had the lowest family values.

From the educational values aspect, trainees showed relatively low values. This showed that normal youth possessed higher educational values. The highest educational values were those possessed by normal youth between the ages of 13 and 16 years. Trainees between the ages of 17 and 21 years possessed the lowest educational values.

As for religious values, trainees who were involved in drugs showed low values when compared with normal youth. This result clearly proved that education influenced religious values. The lowest religious values were found to be among trainees who only received a primary education. Religious values also increased with the age of the youth.

Youth were often associated with loitering, the habit of aimlessly hanging around public places. The result of the study showed that normal youth loitered less when compared to the trainees. Karaoke, video and snooker centres, pubs, discos and shopping complexes were places favoured by youth.

The older the youth became, the more they loitered. From the educational and family income aspects, youth who loitered the most, were trainees with an STPM or higher education but who came from families whose income was less than RM500 per month.

A correlative test showed that family, educational and religious values had a negative relationship with several behaviours that were studied. Youth who showed high educational values were youth who smoked less (r = - 0.20 for normal youth and r = - 0.04 for trainees), used drugs less (r = - 0.11 for normal youth and - 0.06 for trainees), practised less pre-marital sex (r= - 0.16 for normal youth and r = - 0.09 for trainees) and less often led a lifestyle that could lead to AIDS infection (r = - 0.05 for normal youth and trainees). A correlative test on religious and family values also showed a similar trend.

This study showed that youth who often loitered were more inclined to behave negatively. In other words, the more youth loitered, the more often they smoked (r = 0.39 for normal youth and trainees), used drugs (r = 0.20 for normal youth and r = 0.09 for trainees), practised pre-marital sex (r = 0.31 for ordinary youth and r = 0.18 for trainees), and led a lifestyle that could lead to AIDS infection (r = 0.07 for normal youth and r = 0.06 for trainees).

Youth Personalities

As many as six kinds of personality traits were surveyed in this study. These were stress and depression, achievement orientation, self-respect, assertiveness, autonomy, and risk-taking. In general, normal youth showed more positive personalities when compared to trainees.

This study showed that normal youth had better personality traits as regards achievement orientation, self-respect, assertiveness and autonomy while being less likely to be stressed and depressed. Trainees, on the other hand, showed themselves to be more likely to be stressed and depressed while seeking situations that were challenging and risky.

Educational and family income factors were found to influence a youth's personality. On the whole, youth who only had a primary education possessed personality traits which were relatively inferior when compared to youth who possessed a higher level of education. It was the same when looked at from the point of view of family income. Youth who came from families who had higher incomes had better personalities.

This pattern was consistent for all personality traits studied in both groups, with the exception of stress and depression. Youth from well-to-do families experienced higher stress than youth from lower-income families.

This correlative test showed that the personality traits of the youth influenced their tendencies towards negative behaviour. Four out of the six personality traits studied, i.e. achievement orientation, self-respect, assertiveness and autonomy, had, in general, a negative relationship with the behaviours of smoking, drug-addiction, pre-marital sex and leading a lifestyle that could lead to AIDS infection.

This meant that the more these personality traits existed in youth, the lower their tendencies to be involved in negative behaviours. This was in contrast to the other two personality traits, viz. stress and depression and risk-taking. These two traits showed a positive relationship with negative behaviour.

This result showed that the more stressed and depressed youth were, then the more often they smoked (r = 0.13 for normal youth; r = 0.05 for trainees), used drugs (r = 0.10 for normal youth; r = 0.04 for trainees), practised premarital sex (r = 0.12 for normal youth; r = 0.13 for trainees), and led a lifestyle that could lead to AIDS infection (r= .08 for normal youth; r = .07 for trainees). Similarly, in the case of risk-taking: the higher the desire to take risks, then the greater the tendency to be involved in the four negative behaviours studied. This pattern was consistent with both the youth groups.

Social Relationships

This study showed that, in general, there were no obvious differences in the area of youth relationships with their parents in the two groups of youth. Nevertheless, a poor relationship with parents had a negative influence on behaviour. Youth who had been identified as smokers or drug users or as being involved in pre-marital sex or who led a lifestyle that could lead them to be infected with AIDS, had poorer relationships with their parents, as compared to youth who were not involved in these kinds of behaviours. This pattern was consistent for both groups.

Youth aged between 13 and 16 years had the best relationships with their parents. Viewed from the educational and parental income aspects, academic qualifications had little influence on the relationships between youth and their parents.

On the other hand, family income had an influence in that, in families with a high family income (> RM1000), the relationships of the youth with their parents was poorer when compared to the relationships of youth from families with lower family incomes (< RM500). This pattern could only be observed among normal youth. For trainees, the factors of education and family income did not show any influence on their relationships with their parents. The best relationships with parents were seen among trainees with primary education and who came from families with high incomes (> RM1000).

From the point of view of relationships with peers, however, it was found that trainees had better relationships with their peers as compared to normal youth. This study shows that youth who were involved in negative behaviours had better relationships with their peers as compared to youth who were never involved with such behaviours.

Relationships with peers were found to be best among trainees aged between 17 and 21 years, while the poorest relationships were among normal youth between the ages of 13 and 16 years. When looked at from the educational and parental income aspects, trainees who possessed a high qualification (STPM or higher) and came from families with high incomes (> RM1000) had the best relationships with their peers.

The correlative test result obtained in this study indicated that relationships with parents had a significant negative correlation with negative behaviours. This meant that the better the relationships that youth had with their parents, the less they were inclined to smoke ( r = - 0.14 for normal youth; r = - 0.09 for trainees), use drugs (r = - 0.09 for normal youth; r = - 0.06 for trainees), practise pre-marital sex (r = - 0.14; r = - 0.12 for trainees), or lead lifestyles that could lead to AIDS infection (r = - 0.11 for normal youth; r = - 0.09 for trainees).

As regards relationships with peers, the results showed a positive correlation with negative behaviours. In other words, the more secure the bonds of social relationships with peers, the higher the tendencies of youth to be involved in negative behaviours. This pattern of relationships only existed among normal youth. With trainees, their close relationships with peers assisted in reducing drug use (r = - 0.60) and pre-marital sex (r = - 0.09).

The Implications of the Study

The above explanations lead us into a new dimension in looking at the AIDS issue in Malaysia . All this while, most AIDS education placed too much emphasis on the prevention aspects which had a direct relationship with the AIDS disease, like those which had to do with sexual behaviour and drug abuse.

This study has pointed out the causes which most likely involve youth in behaviours which are closely connected with AIDS infection. In view of this, prevention efforts in AIDS education should also place more emphasis on causes which could influence youth to behave in ways that could lead them to be infected.

The causes mentioned are closely related to the values, personality traits and social relationships of youth. Furthermore, the environmental aspect should also be tackled so that unsuitable environmental factors that adversely influence the values, personality traits and social relationships of youth could be given more importance.

This study also discovered that exposure of youth to AIDS information did not necessarily increase AIDS awareness among them. The medium which is used to deliver the information should also be given more attention. Should the present approach, which places the responsibility on the government and several NGOs, be continued? What about the involvement of the community in AIDS education?

AIDS education information will probably not have a lasting effect if the educating effort is not undertaken systematically and continuously. With the involvement of the community in the educating effort, it is believed that AIDS education information will be more meaningful and effective.

Based on the above conclusions, this study suggests the following proposals:

• A communication strategy in AIDS education that shifts its emphasis on the mass media to one that is interpersonal and that has more credibility. Information by way of the mass media is capable only of creating awareness but lacks the ability to dispense deeper knowledge which subsequently causes changes in attitude, values and behaviours. Furthermore, the responsibility of communication must also shift from the government and NGO's to the community as part of a community participation programme.

• AIDS education information should also attempt to inculcate positive values (such as religious, family and educational values) and personality traits (assertiveness, achievement orientation, self-respect) among youth. Such information should not be regarded as secondary information but rather as primary. Values and personality traits which are not properly fostered will encourage negative behaviours that could lead to AIDS infection.

• Various basic approaches should be considered. Youth who always like to only have fun and to loiter were found to be often involved in negative behaviours. Efforts should be made to encourage employers to also be involved in creating a positive lifestyle by providing recreational facilities for their employees. The increase in the number of video and snooker centres, which are becoming the preferred gathering places of our youth, should be controlled and conditions for entrance into their premises should be tightened.