**5. Education towards behavior change**

Education about STDs, including HIV/AIDS, should cover a wide range of attitudes and behaviors. Some believe that usually the mere presence of knowledge is sufficient to motivate healthy behaviors. Hence, motivation can lead to health-influencing behavior. This is known as *the knowledge-action model* of behavior change. However, in some cases, knowledge may be sufficient to elicit changes in behavior, but in other cases, it may not. Therefore, behavior may not change as a result of providing facts. The transfer of knowledge into action is dependent on a wide range of internal and external factors, including values, attitudes and beliefs. The communication of information can create, affect or change people's attitudes. Attitude is defined by Ribeaux and Poppleton (1978) as a learned predisposition to think, feel and act in a particular way, towards a given object or class of objects. Often, values and attitudes change precedes behavioral change. Attitudes can be transferred or reflected to behaviors or feelings. In many cases, people's attitudes are taken to determine their behaviors. Therefore, proper understanding of knowledge-attitude-behavior change models and theories provides guidelines for information, communication and education planning towards community health promotion and HIV/AIDS prevention and control.

Social scientists have evolved a number of models to explain the process of change influenced by personal and interpersonal communications within an individual. Stage models view behavior change as a series of actions or events. *The health-belief model* can be the best to explain the modification towards an AIDS-related protective behaviour. Rosenstock (1974) suggested that preventive health behavior can be understood as a function of perceived self-susceptibility of acquiring the disease, perceived severity of the disease, perceived benefits to be realized by engaging in particular preventive behaviors. Health-related action, then, is hypothesized to depend upon the simultaneous occurrence of three classes of action:


training for adolescent health and development, including protection from HIV/AIDS

Health literacy is explained by competence in critical thinking and problem solving, responsible and productive, self-directed learning, and effective communication. School health education is to teach students the information and skills they need to be literate and maintain and improve their health, prevent disease and reduce their health-related risk behaviors, including those related to HIV/AIDS. School planned comprehensive curricula, covering health education and promotion, including HIV infection prevention, now represent a prerequisite. Students should comprehend concepts related to HIV/AIDS prevention and health protection and promotion. Schools and universities are settings that most children and many young people, respectively, attend. This provides an opportunity for knowledge and skills provision and accordingly for changing behaviors and modeling healthy practices. Therefore, schools and universities are a crucial setting for health

Schools and universities represent an effective and efficient means to reach a large proportion of young people and, in turn, their families and communities (Kore et al., 2004; Naidu & Aparna, 2008). Several researchers proved that students' HIV/AIDS education interventions improve knowledge (Svenson et al., 1997; UNAIDS, 2008; Ahmed et al., 2009). This in turn increases personal concern about the risk and possible disease contraction, and thus leads to disease prevention behavior. Educated students succeeded in developing skills for negotiating prevention and risk reduction, and resisting peer pressure to engage in riskrelated behaviors (Becker & Maiman, 1975; Hingson et al., 1990; Svenson & Varnhagen, 1990; Svenson et al., 1997). Nevertheless, other researchers reported that school or university education courses do not necessarily affect students' behaviors (Baldwin et al., 1990;

The International Union for Health Promotion and Education (IUHPE, 1999) demonstrated that schools are cost-effective sites for health promotion interventions. The effectiveness and sustainability of school health is governed by how closely health promotion interventions are linked to the primary business of schools in developing the educational skills and knowledge base of young people. Schools can create an educated population who are the better able to make use of any health education they receive in later life from sources such as newspapers, magazines, books and booklets or leaflets. Provision of education concerning sexual health and of HIV/AIDS education is best started at school. The United Nations Program on HIV/AIDS (UNAIDS, 1999) showed that responsible and safe behavior can be learned. Reaching the adolescents as early as possible is arguably the highest HIV/AIDS prevention priority. This includes protection from other sexually transmitted diseases.

Students empowerment, including teaching of appropriate skills, combined with proper provision of HIV preventive knowledge and acquiring healthy attitudes, can motivate practicing healthy behaviors even when students are outside of the school or university setting (Svenson et al., 1997). Several health issues, such as HIV/AIDS control, can be integrated within and into the different subjects, including biology, sociology, environment,

**7. Effectiveness of school education against HIV/AIDS** 

(WHO, 1993).

promotion and HIV/AIDS control.

**8. Appropriate students HIV/AIDS education** 

DiClemente, 1992).

*The transtheoretical model* or *the stages of change theory* is among the simple models that can be applied in the field of HIV/AIDS prevention and control (Prochaska & Di Clemente, 1983)*.* According to this model, people appear to pass through a series of distinguishable stages before they adopt a new practice. These stages are: *Pre-contemplation*, not recognizing the problem or the need to change; *Contemplation*, seriously thinking about the problem and the possibility of change; *Preparation*, making a commitment to change and taking steps to prepare for that change; *Action*, successful modification of behavior for a period of one day to six months; and *Maintenance*, continuation of change from six months to an indefinite period. Research has shown that relapse and recycling through the stages of behavior change happens often as individuals try to stop or change particular behaviors.

*The knowledge-attitude-behavior change (or AIETA) model* (Park & Park, 1997) is a simple and similar model to the one described above to explain the process of change. The stages of change in this model are: *Awareness:* At this stage the individual comes to recognize the new idea or practice. He/she has only some very general information about it and knows little about its usefulness, limitations and applicability to him/her. *Interest:* This is the stage when the individual seeks more detailed information. He/she is willing to listen or read or learn more about it. *Evaluation:* During this stage, the individual weighs the pros and cons of the practice and evaluates its usefulness to him/her or his/her family. Such an evaluation is mental exercise and results in a decision to try the practice or reject it. *Trial:* This is the stage when the decision is put into practice. He/she would need additional information and help at this stage so as to overcome the problems in implementing the idea. *Adoption:* At this stage, the individual decides that the new practice is good and adopts it.

#### **6. Response to adolescence needs**

Adolescence is a period of dynamic change during which the differences between males and females become more apparent, especially with regard to sexual characteristics and reproductive capacity. In all societies, some form of courtship takes place during which adolescents may began to form lasting relationships, which commonly lead to marriage and family formation. During the different phases of adolescence, adolescents have different needs. For instance, early on, they need to understand the nature of changes that are taking place in themselves, as well as the new demands and expectations that are placed upon them. In addition, they may be aware of anything which may be a cause of concern. As they move through later adolescence, as well having new kinds of relationships with adolescents and adults of both gender, they need to have responsible and satisfying relationships with others. Ultimately, in adulthood, they benefit from their capacity to form lasting relationship and have good parenting skills.

In order to meet the natural needs of adolescents, a response is required which is promotive or preventive in nature. In early adolescence, this will include appropriate education and health screening. In middle adolescence, it may include guidance, support and empowerment. In late adolescence or adulthood, it includes preparation for marriage and parenthood. Those people in a position to help the young are likely to be those who are close to them and whom they trust. Such people must be adequately prepared, whether formally or informally. The important figures include the parents, other family members, teachers, social workers, youth leaders, health professionals, role players and other popular figures. Those who determine policy in the key sectors such as health, education, culture, religious or ethnic affairs, youth and social welfare will be needed to facilitate appropriate

*The transtheoretical model* or *the stages of change theory* is among the simple models that can be applied in the field of HIV/AIDS prevention and control (Prochaska & Di Clemente, 1983)*.* According to this model, people appear to pass through a series of distinguishable stages before they adopt a new practice. These stages are: *Pre-contemplation*, not recognizing the problem or the need to change; *Contemplation*, seriously thinking about the problem and the possibility of change; *Preparation*, making a commitment to change and taking steps to prepare for that change; *Action*, successful modification of behavior for a period of one day to six months; and *Maintenance*, continuation of change from six months to an indefinite period. Research has shown that relapse and recycling through the stages of behavior

*The knowledge-attitude-behavior change (or AIETA) model* (Park & Park, 1997) is a simple and similar model to the one described above to explain the process of change. The stages of change in this model are: *Awareness:* At this stage the individual comes to recognize the new idea or practice. He/she has only some very general information about it and knows little about its usefulness, limitations and applicability to him/her. *Interest:* This is the stage when the individual seeks more detailed information. He/she is willing to listen or read or learn more about it. *Evaluation:* During this stage, the individual weighs the pros and cons of the practice and evaluates its usefulness to him/her or his/her family. Such an evaluation is mental exercise and results in a decision to try the practice or reject it. *Trial:* This is the stage when the decision is put into practice. He/she would need additional information and help at this stage so as to overcome the problems in implementing the idea. *Adoption:* At this

Adolescence is a period of dynamic change during which the differences between males and females become more apparent, especially with regard to sexual characteristics and reproductive capacity. In all societies, some form of courtship takes place during which adolescents may began to form lasting relationships, which commonly lead to marriage and family formation. During the different phases of adolescence, adolescents have different needs. For instance, early on, they need to understand the nature of changes that are taking place in themselves, as well as the new demands and expectations that are placed upon them. In addition, they may be aware of anything which may be a cause of concern. As they move through later adolescence, as well having new kinds of relationships with adolescents and adults of both gender, they need to have responsible and satisfying relationships with others. Ultimately, in adulthood, they benefit from their capacity to form lasting relationship

In order to meet the natural needs of adolescents, a response is required which is promotive or preventive in nature. In early adolescence, this will include appropriate education and health screening. In middle adolescence, it may include guidance, support and empowerment. In late adolescence or adulthood, it includes preparation for marriage and parenthood. Those people in a position to help the young are likely to be those who are close to them and whom they trust. Such people must be adequately prepared, whether formally or informally. The important figures include the parents, other family members, teachers, social workers, youth leaders, health professionals, role players and other popular figures. Those who determine policy in the key sectors such as health, education, culture, religious or ethnic affairs, youth and social welfare will be needed to facilitate appropriate

change happens often as individuals try to stop or change particular behaviors.

stage, the individual decides that the new practice is good and adopts it.

**6. Response to adolescence needs** 

and have good parenting skills.

training for adolescent health and development, including protection from HIV/AIDS (WHO, 1993).
