An exploratory educational intervention study was conducted among secondary school adolescents of two government secondary schools in Ilam District. This study is intended to assess knowledge and attitude regarding HIV/AIDS. A structured teaching programmes was conducted for the students of class 9th and 10th to find out the change in the knowledge and attitude of secondary school adolescents regarding HIV/AIDS. The sample size was 170 including the students of two secondary schools of Ilam district.

The all obtained data, were thoroughly analysed and interpreted on the basis of objective and hypothesis of the study. The major study findings are discussed in this chapter. The pretest findings are related to the first objective of this study and the post test results are concerned with the second objective.

In pretest the existing knowledge of the respondents about HIV/AIDS was moderately adequate, that is 80.58%. Although misconceptions and confusion regarding non-sexual transmission or routes of HIV, Signs and symptoms and treatment noticed at a considerable level.

Out of 170 adolescents, 35 of them were exposed previously on HIV/AIDS programme. Majority of them had moderately adequate knowledge during pretest. It shows that seminar workshop and awareness rally about HIV/AIDS prevention could play an important role in the general public to increase the level of awareness towards HIV/AIDS.

Almost all adolescents had heard about HIV/AIDS. It is congruence with the result of the study done by Sharma Mahesh, Poudel Krishana and Poudel Kalpana (2000). They found that almost all boatman (98%) had heard about HIV/AIDS.

Radio- 72.32%, Television- 54.70% and poster - 37.64 seem to be powerful for mass education than others such as interaction among friends and newspapers seventy two point thirty five percent (72.35%) of the adolescents had radio and 54.70% of them had a television in their home for receiving information. Baseline study conducted by STD/HIV prevention programme (1996) found that radio and television were the main sources of information. It was also found that poster was another powerful media by means of which many students came to know about HIV/AIDS. that it was also expressed by students that they liked to watch TV and movies more than reading newspapers and magazines Twenty Three point fifty two percent (23.52%) of them had heard about HIV/AIDS from friends . Peer education seem to be more appropriate means of communication to convey specific information and which allows students to express their feelings and concerns about HIV/AIDS. That can serve as the first point of information.

In pretest only 25.3% of the adolescents knew about the full form of AIDS. In discussions with students about the distinction between AIDS and HIV, they had a lot of confusion between the term HIV and AIDS. Similarly low percentage 39.4% of the adolescents stated the data of first reported AIDS patients in world only 14.70% of them were able to state the date of first reported AIDS patient in Nepal. It shows that adolescents lacked general knowledge on HIV/AIDS. This might be the impact of mass media which concentrates more on preventive aspects rather than details of it .

In pretest very low percentage 19.4% of the adolescents mentioned that AIDS is life-threatening disease, preventable as well as contagious disease.

Majority of the students (82.35%) knew the causative organisms of AIDS. Almost all adolescents were aware that HIV/AIDS is prevalent in Nepal and majority of them (82.35%) said that AIDS patient need not to be isolated. This is also due to the effect of powerful mass media which concentrates more in explaining about its fatality, its preventive measures and also it gives the fact about the prevalence in Nepal.

Ten percent (10%) of the adolescents expressed that sex workers, drug abuser, unfaithful to their sex partners were cited as the groups at the greatest risk of contracting the virus.

During pretest overall knowledge about HIV/AIDS was good among adolescents but had considerable misconceptions were still frequent. Eighty one point seventy six percent (81.76%) of the adolescents were aware that HIV/AIDS is spread by sexual contact that is probably due to the effect of mass media which gives more importance on the spread of infection by sexual contact .

Majority of the adolescents (82.25%) were aware that HIV infected mother can transmitted the infection to unborn foetus during pregnancy Sixty four point seventy percent (64.70%) of them said that breast feeding also transmits HIV/AIDS. Even though they were not aware of the underlying Pathophysiology, they knew that the child may also get affected through the infected mother.

Eighty four point seventy percent (84.70%) of the adolescents said that HIV/AIDS can be transmitted through common use of syringe by drug abuser. This may be due to information about the prevalence of HIV among intravenous drug users (IVD US) in Nepal. Very low percentage 17.05% of the adolescents knew HIV/AIDS could be transmitted by deep kissing with HIV infected person. It may be due to mass media, which gives importance that HIV/AIDS spreads through sexual contact than other mode of transmission.

Most of them who knew about HIV, had some false beliefs about the mode of transmission that HIV could be contracted through the touch with AIDS patient 8.23%, hugging with AIDS patient-17.64%, sitting together using common toilets, swimming pool - 11.17% and bites of insects 31.76%. Incidental information that they got from their friends, magazines and mass media might miss lead sometimes. It is because mass awareness cannot convey clear and enough massage.

Nine point forty one percent 9.41% of the female adolescents had not heard about condom. Those who knew about condom (24.70%) knew that it is used for family planning purpose only and 29.41% of them knew about the protective value of condom against STD. About 9.41% of female adolescents didn't response this statements. It shows girls are more shy to answer explicit questions relating to sexual behavior and STD/HIV.

The majority of them , knew accurately that using condom during sex, being faithful to one another, avoiding multiple partners, using only sterilized equipment avoid taking drug through contaminated syringe can help to prevent the spread of AIDS. But very low percentage 41.76% of them were aware about transfusion of safe blood and only 34.70% of the adolescent were aware of homosexual activities. The fact behind this result is homosexuality is not openly acceptable in Nepal unlike in western countries.

In pretest 25.88% of them know about sign and symptoms of disease and 8.82% of adolescents were familiar about the Elisa is the confirmatory test for AIDS and 6.47% of them mentioned westron blot. Only 22.35% of them knew about window period and 40.58% of adolescents knew asymptomatic state of AIDS. Moreover, the test for HIV/AIDS, sign and symptoms are not propagated through mass media education at school is limited in certain aspects. So there is no chance of knowing this until and otherwise they have undergone any study programme on AIDS.

The majority of them did no know about the treatment available for HIV/AIDS and 60.58% of them did not know that treating a new born baby within 48hrs with AZT reduces the risk of transmission of HIV/AIDS from HIV infected mother. About 25.29% of students believed AIDS could be cured.

Around 30% of adolescents mentioned that there is medicine (AZT) available for curing HIV/AIDS. Medicine available for curing HIV/AIDS makes them to perceive AIDS is a curable disease.

Overall findings about knowledge of adolescents towards HIV/AIDS was found during pre test.

• During pretest sixty point fifty eight percent had inadequate knowledge (0-50%) in sign and symptoms of HIV/AIDS.
• Fifty percent of respondents had inadequate knowledge about the treatment of HIV/AIDS. 63.94% of them hand adequate knowledge on spread and transmission of HIV/AIDS.
• Forty eight point eighty two percent of adolescents had adequate knowledge
  (75-100)% on preventive measure towards HIV/AIDS.
• In pretest study Adarsha Secondary school adolescents had good knowledge than Amar secondary school. School adolescents from urban area had better knowledge then the school adolescents from rural area. Adarsh Secondary school is in municipality and Amar secondary school is in VDC of IIam district. Probable reasons for these differences may be due to exposure to all propaganda like posters in the public places i.e. bus stop, hospital and other public places. People from urban area are more accessible to the availability of mass media newspaper and magazines.
• In pretest study findings there was also a considerable difference in the level of knowledge among male and female school adolescents. Out of 75 male students (80%) had moderately adequate knowledge, where as out of 95 female students 81.05% of them had moderately adequate knowledge. The difference among groups with the same educational background suggest that knowledge concerning HIV/AIDS is also influenced by gender issues.
• In the pretest the majority 81.76% of the adolescents disagreed to the statement that AIDS is caused by curse of God. Seven point sixty four percent of adolescents agreed that AIDS is caused by curse of God. 3.52% of them were uncertain whether the AIDS is caused by cure of God or not.
• Sixty four point eighty nine percent of them disagreed to the statement that person affected with AIDS should not allowed to stay in community. Twenty nine point forty one percent of adolescents supported this statements and five point eighty eight percent of them were uncertain that patients with HIV/AIDS should allow to stay in community or not.
• Forty five point eighty eight percent of students disagreed to the statement of premarital sexual relation for male and female 43.52% of them agreed with statement and 8.82% of them did not response this issues.
• Majority (60.34%) of students disagreed with statement know in there is no cure for AIDS there is no point in curing AIDS patient and 31.16% of them agreed to this statement. 9.41% of adolescents showed their uncertainty about curing for AIDS patients.
• Seventy one point seventy five percent of students agreed to the statement of young people /student should know about HIV/AIDS but 14.7% of students disagreed with statements. Ten point fifty eight percent of students did not response this statement.
• Sixty three point twenty two percent of them agreed to continue their social relationship with their friend who got AIDS22.34% of adolescents were unwilling to continue their social relationship with their friends if they got AIDS, 14.11% of them were uncertain on this matter.
• In this study findings 70.78% of students agreed that health education is necessary for men and women to have safer sex, 18.22% of them disagreed with this statements and 5.29% of students were uncertain either health education for safer sex is necessary or not.
• Seventy one point seventeen percent of school adolescents believed that AIDS is real threat of human population 19.4% of them disagreed with the statement AIDS is real threat of human population.
• Sixty one point sixteen percent of students expressed that peer group discussion about HIV/AIDS is more effective for its prevention where as 11.76% of them disagreed to this statements and 17.64% of them did not response this statements.
• Sixty nine point four percent of school adolescents were ready to discuss about HIV/AIDS prevention among siblings, 11.17% of them disagreed with statements 4.70% at school adolescents were uncertain either discussion can be done with siblings or not. It may be due to socio-cultural norms.
• In pretest 71.76% of the students agreed to participate in HIV/AIDS prevention program to bring community awareness against HIV/AIDS, 8.82% of them were uncertain about this statements and 7.64 of them, disagreed to participate in HIV/AIDS prevention program.
• The majority 61.75% of school adolescents ready to provide care to some one who got AIDS in their family, 20.58% of them expressed their unwillingness to provide care to some one who got AIDS in their family.
• Fifty seven point sixty three percent of school adolescents believed that extra marital sex is not good for married men and women, but 29.4% of them agreed on this opinion.
• Seventy six point forty six percent of school adolescents agreed that AIDS awareness advises from their parents is most important to save their life where as 11.76% of them disagreed and 7.05% of them were uncertain either parents can give AIDS awareness advises or not. They also expressed that they don't talk much about AIDS at home because, it is culturally unaccepted to discuss about sex and sex related matter freely among the family members.
• Sixty seven point sixty four of school adolescents agreed to provide love, support and affection to AIDS patients 21.17% of them disagreed to provide support and affection.
• Sixty five point two percent of them agreed to suggest their AIDS suspected friend for blood testing.
• The second objective was to make sure about the effect of structured teaching on knowledge and attitude of school adolescents Structured teaching was conducted for school adolescents, right after pretest, Post test was conducted in the next visit which falls after two week.
• After structured teaching program, the significant difference was observed in the mean scores of accurate response on knowledge and attitude related test between pre and post test. The mean score of knowledge was 27.73 during pretest. After the structured teaching the mean score of knowledge remained 40.78 Similarly in pretest the mean score of attitude was 60.53 and in post test the mean score of attitude remained 67.13.
• There was a significant increase in the overall knowledge of school adolescents specially sign and symptoms and treatment of HIV/AIDS. The result of this study coincides with study done by Saleh MA, al GHAMELI YS: at YAHIA AA (2000) They had found that there was significantly improved respondents scores on general knowledge on AIDS views on transmission and misconception of AIDS after health education program.
• After teaching, almost every body come to knew the full form of HIV /AIDS and reduced the level of confusion between the term AIDS and HIV. In Post test majority (73.52%) of them said HIV/AIDS is a life threating disease, non-curable disease and contagious disease.
• Almost all school adolescents (94.7%) stated the correct data of reported first AIDS case in world and Nepal.
• In post test as the high risk group known 8o.58% of then expressed that sex workers, drug abuser and multiple sex partners were cited as the groups at the greatest risk of contracting the HIV virus.
• Seventy two point thirty five percent of school adolescents came to know that the condoms are effective for family planning purposes which protect from unwanted pregnancy and also effective against HIV/AIDS Transmission.
• Ninety Six point forty seven percent almost everybody came to know that HIV virus causes AIDS.
• In pretest only 17.05% of the adolescents knew that AIDS could be transmitted by deep kissing with infected person but in post test their level of knowledge increased by. 91.76%
• In post test 92.23% of respondents knew that AIDS could be transmitted through breast milk It was found they had gained more knowledge about maternal fetal transmission In pretest only 64.70% of the respondents knew about this matter.
• A few of them had misconceptions that AIDS can be spread by touching any AIDS patient. Hugging with AIDS patient sitting together using common toilets swimming pool and bites of insects. Their misconceptions were demystified after the teaching.
• In posttest 76.47% of them gained knowledge about sign and symptoms of AIDS. Only a few of them knew about the confirmatory test of AIDS before the structured teaching program but in post test it was found that knowledge about the confirmatory test (Elisa westron blot) had increased significantly.
• Majority of school adolescents were unknown about window period and asymptomatic state it was found almost every body 91.17% of them gained more knowledge about window period and 85.29% of them came to knew about asymptomatic state.
• Misconception like "AIDS could be cured and there are medicines available to cure AIDS" were found to have cleared in 94.11% of adolescents. In pretest only 30% was aware of the treatment AZT where as in post test 83.52% of them have answered correctly. In post test, it was found that knowledge about the effectiveness of AZT treatment to newborn baby of HIV infected mother had increased significantly which was found 84.70% of the adolescents.
• The majority of them were aware of the preventive measures of AIDS except transmission through unchecked blood transfusion and homosexual practices. Which has stressed during teaching and the feedback was quite effective during post test Ninety one point fifty eight percent of them gained knowledge on this aspects.
• The overall attitude of school adolescents towards HIV/AIDS was good in pretest findings it was found in 7.64% of adolescents had inadequate positive attitude followed by moderately positive (31.76%) and adequate positive attitude 60.38%. Probably it was due to the fact that in mass media, it emphasized mostly the facts about HIV/AIDS for e.g. AIDS is a preventable disease and will not spread by touching, hugging and sharing the things and also it emphasized on causative factors and its prevention. So that overall attitude of adolescents towards HIV/AIDS was good in the pretest itself. From post test scores, it was found there was significant change in the attitude of adolescents.
• In pretest seven point sixty four percent (7.64%) of school adolescents were agreed that AIDS is caused by curse of God but in post test this misconception was removed. After class hundred percents of them disagreed to this statements as AIDS was caused by course of God.
• Twenty Nine point four percent (29.4%) of school adolescents agreed to the statements that person affected with AIDS should not be allowed in community but in post test it was reduced to 1.75%.
• Forty three point fifty two percent (43.52%) of adolescents agreed to the statement of premarital sexual relation but in post test it was found that only five point eighty seven percent (5.87%) of them agreed to this statement.
• Ninety two point eighty one percent of school adolescents emphasized in curing the AIDS patients after involving in structured class.
• In post test eighty-four point one percent (84.1%) of school adolescents agreed that all young students should know about HIV/AIDS.
• Ninety eight point eighty two percent (92.82%) of school adolescents were ready to continue their social relationship with their friend who got AIDS.
• Almost all adolescents ninety point forty one percent (91.41%) believed, AIDS is a real threat to human population.
• After structured teaching program almost all school adolescents agreed with the statements the peer discussion about HIV/AIDS is more effective for prevention of HIV/AIDS.
• All adolescents ready to participate in AIDS prevention compaign to bring community awareness against HIV/AIDS.
• In pretest twenty point fifty eight percent (20.58%) of them showed their unwillingness to provide care to any of their family members who get AIDS but this was reduced in two point thirty five percent (2.35%).
• Ninety three point fifty two percent (93.52%) of school adolescents agreed with the statement it is not good for men and women to have extra marital sexual relation.
• Almost all adolescents agreed to the statement AIDS awareness is one of the important advises of patients to their children.
• Almost all Ninety eight point eighty eight percent (98.88%) of the school adolescents expressed AIDS patient need love support and affection and ninety nine point ninety nine percent (99.99%) of them ready to suggest their AIDS suspected friend for testing blood.

Besides the level of knowledge the attitudinal questions also revealed considerable difference. Male's attitudes towards HIV/AIDS were found more positives than female. In comparing the statements by respondents from both genders. It became clear that the male respondents expressed their opinions clearly while only some of female students did not response the statements. Mostly female adolescents were rather indecisive about agreeing or disagreeing with a statement.

5.1.1 Major Demographical Findings of the respondents.

1.1 Out of 170 respondents, 94 of them were from class 9 and 76 were from class 10th. The number of female students were 95 where as male students were 75.

1.2 Out of 17 respondents, 114 students were of between the age of 16-18 years, 46 were between the age of 13-15 years and remaining 10 were between the age of 19 to 21 years.

1.3 Majority of students were Brahmin–fourty three point thirty five percent (43.35%) followed by Chhetri– 14.70%, Rai – 10.58%, Limbu – 8.82%, newar 5.88 % and others were 17.64% which includes Magar, Tamang, Gurung, Kami and Damai.

1.4 Ninety two point thirty five percent (92.35%) of students belongs to Hindu and only seven point sixty four percent were Buddhist.

1.5. Majority of students fifty seven point sixty four percent (57.64%) were from rural area and forty two point thirty five percent (42.35%) were from urban area.

1.6 Fifty five point two percent (55.2%) students wee from joint family and 44.7% were from nuclear family.

1.7 The family income of majority (91 students) was below Rs. 4000 per month, however the family income of 41 students was Rs. 4000-7000, the income of 18 of them was Rs. 7000-10000 and only remaining 20 respondents family income was above 10,000.

1.8 Among the 170 respondents their mothers occupation varies like this agriculture 81.17% business – 7.05%, 5.88% and service– 2.35% unfortunately 3.52% of respondents did not response this question.

1.9 Father's occupation, Agriculture 69.41 % service 24.11 % and business 6.47%.

1.10 Educational status of mothers; 43.52% were illiterate, primary level 31.17%, middle school – 15.29%, High school level – 3.52% and campus 2.94% only. for 3.52% of the students did not response this questions.

1.11 Educational status of fathers; 22.94% were illiterate primary education 26.47% middle school 27.05% high school 8.82% and campus 14.7%.

1.12 The source of information on HIV/AIDS for the respondents were
72.35% –radio, 54.70% – T.V, 38.82%– magazines, 29.17%– newspapers.

5.1.2 Research Hypothesis:

The investigator stated the hypothesis that school students who were exposed to a structured teaching program will have improved knowledge and develop positive attitude towards the people with HIV/AIDS.

The study revealed that there was a big improved test scores in overall knowledge and attitude scores after structured teaching. In the post test, it was found that the misconception of school students regarding, spread, diagnosis treatment and prevention of AIDS had been clarified and the knowledge about the cause of AIDS. sign and symptoms treatment and prevention had been improved significantly. The overall attitude of students towards HIV/AIDS had been adequately changed into positive towards HIV/AIDS.

This supports hypothesis that was selected by the researchers at the time of proposal writings.

This study is also consistent with the conceptual framework based on Newman's system theory. The input proved to be effective in departing the knowledge and changing attitude of school students on HIV/AIDS.