A study on the factors that influence attitude and knowledge of hiv

This study has focused on the factors that influence of knowledge of HIV/AIDS and attitude towards people infected HIV on street children in Ho Chi Minh City.. LIST OF TABLES Pages Table

越南胡志明市街童愛滋之認知與態度影響因素研究

A STUDY ON THE FACTORS THAT INFLUENCE ATTITUDE AND KNOWLEDGE OF HIV/AIDS OF STREET CHILDREN IN HO CHI MINH CITY, VIETNAM

Graduate Students: Phan Thi Thu Nguyet

Supervisors: Professor: Chen, Chi – Shung

Meiho Institute of Technology

Graduate Institute of Health care

Thesis

A thesis submitted to the Graduate Institute of Health Care of

Meiho Institute of Technology

In partial fulfillment of the requirement for the degree of

Master of Health care

Neipu, Pingtung, Taiwan, Republic of China

June, 2009

ABSTRACT

HIV/AIDS incidence is increasing more quickly in the world; especially street children who are at high risk for HIV/AIDS because lack of social support, isolation, violence, and low levels of education These challenges create a complex burden of health risks and put street children at poor health outcomes and poor quality of life This study has focused on the factors that influence of knowledge of HIV/AIDS and attitude towards people infected HIV

on street children in Ho Chi Minh City The main purposes of the study are:

(1) to explore on the knowledge of HIV/AIDS disease, attitude towards people infected HIV and attitude of use the condom of street children;

(2) to determine the factors that influence their knowledge and attitude of street children

The survey design was used in the study Data were collected as part of Ho Chi Minh

City where street children live Street children (N = 200) completed questionnaires and interviews The findings that the average score for HIV/AIDS knowledge was 5.31(SD = 2.31)

in the 10 items; the average score for attitude toward HIV/AIDS was 16.80 (SD = 2.51, range from 6 to 24) in the 6 items; Attitude of the use condom was 8.60 (SD = 1.94, range from 3 to

12) in the 3 items When compared to the different demographic characteristics would result

in significant differences of street children on HIV knowledge, attitude towards people, and attitude of use the condom However, the results in the age, education, where they live, family’s economic status, family’s conducts, parent status, and work groups were different significantly The age of 16 - 18 years old was better than the age of 11 - 15 years old on

knowledge The secondary education and senior high education were better than basic literacy,

illiteracy and primary education on the knowledge of HIV/AIDS The secondary education was better than basic literacy and primary education on the attitude toward HIV/AIDS The street children live in the shelter and with others were less than with family members and with friends on knowledge of HIV/AIDS and on attitude towards HIV/AIDS The street children in

poor family on knowledge HIV/AIDS were less than who lives with well – fixed family and well – fixed family children were better than rich family children Street children in Substance abuse groups, Dilly – dally groups and the others groups on the knowledge HIV/AIDS were better than Gambling groups Dilly – dally and the others groups were better than Gambling groups on attitude toward HIV/AIDS Among the attitude of street children’s use of the condom, the groups dilly – dally better than the others groups There was a significant difference between normal work of street children and the others’ work on attitude toward knowledge HIV/AIDS

The results can assist the Vietnamese government policy to prevent HIV/AIDS infections, social workers to intervene, and providers to develop education for street children Furthermore, it is possible for research plans in the future

Key words: street children, family factors, HIV/AIDS, knowledge and attitude toward

people and attitude of use the condom

ACKNOWLEDGEMENTS

This study is the first-step research in my professional career The research not only provides directly me with new awareness but also teaches me good challenges and grateful life

My special thanks go to my supervisor, Associate Professor Chi – Shung Chen, who is Director of Social Work Department, Meiho Institute of Technology –Taiwan, who are always

an encouragement, patience and believe in me during the process of the research and the completion of this thesis

Special thanks also go to the Director of Graduate Institute of Health Care, Professor Hsiu – Yueh Hsu who gave me bravery to face life when I came to Taiwan to study with her lovely voice, her kindness and enthusiasm

I am also specially grateful to Associate Professor Mei – Yao Ho who guided me single - handedly in this researcher and who has always strengthen my mind with encouraging words, “Moon, you can do it.”

I would like to thank Associate Professor Song – Lin Huang and his warm wife, whose unobtrusive love gave me great help in difficult times

I am deeply indebted to all of the professors whose gave me the possibility to complete all courses for 2 years to study in Taiwan: Prof Hui-Man Huang, Prof Shan-Ming Cheng, Prof Kuo-Hung Tseng, …

I also would like to thank Meiho Institute of Technology for offering me a scholarship and thank Professor Pi - Yun Chen, Former - Director of International Education and collaborations’ office who taught me not only how to study in the books but also to study in life In particular, I wish to thank all the staff : Meiyu, Matt and Mollie

Special thanks to Professor Le Hai Thanh, Director of Social Work Department in University of Social Sciences and Humanities in Ho Chi Minh City, Vietnam, who is close to

me in spite of the limitation in space and in time I am an overseas student in Taiwan and Ms Bui Thi Gam, his secretary, who believes in me that my dreams can come true

My deep and heartiest thanks go to my wonderful parents, and my sisters and brothers Nguyen Thi Luong, Phan Hai, Phan Thi Le Hoa, Phan Thanh Ha, Phan Thi Kieu, Phan Hoang Chi, Phan Thi Lieu, Phan Thi Tu Anh I am especially dependent on my family in Vietnam for these two years in Taiwan, while I am getting Master Degree

I wish to thank all my Vietnamese students who did not forget me even I go for study far away them: Nhu, Huyen, Binh, Ve, Hieu, Suong, Tu, Thu, Hien, Minh

I wish to thank as well as my Taiwanese classmates and Vietnamese students for their advice and support me: Chi Fu, Wisdom, Phuong, Rose, Thang, Thai, Maichi

I wish to thank all my good friends in two years I am living at Neipu - Taiwan: Rachel, Sandy, Michael whose are stimulating and valuable hints

Special thanks also to all of street children in this study who are like my students and provided valuable experience and input for my research; without them this study would not have been possible

Finally, as a social worker, and social work teacher I have spent my life catching up with poor people I am grateful to serve them

I am so glad to be a student at Meiho Institute of Technology–Taiwan I found that Taiwanese people are very friendly; many things put in me during two years

I have grown up professionally for all

潘氏秋月 Phan Thi Thu Nguyet,

TABLE OF CONTEXT

Pages

Abstract……… i

Acknowledgements……… iii

List of Tables viii

List of Figures ix

CHAPTER 1 INTRODUCTION……… 1

1.1 Background and significance of the problem……… 1

1.2 Statement of the problem……… 7

1.3 Statement of the purpose……… …… 7

1.4 Significance of the study………

8

CHAPTER 2 LITERATURE REVIEW……… 9

2.1 Theoretical orientation……… 10

2.2 Definition of Theory……… 12

2.3 Related Literature in Vietnam and other countries from media……… 13

2.4 Framework of the literature……… 16

CHAPTER 3 CONCEPTUAL FRAMEWORK OF THE STUDY……… 18

3.1 The framework……… 18

3.2 Definition of Terms……… 19

3.3 Research Hypotheses……… 20

3.4 Materials and Methods……… 21

3.4.1 Research design……… 22

3.4.2 Sampling and Setting……… 22

3.4.2 Research Instruments……… 23

3.4.3.1 Research Questions………

23 3.4.4 Research Progress……… …… 24

3.4.4.1 Training the observers……… ……

25 3.4.4.2 Pilot study……… 25

3.4.4.3 Validity and Reliability……… 26

3.4.4.4 Data collection……… 28

3.4.4.5 Data analysis……… 29

3.6 Ethical consideration……… 30

CHAPTER 4 ANALYSIS AND INTERPRETATION OF DATA……… 32

4.1 Analysis of Questionnaires data……… 32

4.1.1 Descriptive Profiles……… 32

4.1.2 Related data of Attitude and HIV/Knowledge to Demographic Characteristics………

41 4.2 Results of research hypotheses testing……… … 49

4.2.1 Tested the means difference between demographic characteristics and Attitude, Knowledge on HIV/AIDS of street children………

49 4.3 Street children with the source of HIV/AIDS information……… 60

4.4 Street children with the source of Receive medical care……… 61

CHAPTER 5: DISCUSSION……… 62

5.1 Summary of the findings……… 62 5.1.1 The study confirmed the finding on Street children’s HIV Knowledge, attitude

Towards HIV/AIDS infected people and attitude of use the condom

62

5.1.2 Street children’s and parent’s status in Ho Chi Minh City in this 63

study… …….………

5.1.3 Related of Empowerment theory Model in this research ………

67 5.3 Implications……… 68

5.4 Limitations of the study……… … 69

References……… … 71

List of Acronyms……… 73

Survey Questionnaires ……… 74

LIST OF TABLES Pages

Table 2: The Data Analysis Plans of street children about Questionnaires 29

Table 9: Total Score for Knowledge, Attitude towards and Attitude of use the condom 48 Table 10: Independent t-test among gender groups on HIV knowledge, attitude towards

HIV/AIDS people and attitude of use the condom

49

Table 11: T-test Independent of the Age groups on HIV knowledge, attitude towards

HIV/AIDS people and attitude of use the condom

50

Table 12: Education groups affected on HIV knowledge, attitude towards HIV/AIDS

people and attitude of use the condom

52

Table 13: Where they live of street children was using ANOVA test and Post hoc tests on

HIV knowledge, attitude towards HIV/AIDS people and attitude of use the condom

53

Table 14: Economic affected on HIV knowledge, attitude towards HIV/AIDS people and

attitude of use the condom

55

Table 15: Conducts of their family affected on HIV knowledge, attitude towards

HIV/AIDS people and attitude of use the condom

56

Table 16: Parents of street children affected on HIV knowledge, attitude towards

HIV/AIDS people and attitude of use the condom

57

Table 17: The time of street children live on the streets effect on HIV knowledge, attitude

towards HIV/AIDS people and attitude of use the condom

58

Table 18: Independent t-test among work groups on HIV knowledge, attitude towards

HIV/AIDS people and attitude of use the condom

59

Figure 1: The theory Empowerment Approach to Social Work practice 18

Figure 12: Source of HIV/AIDS information of street children 60

Figure 13: Source of Receive Medical care for street children 61

CHAPTER 1 INTRODUCTION

“Give me your tired, your poor, your huddled masses yearning to breathe free the wretched refuse of your teeming shore, send there, the homeless, tempest – tots to me I lift my lamp beside the golden door.”

Emma Lazarus “The New Colossus”

Health is very important, because “that health is a special goods has been recognized through the ages” (Anand, 2006) However, up to now, in the world there have been many people who have died because they do not have knowledge about fatal diseases They were killers by themselves Disease emerges to be defined as “dread” (Doka, 1997)

1.1 Background and significance of the problem

The first case report of AIDS appeared in 1981 with the identification of clusters of Pneumocystis carinii pneumonia and Kaposi’s sarcoma in previously healthy young homosexual men in California and New York (Anita Barry, 1996) In 1983, the cause of AIDS was identified as a retrovirus, which was subsequently named human immunodeficiency virus, type 1 (HIV- 1) In 1985, the first laboratory test to detect antibodies

to HIV -1 was licensed by the Food and Drug Administration (FDA)

On recent data from the Center for Disease Control (CDC), it is estimated that between

34 and 46 million HIV antibody tests are currently performed each year in the United States HIV antibody testing is generally performed in persons thought to be at risk for HIV infection through sexual or dug use behaviors or through exposure to contaminated blood products (Piliero & Libman, 1996)

HIV- 2 is a retrovirus that is antigenically similar to HIV – 1 but has a different epidemiologic pattern It is primarily seen in West Africa and parts of Europe and is spread heterosexually (Piliero & Libman 1996)

In the world over 25 years there have been more than 25 million people who have died

of AIDS since 1981 Africa has 12 million AIDS orphans At the end of 2007, women accounted for 50% of all adults living with HIV worldwide, and for 61% in sub- Saharan Africa Young people (under 25 years old) account for half of all new HIV infections worldwide In developing and transitional countries, 7.1 million people are in immediate need

of life – saving AIDS drugs; of these, only 2, 015 million (28%) are receiving the drugs

According to the statistics of HIV/AIDS in 2007, the deaths of AIDS disease now spread to all the world During this time, HIV/AIDS really becomes threat to young population of the world

From the data background above, the researcher totally agrees that AIDS as a social disease (Doka 1997); therefore, the study tries to explore the effects of this epidemic in Vietnam in general, and then she will review the number of street children infected with HIV

in Ho Chi Minh City in particular

HIV/AIDS situation in Asia

AIDS spread in Asia early to mid – 1980s (Doka, 1997) Today HIV prevalence is highest in South – East Asia Thailand and India are likely to be Asian epicenter of the disease

At the beginning of 1986, India is at particular risk for three reasons First, India does have a population of intravenous drug users Second, India has a large pool of paid blood donors, many of whom sell blood in less than sterile conditions Finally, prostitution is not uncommon

in India, but trussed by poverty, urbanization, and in some cases, even religious ritual (Doka, 1997) There were 2.5 million people living with HIV in India (UNAIDS/WHO: July 6th, 2007), with one billion population in India It begins to challenge India governments

AIDS will also continue to effect Thailand society The first case of AIDS in Thailand occurred in 1984 (Phanuphak P, Locherenkul C Panmuong W., Wilde H 1985) In Thailand, the service industry of Sexual tourism, drug users, migrant workers, that were cause of

infected HIV is stronger MSM (Men who have sex with men) are currently a major risk group in Thailand

In Bangkok (Thailand’s capital and largest city), HIV prevalence among MSM rose from 17% to 28% between 2003 and 2005 HIV prevalence among MSM is younger than 21 years of age (Human rights Watch 2004) In this face of this crisis, the Thai government has provided antiretroviral drugs (ARVs) to people living with HIV through more than 914 public hospitals (Ford,2004) In 2005 prevented more than 6.7 million people from becoming infected with HIV and will save as much as US$18,6 billion in treatment costs by 2012 (World Bank Group, Government of Thailand, 2006)

In other countries of Asia, more people engage in sex work (either as a client or a worker) That can carry a high risk of HIV In China’s first AIDS case reported in Beijing in

1985 The Chinese Health Ministry in 2007 estimated that 700,000 people were living with HIV in China, including about 75.000 AIDS patients At the same time, HIV outbreaks are becoming evident among in Indonesia, Nepal, Pakistan, Cambodia and Vietnam Across Asia,

an estimated 4, 9 million people were living with HIV, including 440, 000 infected in the pass years, while about 300,000 died from AIDS (UNAIDS, 2007)

HIV/AIDS situation in Vietnam:

Like most countries in Asia, AIDS is likely to be a threat to the economy, society and future of Vietnam It affects community Yet, in 1990 the first case of HIV in Vietnam was detected in Ho Chi Minh City; the number of invidual infected with HIV has grown rapidly in

64 provinces of Vietnam

Although reported cases of HIV infection in Vietnam are new, the World Health Organization (WHO) estimates that the epidemic will expand dramatically unless prevention measures are taken quickly The number of people infected with HIV/AIDS recently emerged

as a major public health problem

According to the Vietnamese Ministry of Health, about a quarter of a million people in Vietnam were living with HIV at the end of 2003 The rates infected with HIV widespread in four the big cities of Vietnam as Ha Noi, Hai Phong, Can Tho and Ho Chi Minh City, where developing economy has attracted foreign investment Besides this will become sexual market for travellers; estimates indicate that the majority of HIV infections are sexually transmitted (81%), among injecting drug users (63%), female sex workers to 11% in Can Tho, 15% in Ha Noi and 24% in Ho Chi Minh city (UNAIDS, 2005)

It is estimated that in the period 2006 – 2010, Vietnam will have 30,000 – 40,000 cases each year Foreign experts said that by 2010, as many as 300 – 500 will be infected with HIV Patients are becoming younger, one in every 200 people are infected between 15 and 49 In Vietnam to the end of 31 August 2007 are 132 HIV infected case; 26,828 case of AIDS, and 15,007 deaths due to AIDS (VietnamNet Bridge, 2007)

According to the IBBS (Integrated Behavioral and Biological Survey), there have been especially high risk sexual behaviors with different partners in Ho Chi Minh City Men having sex with men (SMS) also do not consistently use condom during anal sex with their partner, and they also have sex with male sex workers and with females HIV rate among SMS in 2006 was 9.4 in Ha Noi and 5.3 in Ho Chi Minh City Vietnam government of acknowledge HIV as an important development issue which requires the mobilisation of different stakeholders outside the health sector (UNGASS, 2007)

HIV/AIDS situation in Ho Chi Minh City:

Since the first HIV positive case detected in Ho Chi Minh City in December, 1990 up

to now, the total number of people living with HIV in Ho Chi Minh City is expected to rise from 72,400 in 2006 to 89,900 in 2010 and 105,800 in 2020 Clients of sex workers have become the largest single group of new HIV infection In 2006, there were about new AIDS cases in Ho Chi Minh City This will climb to estimated 7,700 new cases in 2010 (HIV

Epidemic, Ho Chi Minh City, 2007) This will create a substantial burden for Ho Chi Minh City not only in term of medical but also in their family and on society in general HIV/AIDS continues to be seen as a social evil thus identifying it as an issue largely for drug users, sex workers and a crimnal problem Working with people living with HIV is very difficult

Ho Chi Minh City Provincial AIDS Committee has early effective prevention programs for people infected with HIV There are such programs as peer education, condom distribution, STS treatment, needle exchange and community prevention centers for high groups

The health care workers will provide information about how to prevent future HIV infection; counseling is available in the future if needed, encouraged to HIV test All supports are to reduce the number of HIV and to encourage the people infected with HIV to live health

The UNICEF-supported HIV/AIDS project provides information, skills and services for young people to be able to protect themselves from HIV infections, with special focus on young people most vulnerable and at risk It also deals with the emerging issue of care, support and treatment for people living with HIV/AIDS The project is being implemented by national government agencies, local government units, NGOs and other partners in the country

Situation of street children at risk of HIV

Definition of Street children

According to UNICEF, over half of the children in the developing world live in poverty (UNICEF, 2004) Street children have a lot of names: homeless children, street urchins, street kids, street youth In reality they sometimes stay with friends, acquaintances, sometimes in shelters, sometimes with family members, sometimes in squats and only sometimes on the street This cyclic process – today is on the street, tomorrow in the house of

a stranger and the day after tomorrow in a shelter (Ploeg & Scholte, 1997)

Most children can live anywhere if they can sleep or need to rest for the end of the day was working exhausted They can live in an abandoned building, containers, automobiles, park, market, under the cars, or bus or inside a dry gutter

Many definitions and topologies have been developed The term Street children are used to refer to children who live on the streets They are deprived of family care, protection, and who have no fixed address and find themselves frequently moving from one place and to another They may spend periods of shorter or longer duration in some form of accommodation (Poleg & Scholte, 1997) There have been a lot of definitions of street children but in this study the researcher will use the definition of UNICEF UNICEF has defined three types of street children: Street – Living, Street working, Street – Family

Street Living Children: Children who ran away from families and live alone on the

streets

Street Working Children: Children who spend most of their time on the streets,

fending for themselves, but returning home on a regular basic

Children from Street Families: Children who live on the streets with their families

Reasons for Street children’s running way

The reasons of street children for why they decide to leave their house are different When children know that their family is not for them They fear to be punished by parents or guardians, so they decide to run way from parents and start living on the streets However, there are other reasons with the crisis of the age puberty that they want to be free and come home late Some street children have a short time on the street, about 1-2 months with mild mental health problem, or some street children have been on the streets for a long time with more than 2- 3 years and they choose the life on the streets This comes up with a big number

To sum up, there are various reasons for adolescents’ running way Often the main reasons focusing on family problem, conflicts, maltreatment and neglect (Tyler, Hoyt, Whitbeck, &

Cause, 2000 Von E Nebbitt Laura E House Sanna J Thompson 2007)

1.2 Statement of problem:

According to the estimates by the Ministry of Labor, Invalids and Social Affairs (MOLISA), the number of street children in Ho Chi Minh City is up to 8,500 in 2007 Like street children in many other countries, they face multiple risks in their lives in daily development Life and work on the street is harsh and dangerous Children are vulnerable to abuse, exploitation, crime, imprisonment, and physical and emotional suffering

Lack of adequate shelter, nutrition, and education, health care and loving caretakers puts them at great risk for any number of medical problem, mental illnesses, and social difficulties The street children who abuse drug also become sexually active at very young age, which affects directly to their own lives It is the reason why of street children are infected with HIV/AIDS There are many street children infected with and affected by HIV/AIDS in the streets

Street children would like to attend school, but do not have the money because of their father spends a lot on beer The situation for the street children in rural and mountainous areas

is a particular concern, especially regarding health and education Street children in Ho Chi Minh City are high group with HIV/AIDS

1.3 Statement of the purpose

The main purpose of the study is:

- To explore on the HIV/AIDS knowledge, attitude towards people and attitude of use the condom of street children; and

- To determine the factors that influence their knowledge and attitude of street children living in the streets

1.4 Significance of the Study

HIV/AIDS is generally acknowledged as a major challenge to street children, those whose lives are counted by days, not the future Though in Vietnam there have been a lot of programs in regard to prevent street children from HIV/AIDS, the number of street children infected HIV is still increasing in Vietnam

The Vietnamese government, the community, non-government organizations, and even social workers and volunteers in Vietnam have tried to approach street children bringing a lot

of information about HIV for them, but this information seems not to be sufficient to protect themselves The simple reason is that what street children have received is uncontainable and short-term information

There has been never publicized statistics of HIV among street children, but no one know how many street children who have been infected with HIV in Ho Chi Minh city

The researcher began working with street children in Ho Chi Minh City since she was as

a student Since then, from the deep feelings in heart the researcher has wished to do a research on these children with a hope to do something more helpful and meaningful to them Now as a teacher of social work Department in a University the researcher has a good opportunity to do this first research In fact, with those street children that researcher has ever worked with this research would help them with more valuable information

This study could be also useful for planners of development programs on HIV/AIDS of street children in Ho Chi Minh City This research will provide them significant information

on the realities of the HIV/AIDS knowledge

More importantly, as a teacher of social work, a professional social worker, this study would further deepen researcher knowledge and skills in researcher professionalism and help the researcher comprehend the theories and practice

CHAPTER 2 LITERATURE REVIEW

In this chapter, the researcher would know the challenges on the HIV knowledge, attitude towards people and attitude of use the condom of Street children in Ho Chi Minh City The researcher gives some ideas to choose one perfect theory for this study, and advances this theory in this area and relevant for future research

2.1 Theoretical orientation

In this section, the researcher will be using the theory “The Empowerment Approach

to Social work Practice” (Lee, 1994) the analysis will be explained in details in this thesis

Why does the researcher choose this theory? The simple reason is that life of street children are like “These are the words of fifteen – year – old African – American girl living in urban poverty whose brave and tragic story ends in suicide (Lee, 1994).As we approach the year 2010, little has changed for the Sudekas of the world except that ranks of the poor are fuller In 1991, almost thirty –six million Americans lived in poverty At least one fifth of American’s children are poor The poverty of Black and Hispanic children approaches fifty percent Forty – four percent of poor two parent families have at least one full – time worker (New York Time, Sept 4, 1992: Brazil, 1990) The empowerment approach to social work practice enables practitioners to co-investigate reality with the poor, the working poor, people

of color, women, and those who are oppressed by virtue of sexual orientation, physical or mental challenges, youth, or age and to help them confront the obstacles imposed by class, race and difference Practice with people who are pushed to the edge of American or global society necessitates a joining with and validation of that experience and a dual focus on people’s potential and on political/structural change The synthesis of a wide range of theories and skill is needed for effective empowerment practice The empowerment practice provides

an overarching conceptualization that links the personal and political level of empowerment

(Lee, 1994)

This area also contains the related literature and studies on HIV/AIDS knowledge, attitude towards people and attitude of use the condom of Street children in Vietnam and other countries

The theoretical orientation: Psychological, education and political perspective in next session

2.2 Definition of Theory:

Empowerment “deal with a particular kind of block to problem – solving: that imposed

by the external society by virtue of a stigmatized collective identify” (Solomon, 1976)

Empower is “to give power or authority to, to give ability to, enable, permit,” which implies that power can be given power, developing power, taking or seizing power, or facilitating or enabling power (Parson, 1991)

Psychological perspective:

Street children have potentialities in themselves; they are at a high risk of acquiring HIV infection and less capable of coping with the consequences of HIV Therefore, empowerment practice addresses: direct and indirect power blocks; individual, familial and organizational resource problem (multiple dimensions of poverty); problem of asymmetrical exchange relationship; problem of powerlessness, constraining, and inhibiting or hindering power structures; problem related to arbitrary social criteria or values (Stanb – Bernasconi, 1991) Benefits of enhancing capabilities and mitigating HIV/AIDS and risk behavior will eventually be visible

The skills of working with indigenous leadership, knowing resource, where the power lies and how to get it: and enabling group members to do for themselves are important in attaining empowerment

Group may have consciousness rising, help to individuals, social action, and social

support, and the development of skill and competence as overlapping foci to help members facing oppression gain equality and justice (Garvin, 1985) Side by side, empowerment is skill

to bolster motivation for street children at lack knowledge of HIV/AIDS Motivation can only

be sustained if basic needs for housing, food, clothing, and financial and emotional support are met As these need are met by street children and worker and through gaining resources and opportunities and attending to presenting, problems The workers can help to keep hope alive…the skill of having the client name and own his or her strengths also provides motivation to continue Hope of changing the oppressive systems must also be offered through the worker’s skills of lending a vision and beginning to enlist the client’s energy in this thinking (Lee, 1994)

Method of psychology in this study with street children and knowledge is very interesting and easy to use doing with street children “in help the client to maintain comfort, manage feeling, and attain an optimal level of self –esteem”(Lee, 1994) the four attributes: motivation, psychic comfort, problem solving, and self direction)

Education perspective

In the theory of Empowerment Approach to social work practice have talking

about: the skills of gently sharing information in the co- teaching role are critical here as well, Knowledge is power…using books, art, music, poetry and other ways of reaching people’s level of conscious awareness- can be extremely helpful Social workers need to apply the theory while and enhance their problem – solving skills

Political perspective

This theory is very important “Empowerment work can empower communities Group, and community centered skills are essential, with other groups and forces in the community to effect social change (Breton, 1991) Empowerment group skills include making

a clear mutual contract that bridges the personal and the political and include a social change

focus (Lee, 1991)

The world of street children is complex What can Vietnam government supply to street children with education, health care and right? Street children can go to school and have more information and they know what right they will get it

2.3 Related of literature of theory Empowerment about HIV/AIDS clients

So far, beside this thesis, there are many researchers using the Empowerment for their research “An empowerment oriented framework for practice seeks to repair some of the damaging effects of homelessness and mental illness It builds on client strengths in the

opportunities for effective participation in the environment” (Cohen An Empowerment oriented framework for practice with homeless mentally ill clients) “Discussions of

empowerment indicate that is can exist at three main levels (Shultz, Isabel, Zimmerman, and Checkoway, 1995) At the broadest level, community empowerment reflects actions taken by

a group of people to improve life in a community Organizational empowerment involves processes and structures desighed to enhance goal directed actions by member of an organization At the individual level of analysis, psychological, empowerment requires an understanding of the sociopolitical environment, which includes knowledge of the law and an

appreciation of one’s rights and responsibilities.” (Nachshen Empowerment and families: Building Bridges between parents and professionals, Theory and research Journal on

Developmental Disabilities, Volume 11 Number 1)

The good news is that the researcher has more belief in this study, when choosing to the theory in this thesis, and learning more experience for the future

2.3 Related of Literature in Vietnam and other country from Media

Vietnam: In Ho Chi Minh City in Vietnam, around 12,474 street children are one of

the most vulnerable groups to HIV/AIDS infection, drug use and sexual abuse In two years 2002-2003 HIV/AIDS prevention programmar was jointly launched by the Vietnam Red

Cross and Australian Red Cross in Ho Chi Minh City for street children who are infected with HIV/AIDS

Life on the streets

Street children learn to cope with life on the streets very quickly Therefore, they grow

up in an environment of cruelty, physical, mental and sexual abuse, and if any of them does not have wits to escape, emerges a hardened criminal with total contempt for society in all its aspects when they are 18 years old

Street children living and working on the streets, drug users and school dropouts were attacked by HIV/AIDS as the major issues facing children Children living in a world of AIDS experience many challenges Street children exist in many major cities, especially in developing countries The United Nations Children’s Fund (UNICEF) recently estimated worldwide that there are 100 millions street children without family living on the streets They increased at risk of HIV/AIDS, sexually transmitted infections (STIs), pregnancy and exploitation They are extremely vulnerable to sexually transmitted diseases including HIV/AIDS An estimated 90% of them are addicted to inhalants such as shoe glue and paint thinner, which cause kidney failure, irreversible brain damage and, in some cases, death

The social phenomenon of street children is increasing as the world’s population grows; six out of ten urban dwellers are expected to be under 18 years of age by the year 2005

The attitude and knowledge towards Children Living with HIV/AIDS

Ho Chi Minh City is the largest city in the country, and is estimated to be home of around 10,000 street children, many of whom lack any knowledge or understanding about HIV/AIDS at all (Nguyen, 2007)

They are also discriminated against by society, so they do receive adequate medical treatment when they do become infected with the disease Many of the older female street children are prostitutes, thus their affect on the wider community is major, with the danger of their

spreading the HIV virus to it Thus education for street children about HIV/AIDS, and ways

of avoiding infection and transmission is necessary, and needly urgently (VietnamNet Bridge – Street children urgently need information about HIV/AIDS, 2007)

“Poverty, crippling fees and huge distances to the nearest school” (Synovitz, 2006) Poor children have persistently shown levels of performance on every indicator of education achievement The test scores, graduation rates, and college entrance/completion rates of low income students have been significantly lower than those of their non poor peers (Arrighi, Maume, 2007)

As a consequence, many families prefer to send their children to work with provide them a vocational skill would be better than school Even though some children go to school, most of them admitted to having missed classes at least once instead of go to school (Alexandrescu, 2002) Because of poverty, even school are free cannot go to school Many children cannot afford to buy uniforms, shoes and books (WHO, 2000)

Living in a group, having joint activities, sharing drugs and practicing other risk behaviors, most of the children love, protect and help one another Thus, they are not afraid of living together with their HIV- infected peers and do not show any discrimination against the latter

They stay in the group and share its activities and are supported by other members (Street Children and other problems related to HIV, 2004)

“One of my friends used to be very nice and kind Since she realized that she is HIV infected, she has become revengeful She did try to give up drugs but other people criticized and discriminated against her, so she re –users drugs and she wants to revenge for her unfortunate fate If the group share the same syringe, she will use it first, then give it to others” (Street Children and other problems related to HIV, 2004)

One the one hand, this is an advantage for those living with HIV/AIDS, but on the other

hand, it also can cause some risks for the rest of the group members who may become infected, especially when they lack knowledge of HIV/AIDS and do not know how to protect themselves (Street Children and other problems related to HIV, 2004) Many street children are illiterate; they cannot read leaflets or posters Some literate children can read and obtain information from them, but they sometimes play trick on others by distorting the message

“When provided with material, they gather to read it The literates read for tee illiterates Sometimes they make a joke by referring different things in the material However, they also receive some knowledge from it.”

“Sometimes I questioned, “Why condoms are used when people have sex with girls, but not with boys? Many of my peers said I was very stupid because “when boys have sex with boys, they don’t need any condoms” (Street Children and other problems related to HIV, 2004)

In addition, the researcher had some experience with street children When asked them about HIV knowledge, they answered: HIV just have with adult people, the children cannot infected with it However, they always have dreams: I would like to become a doctor because

I want to help mother when she got sick… I want to give my friend medicine when they did not have money…

In the world:

“Being a street child means going hungry, sleeping in insalubrious places, facing up to violence and sometimes becoming an expiatory victim; it means growing up without companionship, love and protection; it means not having access to education or medical services it means losing all dignity and becoming an adult before even having been a child.”

“Are there any alternatives to this fate? Is it possible to avoid them being exposed to the

dangers represented by drugs and HIV & AIDS?”(Street children, drugs, HIV & AIDS: preventive education responses, UNESCO, Paris, 2003)

No idea of how HIV is spread

“I can get it (HIV) from eating rotten food; this is the only way I know that you catch it

“I have heard of HIV, if you have it you will slim up AIDS comes through dirty things – you must keep clean and wash so that you don’t get it, but for us to keep clean on the streets is hard.” (Sudan: Jaba’s street children survice at risk of HIV 2007)

On the whole, the World Health Organization reckons that there are between 50,000 and 100,000 HIV positive children and adolescents in Brazil Going further, it has also been estimated that between 1% and 2% of Brazil's population of 7-8 million street children, or

between 70,000 and 110,000 individuals, are HIV positive

Although there have been many proposals and programs for addressing the problems

of Brazilian street youth (Eisenstein, 1993, 1994; Kirsch, 1995), it would appear that only minimal headway has been achieved

2.4 Framework of literature

Figure 1: The theory Empowerment Approach to Social Work practice Model

Model show the present literature will deal with the process of street children on knowledge infected with HIV/AIDS is influenced by their socio culture factors

Especially speaking, the empowerment will approach to improve the self-protected skills for street children with HIV/AIDS factors

EMPOWERMENT

HIV knowledge

Attitude towards HIV/AIDS people

Attitude of use the condom

CHAPTER 3

This chapter is includes the information on the growing awareness on the part of all conceptual frameworks and begin with research hypotheses, to deal with description of the method research, research instruments, and method of data analysis

3.1 The Framework

This conceptual framework bridges the background information between street children and their attitudes, and their awareness of HIV/AIDS knowledge as well The conceptual framework helps to understand what causal factors of the street children with HIV/AIDS knowledge and their attitude with community life This framework includes relationship among variables based on significant correlations Specifically, the traits of demographic characteristics are dependent variable; attitude and HIV/Knowledge are independent variable

- Economic of their family

- Conduct of their family

- Parents status

- Time on the streets

- Type of work

+ Knowledge HIV + Attitude towards people + Attitude of use the condom

3.2 Definition of Term

It is necessary to define some terms that are frequently used in the study This part presents the different concepts within the context of the study

Knowledge: is defined variously as expertise, and skill acquired by a person through

experience or education The theoretical or practical understanding of a subject Knowledge in

an organization is commonly referred to as intellectual capital (Smite Kothuri, 2002) Yet, in this study, knowledge involved how much aware street children are about HIV/AIDS It involves complex cognitive of street children at the risk in their lives on the streets: experiencing, and learning in investigation

Attitude is defined as a complex mental state involving beliefs and feelings and values

and dispositions to act in certain ways (Medical dictionary, 2009), but in this study, the researcher used it as a kind of attitude of street children about HIV/AIDS

Behavior refers to the action or reactions of a person in response to external or

internal stimuli (Thomas Maugham II) In this section, behavior is the most general term to describe street children with family, friends, and community Behavior are repeated in their lives as smoking, drugging, and telling lies Behavior of street children at the risk of HIV/AIDS

Peer group: A peer group is a group of approximately the same age, social status, and

interest Generally, people are relatively equal in term of power when they interact with peers

As used in this study, peer group is considered including some groups of children working on the street, or drug users, or sexual partners The peer groups have knowledge, and experience about HIV/AIDS

Condom: A flexible sheath, usually made of thin rubber or latex, designed to cover the

penis during sexual intercourse for contraceptive purpose or as a means of preventing sexually transmitted diseases (Medical dictionary, 2009)

Mass media: Newspapers and magazines, television and radio news programmers and

documentaries Assessing the mass media is a good way to get the street children involved in the monitoring activity

Risk: A risk factor is something that increases a person’s chances of getting a disease

Sometimes, this risk comes from something a person does Manufactured virtual risks are produced by human activity, and food additives

3.3 Research hypotheses

The following benefits are 9 hypothesized and are being studied:

- Different demographic characteristics would result in significant differences of street

children on HIV knowledge, attitude towards people and attitude of use the condom:

1 Different demographic characteristics would result in significant differences of

street children in Gender groups on HIV knowledge, attitude towards people and attitude of use the condom

2 Different demographic characteristics would result in significant differences of

street children in Age groups on HIV knowledge, attitude towards people and attitude of use the condom

3 Different demographic characteristics would result in significant differences of

street children in Education groups on HIV knowledge, attitude towards people and attitude of use the condom

4 Different demographic characteristics would result in significant differences of

street children in where they lives groups on HIV knowledge, attitude towards people and attitude of use the condom

5 Different demographic characteristics would result in significant differences of

street children in economic groups on HIV knowledge, attitude towards people and attitude of use the condom

6 Different demographic characteristics would result in significant differences of

street children in conducts groups on HIV knowledge, attitude towards people and attitude of use the condom

7 Different demographic characteristics would result in significant differences of

street children in Parents status groups on HIV knowledge, attitude towards people and attitude of use the condom

8 Different demographic characteristics would result in significant differences of

street children in Time on the streets groups on HIV knowledge, attitude towards people and attitude of use the condom

9 Different demographic characteristics would result in significant differences of

street children in work groups on HIV knowledge, attitude towards people and attitude of use the condom

3.4 Materials and Methods

Methodologically, there are special concerns when researching children as: Appropriate research strategies, in both methodological and ethical senses, need to be thought through very carefully (Young & Barrett, 2000)

3.4.1 Research design

This study focused on the attitude and knowledge on HIV/AIDS of street children in

Ho Chi Minh City who both live and survive daily on the city streets

Quantitative method using the questionnaires survey involves the gathering of relatively limited data from a relatively large number of cases Under this study, the researcher utilized the survey approach

3.4.2 Sampling and Setting

Setting

This method was used in a variety of settings at different times with 230 children in Ho

Chi Minh City, because some of them live on the streets at different areas Although 150 children took part at Tre Xanh Shelter in District 1, Cau Han Project in District 4 and Tuong Lai Project in District 10, The Vocational Training School of Restaurant Services for street children in Ho Chi Minh City and 80 children were also the researcher’s outreach on the streets where they work and wander about the streets at Tan Binh District, Binh Thanh District, and Hoc Mon District

Sampling

The population for this study is a specific source community and the project for street children The researcher used method of choosing convenience sample to select street children both males and females who would be recruited The study targeted sample street children in

Ho Chi Minh City and involved interviews:

Sample of 230 street children in the areas where street children live: There are approximately 230 street children, the researcher chose to sample of 30 street children for research pilot and sample of 200 street children for formal research of this study; their ages range from 11 years to 18 years old

The researcher has been very much familiar with street children from the time she worked with them as a social worker 5 years ago Basing on her understanding street children, the researcher designed the questionnaires to prevent the respondents getting tired or bored

when interviewed The questionnaire was constructed as short as possible and designed for

self-administering, but the participants would be offered to choose to be interviewed by the researcher or to complete the questionnaires by themselves

3.4.3 Research instruments

The researcher collected the data from the research instrument used in this study which consists of two parts The first part (9 questions) is about the demographic backgrounds - age, gender, education completed, type of work, living arrangement, relationships with parents

The second part of the questionnaire contains questions about street children’s knowledge, attitude toward HIV/AIDS disease It includes 22 questions about definition of AIDS, transmission of HIV/AIDS, treatment of HIV/AIDS, prevention of the spread of HIV/AIDS, and attitude with HIV by using multiple choice of test items The knowledge scale used in this part is based directly on the 22 knowledge questions adopted and developed from the source of WHO, United Nations Educational, and some booklets of HIV/AIDS for the Youth in Vietnam

3 Amount of education/literacy level

4 Usual sleeping location

4 Preventive measures on the spread of HIV/AIDS; and

Attitude toward knowledge HIV/AIDS in term of:

1 Peer group

2 Social workers, and

3 Mass media

4 Environment

Attitude of Sexual behavior (what do they know about using the condom? What are the characteristics of sexual practices? What is the possible result of consultation in a medical centre (STD or HIV screening?)

What implications can be drawn from the findings of the study?

The social workers practice: intervention, prevention

The government of Vietnam, and

The different organizations are, institution and foundations that work with street children in Ho Chi Minh City?

3.4.4 Research Progress

3.4.4.1 Training the observers

The researcher and research assistants (a team) have informed the interviewees that they would be commissioned by Meiho or University in Ho Chi Minh City to learn more about the street children’s lives and the reasons why they are living/working on the street Then the research team asked for permission to interview some child

If the child were assured that they would stay remain confidential and no one, except the researcher and or/research assistants would know who provided that information; and in the end they would be given a small present as a token of appreciation and compensation for the time and earning opportunities lost while being interviewed

The major tool used in the study would be interview schedules designed to investigate the situation of street children Then the results of the interviews would be the major source for the questionnaire subjected to a quantitative research

All the research assistants training would be interviewers and volunteers of organisations working with street children directly on the streets, in markets and at bus

termini and care shelters After the initial contacts factilitated by social workers and volunteers, further contact would be mainly through snowballing where street children would

be interviewed, and introduce their friends for the interviewer

3 4 4 2 Pilot study

Before the study was applied to the whole in University of Social Sciences and Humanities, this pilot study took a first step for conduct This requires comparing the results from the questionnaire to the criterion measure, which was pilot study on street children about their attitude and HIV/AIDS knowledge Also 30 street children received questionnaires about Attitude and HIV/Knowledge for this pilot study Research on street children was really not easy The questionnaires were deigned before the beginning of the research but the pilot study met:

- Some of the questions were not clear to the research street children due to the limited educational background of street children which limited their comprehension of the questions

The researcher was assisted by the supervisor at Meiho Institute of Technology and two research assistants (two were post-graduates, each with a Master Dergree in Social Sciences who is teaching at University Social Sciences and Humanities in Ho Chi Minh City, Vietnam) and Project Manager who is working with street children, and social workers, all

of whom were invited to review, evaluate and comment for this pilot

3 4 4 3 Validity and reliability

Validity:

In this study, validity is a very important term The questions in the questionnaires were chosen to reflect the nature of street children in Ho Chi Minh City about the attitude and HIV/AIDS knowledge In addition, the questionnaires included the questions about Attitude

of the use of the condom The content and construct validity is high

Validity refers to the ability of responder to measure what it is supposed to measure Because the study was researched in Vietnam, it must be checked and double checked The study was checked by the supervisor and two experts at Meiho Institute of Technology Then

it consulted an expert English – Vietnamese translator

Overall, the results of reliability test were shown in the table As what it showed, the Cronbach’s Alpha score of the HIV/AIDS knowledge was 661 and with the second group about the Attitude toward HIV/AIDS, the Cronbach’s Alpha score was 700 and the Cronbach’s Alpha score of the last group about Attitude of use the condom was 895

The result showed that the questionnaires could be used to evaluate the Attitude and HIV/AIDS of the study participants

Table 1: Reliability Statistics: Cronbach’s Alpha

Groups Cronbach’s Alpha N of terms

Scale Variance if Item Deleted

Corrected Item-Total Correlation

Who is not the risk group that can be

Table 1.2 : Total relation of Attitude towards people

Scale Mean if Item Deleted

Scale Variance

if Item Deleted

Corrected Item-Total Correlation

Study and work with him/her as

Sympathize, help him or her

Tell this case to a social worker so

Table 1.3 Total relation of Attitude of use the condom

Scale Mean if Item Deleted

Scale Variance if Item Deleted

Corrected Item-Total Correlation

I think the condom can protect me

I think the condom can protect me

from sexually – transmitted

The researcher visited each investigated area where street children live over 2 months

of the years (during July and August, 2008) The information took dependent on the time of street children, before/after their work of the day, or evening (after 8 or 9 PM) and on weekend If they feel comfortable and would like to answer the questionnaires, if they did not want deal with the researcher or social workers, the researcher had to come back another time Some of street children cannot read, write or have some metal problem, the researcher had to save more time to explain the questions to them

3 4.4.5 Data analysis

The questionnaires data were entered into a computer and the researcher used the

software of Statistical Package for Social Sciences (SPSS) for Window version 14.0 After all

interviews for each individual site were completed, the data was analyzed to find the answers

to the general research question Analysis is the examination of data in terms of characteristics

in order to answer the questions raised in the specific problems of the study After gathering the data, the researcher checked out the entire returned questionnaire Then the researcher categorized the responses, made the coding guide, coding and tabulating the responses Finally, researcher analyzed, presented and interpreted the data

Analysis of variance techniques (ANOVA) was also used to test the difference

between means of different groups (in terms of gender, age, and educational attainment.) The stronger relationship between variables, the better predictors are

Table 2: The Data Analysis Plans of Street children about questionnaires

Survey objectives Independent variable Dependent Variables Street children analysis

statistic

1 Descriptive profiles => Demographic

characteristics of street children

=> Attitude and HIV/AIDS knowledge

=> T test, ANOVA, and post hoc test

4 Source of information

about HIV/AIDS and

Medical care of street

children

=>Demographic characteristics of street children

=> None => Frequencies

3 6 Ethical consideration

The importance of ethical issues in this study must be carefully thought through when undertaking researching with street children The researcher had to learn code of ethics before

starting the research and had a sense of responsibility in this study The researcher ensured

confidentiality; the respondents’ names were not be asked To identify the cases, all the

questionnaires were to be numbered

As Ethical guidance: 2009 – 2010 of Institute of Applied Social Research Ethics

Committee “If research is being undertaken with children, young people (under 18) or vulnerable adults…if you are undertaking research with these groups special consideration should be given to their levels of competence and the language you use to ask questions should be appropriate ” (Melrose, 2009)

In the first step for ethic in this research, the researcher came to meet the Project Manager in the shelters of street children in Ho Chi Minh City, gave them the questionnaires

of this research and attached with the letter of introduction of University of Social Science and Humanities in Ho Chi Minh City where the researcher works, and hope they would accept

so that the researcher could do the research with street children living at these shelter At this step, the researcher waited for the Project Manager to read the questionnaires to see wheter what would be asked really fitted street children and would not negatively influence on them Then, the researcher began this research On the other hand, on the time the researcher asked street children about their knowledge and attitude on HIV/AIDS, Project Manager appointed the volunteer or social workers, and assistance for researcher to work with street children on through that time, which helped the researcher understand some children’s behavioral problems The goal was to make the research as clear as possible especially for the children interviewed After the interview, the researcher saved some time with the children and taught them some knowledge and attitude about HIV/AIDS

The researcher expounded about the purpose, the look of deeply significance of the researcher with their life All the personal information was kept protected, safeguarded and coded by data processed

CHAPTER 4