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AIDS knowledge and education for South Korean-born college students attending Korean colleges and United States-born Korean American and South Korean-born students attending United States college...
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AIDS knowledge and education for South Korean-born college students attending Korean colleges and United States-born Korean American and South Korean-born students attending United States college...
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AIDS KNOWLEDGE AND EDUCATION FOR SOOTH KOREAN-BORN COLLEGE STUDENTS ATTENDING KOREAN COLLEGES AND U.S.-BORN KOREAN AMERICAN AND SOOTH KOREAN-BORN STUDENTS ATTENDING U.S. COLLEGES IN CALIFORNIA by Linda K. Chon A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY EDUCATION August 2002 Copyright 2002 Linda Kyung-Rae Chon Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number: 3094409 Copyright 2002 by Chon, Linda Kyung-Rae All rights reserved. ® UMI UMI Microform 3094409 Copyright 2003 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UNIVERSITY OF SOUTHERN CALIFORNIA The Graduate School U niversity Park LOS ANGELES, CALIFORNIA 900894695 T h is d is s e rta tio n , w ritte n b y __________Linda Ky.ung-Rae Chon __ U n d er th e d ire c tio n o f h. & x. . D is s e rta tio n C om m ittee, a n d a p p ro ve d b y a il its m em bers, has been p re s e n te d to a n d accep ted b y The G rad u ate School , in p a rtia l fu lfillm e n t o f req u i rem en ts fo r th e degree o f D O C T O R O F P H IL O S O P H Y - 7 ^ = ^ r D ean a ■ a n o f G raduate S tu d ies D a te -August... 6 . * 2 0 0 2 . . . D I S S E R TA T IO N C O M M IT T E E Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. DEDICATION To God: For providing me the strength to survive. & To My Parents: Mr. John K. Chon & Mrs. Yon C. Chon For all the love and support, especially for always believing in me. Love Always, Your daughter, Ph.D Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iii ACKNOWLEGMENTS My husband Jimmy Lee, for helping to edit this paper over and over again and staying up long nights with me for moral support. Dr. Rideout, for editing and the valuable comments that helped improve this research. APICHA and Jen Kim, for the use of the survey instruments and the kind help she provided. My cousin Jay Lee, for helping with the translation. Tim, for helping with the statistics. I would also like to acknowledge my committee members and all those who participated in the survey to make this research possible. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iv TABLE OF CONTENTS DEDICATION .............................................. ii ACKNOWLEGMENTS ......................................... iii LIST OF TABLES ....... ................................. x ABSTRACT ................................ xii CHAPTER I ............................................... 1 INTRODUCTION ........................................... 1 Background of the Study .......................... 1 Statement of the Problem .................. 4 Purpose of the Study ............................. 5 Research Questions ............................... 6 Hypotheses ........................................ 6 Significance of the Study ........................ 7 Delimitations ..................................... 9 Limitations .................................... 9 Definitions ....................................... 10 Overview of the Proposal ......................... 12 CHAPTER II .................. ........................... 13 REVIEW OF LITERATURE ................. .............. 13 Introduction ........................... . 13 AIDS: Nature of the Disease and Current Trends In the United States, Globally, and in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. V South Korea ................................ 17 Nature of the Disease ...... 17 Current Trends in the United States ....... 23 Cumulative Cases by Age ............. . 24 Cumulative Cases by Race/Ethnicity .... 25 Cases by Exposure Category ............ 26 Distribution Among Children by Exposure Categories .............. 26 Areas With Most Cases .............. 27 Leading Metropolitan Areas ............ 28 Current Global Trends ................. 28 Global HIV/AIDS Estimates for Adults And Children, end of 2001 ....... 29 Regional HIV/AIDS Statistics, end of 2001 ..... ......................... 32 Current Trends in South Korea ............ 3 3 South Korea Statistics ........... 38 HIV/AIDS and South Koreans ............ 38 HIV/AIDS in South Korea ....... 39 HIV/AIDS among South Koreans Living In Other Countries ............... 47 Summary and Conclusions ..................... 54 CHAPTER III ............................... ....... 57 METHODS . ............................................. 57 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Restatement of the Research Problems ....... . 57 Design Variables ............. 57 Research Approach ................................ 57 Subject Selection Methods ......... .............. 59 Instrumentation .................... .......... . 60 AIDS Education Questionnaire ............... 60 Asian and Pacific Islander Coalition on HIV/AIDS (APICHA) ...... 61 Interview Protocol .......................... 62 Data Gathering Procedures ................ 63 Data Analysis Plan . ............................. 66 Descriptive Analyses ............ ........... 66 Inferential Analyses ........ . 66 CHAPTER IV .............................................. 68 RESULTS ................................................. 68 Description of the Sample ........................ 68 Participant Gender Information ............. 68 Sample Gender Frequency . .................. 69 Description of the Groups ......... . 69 Group 1 ..... 69 Group 1 Gender Frequency Table.............. 7 0 Descriptive Statistics for Group 1 ......... 70 Group 2 ........................... 71 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. vii Group 2 Gender Frequency Table ..... 71 Descriptive Statistics for Group 2 ........ 72 Group 3 ....... 72 Group 3 Gender Frequency Table ............. 72 Description Statistics for Group 3 ........ 73 Means for the Groups for Each Variable..... 73 Findings Regarding Hypotheses ................... 73 Hypothesis 1 ................................. 73 Hypothesis 2 ................................ 74 Hypothesis 3 ...................... 74 ANOVA Findings .............................. 75 Post HOC Analysis ........ 75 Multiple Comparisons of Group Differences... 77 Findings Regarding Interviews................. 77 Group 1: Korean-born Korean Students Studying in South Korea ..... 77 Informal Interview Comments ............ 79 Group 2: Korean-born Korean Students Studying in the U.S. ........................... 80 Informal Interview Comments ................ 81 Group 3: U.S.-born Korean American Students Studying in the U.S .................... 82 Informal Interview Comments ................ 84 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. viii CHAPTER V ....... ...................................... 86 SUMMARY, DISCUSSION, CONCLUSIONS ............. 86 Summary ........................................... 86 Research Objectives ....... .................. 86 Summary of Findings Related to Hypotheses .. 87 Summary of Findings Related to Interviews .. 88 Summary of Findings Related to Research Questions .............................. 92 Discussion .............................. ......... 93 Significance of Findings Related to Literature ............................. 93 Limitations ....... .......................... 97 Conclusions ....................................... 98 Recommendations for Future Research ....... 102 REFERENCES .............................................. 104 APPENDIX 1 .............................................. 107 APPENDIX 2 ........................... 109 APPENDIX 3 .............................................. Ill APPENDIX 4 ................... 113 APPENDIX 5 ........ 115 APPENDIX 6 ................. 119 APPENDIX 7 .............................................. 123 APPENDIX 8 .............................................. 124 APPENDIX 9 .................. 125 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ix APPENDIX.10 ............... 126 APPENDIX.11 ..... 127 APPENDIX 12 ....... 130 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF TABLES T Si) 1 C I oo.«ooB.eoBO BBO BO oooB*«.o...«.O BO o«a.»»»o. Cumulative Cases by Age in the U.S. Through 2001 T l 6 2 *e*OBO.O»m.»»OB.OOn..»B.aOOO»»B»BBO.O..ffl»< Cumulative Cases by Race/Ethnicity in the U.S. Through 2001 Table 3 Cases by Exposure Category in the U.S. Through 2001 T l C 4 ....... ........... ....... ........... ...... Distribution Among Children by Exposure Categories in the U.S. Through 2001 T a b l e 5 O. .. ...... ...... ..BOOB..........*..*..... Areas With Most Cases in the U.S. Through 2001 T3! 1.0 0 Leading Metropolitan Areas in the U.S. Through 2001 Table 1 ......................................... Global HIV/AIDS Estimates for Adults and Children, end 2001 1 ' a . J o 1 ^ 5 8 ......................................... Regional HIV/AIDS Statistics, Worldwide at the End of 2001 * 1 C i l O 1 0 ..... ............ .......... ...... ........ South Korea Statistics for 1999 T alo 1 e 10 ........................B.noo.o... ....... Sample Gender Frequency 1 * S . ^ 0 1 ^5 11 Group 1 Gender Frequency Table Table 12 Descriptive Statistics for Group 1 fahl o is X G L S * J - X . k C X . o o m o l s e e f t e s a s o s e s B i e e e e B s s i Group 2 Gender Frequency Table Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. . . 24 . . 25 . . 26 . . 2 6 . . 27 . . 28 . . 29 . . 32 . . 38 . . 69 . . 70 . . 70 . . 71 T 133- g 34 Descriptive Statistics for Group 2 T a^G 1 e 15 Group 2 Gender Frequency Table 13 I d 16 16 Descriptive Statistics for Group 3 T 31d 10 17 Means of the Groups for Each Variable "1 a ip 1 0 I S t > > i a a « i * » > f l * a f t e » e « B a a a » s a a a * a i ANOVA Findings T a 3c 1 e 1 9 • o B a » o a . I » O B < B « o n » o o i B > > ® o « 0 » a a n » . B a Multiple Comparisons of Group Differences Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ABSTRACT The conducted research examined South Korean HIV/AIDS education among a sample population of Korean-born South Korean students attending South Korean colleges and Korean- born and U.S.-born South Korean students attending American colleges. As rationale for the study, it was noted despite the HIV/AIDS epidemic globally, and its increases in South Korea, HIV/AIDS education is lacking among Korean-born students. Specifically, more Korean-born college students were not as concerned about the disease as the U.S.-born or U.S. schooled college students because they felt that it did not concern them; thus the study found significant differences between responses of Korean-born and schooled South Koreans and those either U.S.-born or U.S.-schooled. The difference found in the level of HIV/AIDS between the two populations appears to be the result of greater overall HIV/AIDS knowledge in the U.S. transmitted through formal, nonformal, or informal education. Although new treatments have extended the healthy lifespan of many people with HIV/AIDS, it still continues to increase among certain groups. This research was targeted to identify the groups at higher risks due to Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. xiii misconceptions and lack of HIV/AIDS knowledge and education. Substantiating the differences between these groups could assist in identifying the degree of risk that members of each group have for contracting and/or transmitting the HIV. Educational prevention is an effective measure for combating the AIDS epidemic. To investigate HIV/AIDS knowledge and education, students currently studying in major South Korean universities and students currently studying in several major California universities were asked to complete several research instruments. These instruments measured: HIV/AIDS knowledge, sexual risk, and HIV/AIDS education. For all three groups, it was concluded that informal methods of education were the key source for transmitting HIV/AIDS knowledge. Further, it was noted that AIDS knowledge may not be reflected in AIDS behaviors since most individuals demonstrated that they failed to be personally concerned about the disease or to believe that it could affect them. Moreover, they were unaware of the magnitude of the AIDS epidemic. When confronted with that information they continued to believe that it could not affect them as long as they were "clean" or lived "right." Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1 CHAPTER I INTRODUCTION Background of the Study According to the Centers for Disease Control (1998) (CDC), approximately thirteen million people in the world now have AIDS. In America, 641,086 cases have been reported since the discovery of the HIV virus and about half of these have now died. UNAIDS (2001) reports that it was projected that by the end of 2001, forty million people, globally, would be living with HIV, with most of the new infections found in young adults; around one-third of those individuals who are currently living with HIV/AIDS, are ages 15 to 24 years and most do not know they carry the virus. In fact, UNAIDS claims that millions know nothing about HIV or not enough to protect themselves from it. However, the Centers for Disease Control (1998) also reports a decline in information of HIV/AIDS, attributing a great deal of the decrease to prevention efforts. Specifically, the CDC noted that: Prior to the introduction of combination therapies for HIV, AIDS incidence was increasing at a rate of less than 5 percent each year. Partly as a result of prevention efforts targeting those at highest risk, the epidemic had slowed considerably from the early years in the epidemic, when increases were 65 percent to 95 percent each year. In 1996, estimated AIDS incidence dropped for the first time, declining 6 percent (p. 1). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 The CDC (1998) further notes that while prevention efforts have helped slow the epidemic from a period of rapid growth to an overall stabilization, this success rate is not the same in all communities. For example, the growth of AIDS has not seriously decreased qmong communities of drug users and/or prostitutes. One group that has not been examined for the impact of prevention efforts on decreasing AIDS/AIDS risk is that of foreign college students studying in America. Regarding HIV/AIDS as may be related to foreigners in general in the U.S. and South Koreans in particular, a study conducted by Kihara, Kihara, Ohya and Ichikawa (1998) found that among immigrant groups living in Japan, HIV/AIDS was generally increasing with the highest increases observed for South Americans and South Koreans. Based on their data, the authors noted that for the foregoing groups, HIV/AIDS prevention and care programs, as well as more epidemiological studies, should be urgently planned and implemented. Findings such as those observed by Kihara, Kihara, Ohya and Ichikawa (1998) imply the need to investigate the effectiveness of South Korean AIDS education as a preventative measure. One study that sheds some light on this topic was conducted by Chou, Chin and Rodriquez (1998). The authors studied the effects of HIV 101 workshops on HIV Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3 knowledge, condom use, as well as intentions to practice safer sex among immigrant and U.S.-born South Asians in New York City. Subjects in the study consisted of Chinese, Filipino, Indian, Korean, and Japanese workshop 101 participants. Findings of the study revealed that U.S.-born Asians had both higher HIV/AIDS knowledge and condom use self-efficacy baseline scores than did immigrant Asians. Chou et. al's (1998) study demonstrates that there may be a problem regarding knowledge of AIDS and safe sex practices among non U.S.-born Asian groups including groups from South Korea. This lack of knowledge may indicate a need for increases in HIV/AIDS education in South Korean schools. The study did not specifically address itself to South Koreans or to South Korean college students studying in the United States, a group that may represent an at risk population. To date, no studies have explored AIDS knowledge, or previous South Korean AIDS education, among this group. Given the findings of Kihara, Kihara, Ohya and Ichikawa (1998) and their plea for more HIV/AIDS prevention, care programs, and epidemiological studies, and considering the findings of Chou et. al, it seems reasonable to assert that South Korean college students studying in the U.S. are a viable population to examine in terms of their general knowledge of HIV/AIDS, safe sex practices, and previous AIDS education. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Statement of the Problem Research regarding South Korean HIV/AIDS education is lacking. Studies show that the AIDS epidemic is not decreasing in South Korea as it appears to be in the United States. There is an indication that HIV/AIDS knowledge is low among non-U.S.-born Asians in general. Findings also show that South Koreans tend to demonstrate less knowledge regarding HIV/AIDS and safe sex practices than Americans. In a study of general knowledge among non U.S.-born Asians living in the United States, Moy, Kim, Chu, Henderson, Hu, Chai and Yeh (1998) reported that among these groups, misconceptions about HIV/AIDS are widespread. Moreover, there are indications that immigrant South Korean groups may be particularly misinformed about HIV/AIDS (Kihara, Kihara, Ohya and Ichikawa, 1998; Chou, Chin & Rodriquez, 1998). UNAIDS (2001) reports that millions know little or nothing about HIV/AIDS and how to protect themselves from it and to resolve this situation, the United Nations General Assembly Special Session on HIV/AIDS in 2001 set goals in place for which national and international governments pledged their support. Among these goals it was determined that strategies must be in place which address factors that make individuals vulnerable to HIV infections, such as lack of education or information regarding self-protection. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 5 Since AIDS knowledge for South Koreans appears to be lacking and education is considered a preventative measure for the spreading of HIV/AIDS, an investigation into the AIDS education in South Korean schools is needed. A study examining whether any observed differences may be related to differences in gender and/or students' ages would provide additional information. These demographics need to be explored because while there is not much research on South Koreans living in the United States, there is some research suggesting that those traveling to countries other than the U.S. may not only be at higher risk for HIV/AIDS but that this risk can vary in conjunction with certain demographics (Choi, Kim, Catania, Hearst and Coates, 1991). Purpose of the Study As new treatments have extended the healthy lifespan of many people with AIDS; AIDS prevalence has shown a decrease for some groups and yet continues to increase among certain specific groups (Centers for Disease Control, 1998). Identifying those groups most at risk due to misconceptions and lack of knowledge about HIV/AIDS and safe sex practices is imperative so that health care agencies and institutions can target these groups with prevention efforts. The purpose of this research was to contribute to this effort to identify and target certain groups at higher risk for Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. HIV/AIDS by examining whether foreign students from South Korea currently studying in the United States may be a group that remains at risk, due to a lack of HIV/AIDS education. Research Questions The research problem can be characterized as an empirical attempt to answer the following research questions: 1. Do U.S.-born Korean American college students differ in their degree of knowledge regarding HIV/AIDS and safe sex practices when compared to foreign college students from South Korea who are currently studying in the United States as well as those currently studying in South Korea? 2. Does HIV/AIDS formal, nonformal, and informal education among U.S.-born Korean American college students differ from that of college students from South Korea who are currently studying in the United States as well as South Korea? Hypotheses Since previous research reveals differences between U.S.-born Asians and immigrant Asians regarding HIV/AIDS knowledge, the following research hypotheses were made. Terms are operationally defined in the definition section. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Research Hypothesis 1 - South Korean-born college students currently studying in Korea will score significantly different from South Korean-born and U.S.-born Korean American students studying in the U.S. on AIDS knowledge which, for the purposes of this study, is operationally defined as students' scores on the APICHA, Asian Pacific Islander Coalition on HIV/AIDS, developed by Chou, Chin and Rodriquez (1998). Research Hypothesis 2 - South Korean-born college students currently studying in Korea will score significantly different from South Korean-born and U.S.-born Korean American students studying in the U.S. on sexual risks which, for the purposes of this study, is operationally defined as subjects' scores on the APICHA. Research Hypothesis 3 - South Korean-born college students currently studying in Korea will score significantly different from South Korean-born and U.S.-born Korean American students studying in the U.S. on AIDS education which, for the purposes of this study, is operationally defined as subjects' scores on AIDS. Significance of the Study There are many reasons why it is important to study people's knowledge of HIV/AIDS and safe sex practices, the most important of which is that these both have an impact on Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. one's degree of risk for contracting and/or transmitting the HIV Virus (Hale, 1994). Educational prevention is shown to be a preventative measure for the AIDS epidemic. There is no known cure for full-blown AIDS and of those diagnosed in the early years when the HIV virus was first discovered, almost all (98%) have died (Hale, 1994). Equally disturbing is our lack of knowledge regarding the percentage of people who, following infection, will then go on to develop AIDS. Often people are infected not because they are unwilling to take preventative actions but simply because they engage in sexual practices based on either ignorance of the disease and its transmission or are mistaken in their beliefs about the condition -- both factors greatly increase their risk (Dworkin & Pincu, 1993). Moreover, indications are that some groups may have less knowledge and more misconceptions than others, and one of these groups may be South Koreans currently in Korea and the United States (Chou, Chin & Rodriquez, 1998). By examining a subset (college students) of this group regarding their knowledge of HIV/AIDS and safe sex practices, and previous education, and comparing results to U.S.-born Korean American college students, this study will assist in the effort to identify at risk groups so that they can be targeted for prevention efforts. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 9 Delimitations The boundaries beyond which the study will not seek to generalize can be delineated as follows: It cannot be claimed that the questionnaires to be used in this study will measure all possible awareness of, or knowledge of, HIV/AIDS, and safe and unsafe sexual practices, or of all elements related to South Korean AIDS education. Given these reliability and validity limitations, results may not adequately represent the whole of South Korean education. Limitations The primary limitation of the study is its descriptive nature. According to Best (1991), descriptive research, being nonexperimental, cannot be used as a foundation for the formulation of causal connections between investigated variables. Therefore, any observed relationships between examined factors must be discussed only in non-causal terms. A second limiting factor of the study involves the fact that all subjects participating in the research must "voluntarily" participate by returning their mailed instrumentation packets. According to Kiess and Bloomquist (1985), volunteers have characteristics that are distinguishable from non-volunteers, for example they are more sociable and less conventional. It is, therefore, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 10 possible that the findings of the study may only be generalizable to the volunteering subset of the population from which the sample was drawn. Limitations of self- reporting test instruments may also be present. Definitions So that the proposed study may be fully understood, the following key terms are operationally defined: AIDS - For the purposes of this study, this term is operationally defined as referring to Acquired Immune Deficiency Syndrome, a disease involving a defect in cell- mediated immunity that has a long incubation period, follows a protracted and debilitating course, has a poor prognosis, and which is transmitted through sexual contact, exposure to contaminated blood, and other exchanges of bodily fluids (Hale, 1994) . HIV Disease - For the purposes of this study, this term is operationally defined as referring collectively to human immunodeficiency disease infection and acquired immunodeficiency syndrome (Hale, 1994). HIV/AIDS Knowledge - For the purposes of this study, this term is operationally defined as students' scores on the APICHA, Asian Pacific Islander Coalition on HIV/AIDS, developed by Chou, Chin and Rodriquez (1998) . Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 11 Sexual Risk - For the purposes of this study, this term is operationally defined as subjects' scores on the APICHA. Safe Sex Knowledge - For the purposes of this study, this term is operationally defined as subjects' scores on the APICHA. AIDS Education - For the purposes of this study, this term is operationally defined as subjects' scores on the AIDS Education Information Questionnaire developed by the investigator. In addition, formal education is defined as education received in a classroom setting, nonformal education is defined as education received through professional methods such as guest speakers, auditorium lectures, pamphlets, and seminars, and informal education is defined as education received outside of the school system or professional references by doctors, such as through family and friends, media, and magazines. Prevention - For the purposes of this study, this term is operationally defined as behaviors designed to decrease the AIDS epidemic, including education. Groups Studied - The study's independent variables are country of birth with two levels, South Korean-born or U.S.- born Korean Americans; and current place of study, U.S. or Korea: 1.) South Korean-born, studying in Korea 2.) South Korean-born, studying in U.S. 3.) U.S. born Korean Americans, studying in U.S. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 12 Overview of the Proposal The first chapter of the proposal presents information regarding the basic nature of the study. The second chapter presents a comprehensive review of the pertinent literature on HIV/AIDS among South Koreans both in Korea and in the United States and indications of AIDS education in South Korea. The third chapter of the proposal delineates and discusses all of the methods and procedures that will be used in the analysis of collected data including subject selection procedures, design variables, and the basic research approach. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 13 CHAPTER II REVIEW OF THE LITERATURE Introduction In 1995 the cumulative number of reported AIDS cases in America surpassed one-half million, and by the year 2000 the World Health Organization (WHO) projects a cumulative total of 30-40 million HIV infected men, women, and children worldwide. On a global scale, the vast majority of people infected with HIV/AIDS are heterosexual. Currently, AIDS is the leading cause of death for men 25-44 and the fifth leading cause of death among women of the same age group (CDC, 1998; 2002a). In addition to the personal consequences of HIV/AIDS, the economic costs of HIV are staggering costs that are added to a health care system that is already unable to meet the needs of many people. According to Hale (1994), it is estimated that total lifetime health care costs for a person with HIV disease range from $65,000 to $85,000. Moreover, these costs are expected to rise as more effective treatments are developed and life expectancy increases. All of the foregoing reasons make research into HIV/AIDS and those who may be at high risk for contraction of the disease imperative. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 14 This research will assist with the goals of the United Nations General Assembly Special Session on HIV/AIDS in June, 2001. This assembly presented a program which included national and international cooperation in the struggle against the HIV/AIDS epidemic. Government worldwide, pledged to participate in achieving goals related to prevention, support, treatment, and care, to alleviate the impact. Special attention was to be paid to orphaned children who were particularly vulnerable. Targeted areas presented as goals are the following (UNAIDS, 2001): 1. Reduce HIV infection among those ages 15 to 24 years, by 25% in the most affected areas by 2005 and globally by 2010. 2. Reduce proportions of infected infants by 20% in 2005 and 50% by 2010. 3. Develop national strategies strengthening health care systems and addressing factors which affect provisions of HIV drugs such as affordability and pricing, by 2003. This includes providing the highest attainable standard of HIV/AIDS treatment, and responsibly monitoring this treatment to reduce the risk of resistance development. 4. Develop national strategies that include supportive environments for orphans and children who Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. are infected or affected by HIV/AIDS, by 2003, and implement these strategies by 2005. 5. Have strategies which address factors which make individuals vulnerable to HIV infections, such as economic insecurity, poverty, lack of empowerment of women, lack of education, social exclusion, illiteracy, discrimination, lack of information about, or commodities for, self-protection, and sexual exploitation. 6. Develop strategies to address impacts of the HIV/AIDS epidemic on all levels such as individual, family, community, and national. The HIV/AIDS epidemic is in various stages around the world, with many regions still experiencing early stages. However, even in areas with low prevalence, epidemics may be hidden within various locations or populations. In other areas, stages are advanced or incidence is rapidly increasing and all countries thus involved, must consider the consequences. The key to preventing the spread of the disease is to enable vulnerable groups and others to participate in safer sex practices and sterile drug- injection behaviors. For this to take place, higher risk population groups must be identified and then methods must be developed to safeguard them against the epidemic. Young people are considered a priority since millions of this age Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 16 group tend to know little about HIV/AIDS. UNICEF reported that for the age group 15 to 24 years, over 50% in over a dozen countries, know nothing about HIV/AIDS. These young people either have never heard of the disease or they are misinformed regarding how HIV is transmitted. It is concluded that providing this group with adequate information is essential for the prevention of AIDS (UNAIDS, 2001). The proposed study will provide information which identifies target groups at higher risk for HIV/AIDS, due to a lack of AIDS education, by examining South Korean college students currently taking classes in America as well as South Korean college students currently taking classes in Korea. Specifically, the proposed research will compare South Korean-born college students to U.S.-born Korean American college students currently studying in America and South Korean-born college students in Korea in terms of their general knowledge regarding HIV/AIDS and safe and unsafe sex practices, and their previous AIDS education. In order to place the proposed study in context, this chapter of the proposal presents a review of the pertinent literature. The first section of the presented review provides some background information on HIV including the basic nature of the disease, recent trends in HIV/AIDS in the United States, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 17 globally, and in South Korea, and the degree of risk associated with different populations living in America. The second section of the review examines studies which have specifically focused on HIV/AIDS and South Koreans and their knowledge regarding HIV/AIDS and safe sex, which may be indicative of their acquired education; this section of the review explores both studies of South Koreans living in the Republic of Korea and those currently living in the United States. The final section of the review presents a series of conclusions based on the reviewed research. AIDS: Nature of the Disease and Current Trends in the United States, Globally, and in South Korea Nature of the Disease Human Immunodeficiency Virus (HIV) is a retro virus causing immunologic deficiencies that leave the host susceptible to opportunistic infections and cancers (Stryker, Coates, DeCarlo, Haynes-Sanstad, Shriver & Makadon, 1995). HIV infects many cells including dendritic cells, endothelial cells and lymphocytes. The greatest damage, however, is from the infection of the T4 or helper T lymphocyte which is the cell that produces the immune response. It is the progressive decline in numbers of T4 lymphocytes that causes disruptions in immune functions, eventually resulting in a complete inability of the infected Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 18 individual to fight off infection (Stryker, Coates, DeCarlo, Haynes-Sanstad, Shriver & Makadon, 1995) . At the stage where an individual is close to being completely unable to fight off opportunistic infections, he or she is said to have full-blown Acquired Immune Deficiency Syndrome or AIDS. According to Stryker et. al (1995), the symptoms of HIV infection are the symptoms of the diseases that attack the body because of a weakened immune system. Most of the following symptoms are not specific to HIV infection. However, if an individual has any of the several different symptoms for long periods of time without the presence of another disease or condition, a doctor should be contacted. These symptoms, the authors state, include: 1. Fever that lasts from a few days to longer than a month with periods of excessive sweating, especially at night. 2. Loss of appetite. 3. Chronic or long lasting fatigue. 4. Weight loss of more than 10 percent of body weight. 5. Muscle and joint pain. 6. Unexplained long lasting sore throat. 7. Unexplained swollen lymph glands. 8. Diarrhea lasting longer than a month with no other disease. 9. Lingering infections. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 19 As the immune system becomes more and more compromised the HIV infected person may acquire opportunistic diseases such as Kaposi's sarcoma, Pneumocystis carinii pneumonia, tuberculosis, neurological disorders such as meningitis, and herpes simplex infections. It is common at this point that the HIV infected person is diagnosed with AIDS. Rosenberg (1995) reports that transmission of HIV can occur sexually or non-sexually through the exchange of body fluids infected with a high concentration of the virus, mainly blood, semen, or vaginal/cervical secretions. Transmission is especially effective during activities that involve "sealed penetration," i.e., anal or vaginal intercourse, and needle sharing. HIV/AIDs may also be transmitted through blood transfusions with infected blood or passed from mother to child during pregnancy, birth and breast feeding. Health care accidents are responsible for some cases of HIV transmission as well, such as a nurse pricking herself with an infected needle. Rosenberg (1995) further notes that there is no chance of transmitting HIV through sexual activities that do not involve direct contact of semen, vaginal secretions, or blood with mucous membranes. Nor is the AIDS virus spread through the air, in food, or by casual social contact. People do not become infected with HIV by someone coughing or sneezing, by sharing cups or pencils, by swimming in a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 20 pool with an infected person, or by shaking hands, hugging or probably even kissing an infected person. Although small amounts of HIV have been found in body fluids like saliva, feces, urine, tears, and sweat, there is little scientific evidence that HIV can spread through these body fluids. The impact of the AIDS epidemic is found worldwide. AIDS is a threat not only to the individual human being but it threatens the development of many countries and their social stability. It results in poverty and retards growth. For example, in half of the countries of sub-Saharan Africa, where the epidemic has increased, the annual per capita growth is falling 0.5 percent to 1.2 percent due to AIDS. It is estimated that by the year 2010, for those countries with the highest prevalence, the per capita GDP may drop by 8 percent, and by 2 02 0 it will drop over 2 0 percent, and the per capita consumption may decrease even more. Industry will be faced with increased training costs, insurance and benefit costs, and increased illness and absenteeism. In an Ethiopian study of 15 firms, over a five-year-period, 53 percent of illnesses were related to AIDS (UNAIDS, 2001). The poor suffer most from the economic impact of HIV/AIDS, but all people are vulnerable. In Botswana, the adult HIV prevalence is more than 3 5 percent and one quarter of the households are predicted to lose at least one income earner over the next ten years. Thus it is predicted that Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 21 an increase in HIV/AIDS prevalence is related to increases in the numbers of families who are poor or destitute, with the per capita household income for the poorest dropping by 13 percent. On the other hand, the numbers of dependents is increasing due to HIV/AIDS and each income earner in the poor category is predicted to be responsible for four more dependents. In addition to these consequences, the more impoverished areas typically lack access to adequate public services to provide social and health care. Households are forced to cope with new HIV/AIDS expenses by cutting down on basic necessities. Assets are sold to cover costs of health care and funerals. In a Rwanda study, households with one HIV/AIDS patient, spend 20 times more on health care compared than households without an AIDS patient and only one-third of these households are managing (UNAIDS, 2 001). The United Nations Food and Agricultural Organization reported that seven million farm workers have died from AIDS-related causes since 1985. Over the next twenty years, it is predicted that sixteen million more will die. This death rate cannot sustain agricultural output of staples and other products. Thus food shortages and hunger may become a widespread problem in some countries. For example rural Thailand households are experiencing their agricultural output being cut by 50 percent. Children (15 percent) are being removed from school to care for family members and to Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 22 work. In Swaziland school enrolment has dropped by 36% due to AIDS (UNAIDS, 2001) . HIV/AIDS also results in the loss of human resources such as teachers, doctors, and other workers. In Malawi and Zambia, there is a six-fold increase in health worker illness and death rates result in reduced personnel and increased stress for those remaining. The educational system is suffering due to the loss of teachers and students. The replacement of skilled professionals has become a top priority for some countries and this is particularly important since these professionals are needed to increase availability of HIV/AIDS services (UNAIDS,2001). Life expectance is dropping in some countries, to less than 4 0 years of age. More and more infants are born HIV- positive and the number of children losing one or both parents is rising; in Africa this number was 12.1 million by the end of 2000. Survival rates are affected by treatment availability. Prices of drugs are high. Brazil has demonstrated that the use of cheaper drugs is an important factor for successful response rates. Free antiretroviral drugs are guaranteed to HIV/AIDS patients in Brazil, Argentina, and Uruguay. Africa is attempting the launching of this type of program (UNAIDS, 2001) . Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 23 Current Trends in the United States Regarding current trends of the disease, by 1998, over 13 million people around the world had been infected with the HIV virus and predictions were that by the year 2000 a cumulative total would be 30-40 million (Centers For Disease Control, 1998). Moreover, the Centers for Disease Control (1998) reports that, as of December, 1997, 641,086 people in America had been reported with AIDS, and at least 385,000 of these had died. In 1998, the incidence of AIDS and related deaths in the United States dropped for the first time in 1996. This drop is attributed to the prevention efforts and to the impact of treatment advances in delaying progression of HIV infection to AIDS and from AIDS to death. The decline is substantial in that during the first two quarters of 1997 (the most recent period for which AIDS cases can be adjusted for reporting delays), the declining trend in both AIDS cases and deaths accelerated, with AIDS cases declining 15 percent and AIDS deaths declining 45 percent when compared to the first two quarters of 1996 (CDC, 1998) . However, the CDC (1998) is also quick to point out that the observed decline is not uniform across subject groups. That is, there remain several groups that are still at high risk for contraction of the HIV/AIDS virus, and which are not substantially represented in the overall decline, and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 24 certain immigrant groups are among those believed to show a continuing increase in contraction of the HIV/AIDS virus. More recent trends are now reported by the CDC (2001) regarding HIV/AIDS data. These data are based on AIDS cases in the U.S. that were reported to the CDC through June, 2001. The cumulative number of AIDS cases in 2001 was 793,026, with adult and adolescent cases totaling 784,032 with 649,186 males and 134,845 females. For children under the age of 13 years, 8,994 AIDS cases were reported. The total number of deaths for those reported with AIDS was 459,667. Of these, 452,111 were adults and adolescents and 5,168 were children under the age of 15 years. Of those for whom the age at death was unknown, 388 persons died of AIDS (CDC, 2001). (See Tables 1-6) Table 1 Cumulative Cases by Age in the U.S. Through 2001 Age # of Cumulative AIDS Cases Under 5 6, 928 Ages 5 to 12 2, 066 Ages 13 to 19 4,219 Ages 20 to 24 27,880 Ages 25 to 2 9 103,085 Ages 3 0 to 34 175,343 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 25 Table 1 continued... Ages 35 to 3 9 177,759 Ages 40 to 44 131,718 Ages 4 5 to 4 9 77,152 Ages 50 to 54 40,972 Ages 55 to 59 22,423 Ages 60 to 64 12,415 Ages 65 or older 11,065 Source: CDC (2001). Table 2 Cumulative Cases by Race/Ethnicity in the U.S. Through 2001 Race or Ethnicity # of Cumulative AIDS Cases White, not Hispanic 337,035 Black, not Hispanic 301,784 Hispanic 145,220 Asian/Pacific Islander 5, 922 American Indian/Alaska Native 2,433 Race/ethnicity unknown 632 Source: CDC (2001). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 26 Table 3 Cases by Exposure Category in the U.S. Through 2 001 Exposure Category Male Female Total Men who have sex with men 361,867 - 361,867 Injecting Drug Use 142,888 54,203 197,091 Men who have sex with men and inj ect drugs 50,066 - 50,066 Hemophilia/coagulation disorder 4, 949 285 5, 234 Heterosexual contact 30,956 54,782 85,738 Recipient of blood transfusion, blood components, or tissue 5, 031 3 , 863 8, 894 Risk not reported or identified 53,429 21,712 75,142 Source: CDC (2001). Table 4 Distribution Among Children by Exposure Categories in the U.S. Through 2001 Exposure Category # of AIDS Cases Hemophilia/coagulation Disorder 237 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 27 Table 4 continued... Mother with or at risk for HIV infection 8,207 Receipt of blood transfusion, blood components, or tissue 382 Risk not reported or identified 168 Source: CDC (2001). Table 5 Areas With Most Cases in the U.S. Through 2001 State/Territory # of Cumulative AIDS Cases New York 144,106 California 121,831 Florida 83,005 Texas 55,292 New Jersey 43,017 Illinois 25,665 Puerto Rico 25,459 Pennsylvania 25,264 Georgia 23,575 Maryland 22,432 Source: CDC (2001). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 28 Table 6 Leading Metropolitan Areas in the U.S., Through 2001 Metropolitan Area # of Cumulative AIDS Cases New York City 122,062 Los Angeles 42,796 San Francisco 28,212 Miami 24,838 Washington, DC 24,029 Chicago 22,217 Philadelphia 19,605 Houston 19,582 Newark 17,472 Atlanta 16,423 Source: CDC (2001). Current Global Trends The CDC (2001) estimates that 40 million people, worldwide, are living with HIV/AIDS today and of this group, 37.2 million are adults, 19.6 are men, 17.6 million are women, and 2.7 million are under the age of 15. Women are becoming more affected by HIV. Most of the people with HIV live in the developing world (95%). Table 7 shows UNAIDS (2001) reports of global estimates for adults and children for the end of 2001. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 29 Table 7 Global HIV/AIDS Estimates for Adults and Children, end 2001 People living with HIV/AIDS New HIV Infections Deaths due to HIV/AIDS Adults 40 million 5 million 3 million Women 37.2 million 4.3 million 2.4 million Children under 15 years 17.6 million 1.8 million 1.1 million Total 2.7 million 800,000 580,000 Source: UNAIDS (2 001). For Eastern Europe and Central Asia, AIDS is the fastest-growing epidemic. Particularly in Russia, the number of new HIV infections is increasing rapidly with an estimate of 250,000 new infections in 2001 resulting in a total of 1 million living with HIV. Since there are also high levels of other sexually transmitted infections and high amounts of injection drug use found among the young population, continued growth in the HIV/AIDS epidemic is predicted (UNAIDS, 2001). For Asia and the Pacific, 7.1 million individuals currently live with HIV/AIDS and 435,000 have died in 2001. Although national prevalence rates appear to be low for this area, there are localized epidemics and a threat of a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 30 area, there are localized epidemics and a threat of a generalized epidemic. Large-scale prevention programs in Cambodia and Thailand have resulted in lowering HIV rates in pregnant women, decreasing it by a third from 1997 to 2000 (UNAIDS, 2001) . In Sub-Saharan Africa AIDS as a crisis is increasing, killing 2.3 million in 2001. New HIV infections total 3.4 million bringing a total of 28.1 million currently living with HIV. Pregnant women exceed 3 0% of the prevalence rates in southern Africa and the HIV prevalence is epidemic in West Africa with five countries showing adult prevalence to be over 5%. Prevalence among women and young people is dropping in some areas such as Uganda (UNAIDS, 2001) . In the Middle East and North Africa, the HIV total is 440,000 and the epidemic is advancing, with particular emphasis on Djibouti, Somalia, and the Sudan. In most other countries prevalence is low but in several countries it is increasing such as in the Islamic Republic of Iran, the Libyan Arab Jamahiriya, and Pakistan. For Latin America and the Caribbean, 1.8 million live with HIV. The Caribbean is the second-most affected region in the world. While most of the South and Central American countries have low prevalence rates, there are areas with high rates. It is predicted that increased epidemics can be stopped by increasing current preventative measures (UNAIDS, 2001) . Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 31 High-income countries are experiencing a threat of a larger epidemic. In these areas, over 75,000 individuals newly acquired HIV in 2001, resulting in a total of 1.5 million people with HIV/AIDS. Current treatments and care, although reflecting recent advances, are not being associated with relative progress regarding prevention. Unsafe sex is resulting in new sexually transmitted infections and increased injection drug use is advancing the epidemic in North America, parts of Europe, and Australia. These conditions are also affecting deprived countries (UNAIDS, 2001). Table 8 shows regional HIV/AIDS statistics regarding when the epidemic started for each region, the numbers of adults and children living with HIV/AIDS that are newly affected in each region, the percent of adults and percent of women with HIV/AIDS in each region, and the main HIV/AIDS transmission for adults in each region, for the end of 2001. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 32 Table 8 Regional HIV/AIDS Statistics, Worldwide at the End of 2 001 Region Epidemic started Adult/child (living with HIV/AIDS/newly infected) % Adults/ % women Main transmission method for adults Sub- Sahran Africa late 70s early 80s 28.1 million/ 3.4 million 8.4%/ 55% Heterosexual N. Africa/ Middle East late 80s 440 000/ 80 000 0.2%/ 40% Heterosexual IDU South Sc S.E. Asia late 80s 6.1 million/ 800 000 0.6%/ 35% Heterosexual IDU E. Asia Sc Pacific late 80s 1 million/ 270 000 0 .1%/ 20% IDU, heterosexual , MSM Latin America late 70s early 80s 1.4 million/ 130 000 0 . 5%/ 30% MSM, IDU, heterosexual Caribbean late 70s early 80s 420 000/ 60 000 2.2%/ 50% heterosexual , MSM E.Europe/ Central Asia early 90s 1 million/ 250 000 0 . 5%/ 20% IDU W. Europe late 70s early 80s 560 000/ 30 000 0.3%/ 25% MSM, IDU N.America late 70s early 80s 940 000/ 45 000 0.6%/ 20% MSM, IDU, heterosexual Australia Sc New Zealand late 70s early 80s 15 000/ 500 0 .1%/ 10% MSM Total 40 million/ 5 million 1.2%/ 48% (Adults are ages 15 to 4 9 years; Hetero = heterosexual transmission; IDU = transmission through injecting drug use; MSM = sexual transmission among men who have sex with men) Source: UNAIDS (2 001). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 33 Current Trends in South Korea As to trends regarding HIV/AIDS in South Korea, Choi, Kim, Catania, Hearst and Coates (1991) were among the first to examine patterns of HIV infection in South Korea. Indeed, theirs was the first HIV seroprevalence survey of South Koreans believed to be at high risk for AIDS. From 1985-1990, a total of 4,918,006 HIV antibody tests were performed using the enzyme-linked immunosorbant assay (ELISA) by the authors. Positive results of the initial screening were confirmed based on Western Blot methods. A sample of 100 HIV-positive individuals was then interviewed about their sexual-risk behaviors. Results of the study showed that of the 136,539 tests of heterosexuals, 52 (0.038%) were HIV-positive. Among 1,308,209 blood samples from sex-industry workers, 12 (0.0009%) were positive for the HIV antibody. Two out of 600 specimens from hemophiliacs (0.33%) and 18 out of 3,472,658 specimens from blood donors (0.0005%) had positive results. An overwhelming majority of HIV-positive Koreans were men (82%) in their 20s and 30s (77%). By exposure category, 50 percent of HIV infection resulted from sexual contact when abroad, 20 percent from heterosexual contact with Korean nationals and 12 percent from heterosexual contact with foreigners inside Korea. Homosexual transmission was limited to 10 percent, while 8 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 34 percent occurred from contact with contaminated blood. It was concluded that Korean nationals returning from overseas living situations are the highest risk group, and that they pose a great threat to heterosexual transmission inside Korea. The authors recommended that both sending and receiving countries offer proper advice about AIDS prevention to prospective travelers. In more current research, the total number of reported HIV-positive cases in South Korea is now around 946. According to Korean News Services (see: AIDS News in Korea, 1999) , officials reported that 88 more people were discovered to be infected with the HIV virus in the first half of 1999; this represents an increase from 208 infected individuals first found in 1985. New agencies (AIDS News in Korea, 1999) also reported that 89 percent of those found to be HIV-positive had contracted the virus through sexual contact, 2.3 percent through blood transfusions, and the rest are transmitted by the baby from the mother, sharing of needles, or medical mishaps. A breakdown for the remaining 8.7 percent was not provided. By age, most newly infected individuals were in their 30s followed closely by those in their 20s. Individuals between 20 and 40 account for 68 percent of the total number of HIV/AIDS cases in Korea. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 35 AIDS News (2002) reported that the increase in AIDS in Korea is due to a more liberal attitude toward sex among the youth. This author noted that Korea's National Institute of Health reported that 159 Koreans became infected within the first six months of the year, which brought the total to 1,439 HIV cases of whom 30 died and 23 developed AIDS. This increase was between January and June of 1999 which was higher than the same period in 2000, which totaled 110 cases, compared to the 1999 total of 88 cases, or the 1998 total of 64 cases. Since Koreans' sexual activities have become more liberal and there is a rise in infections for homosexuals, these attitudes are considered a factor in the HIV increase. More people are being tested for HIV, and out of 1,209 HIV cases confirmed, 1,167 (97%) reported sexual transmission as the cause. Blood transfusions or blood- based medical products was the second most common route of infection. Alternatively, You and AIDS (2002), reported that the increasing use of drugs in Asia is responsible for the increase in AIDS cases. While the governments of Asian countries are attempting to decrease sexual transmission of HIV, they are lacking in the prevention of virus spreading among the population of injection drug users. A report on 22 Asian countries stated that Asia had very few HIV/AIDS prevention programs which dealt with drug using needle Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 36 exchanges; drug users share needles which are only cleaned with water rather than boiling water or bleach. Drug use is said to develop quickly along traffic routes which increases the HIV threat for the country. In some parts of Asia, injecting drug use and commercial sex work are combining to increase the spread of HIV. Drug users were responsible for 70 percent of HIV infection in 2001, compared with 66 percent in 1997. Asia Source (2002) reports that by the end of 2001, 7.1 million people, both adults and children, in the Asia Pacific region are predicted to be living with HIV/AIDS. This is estimated by the Population Reference Bureau 2000 World Population Data Sheet. Of this group, the South and Southeast Asia regions account for a total of 6.1 million. The Executive Director of UNAIDS stated that Asia contains 60 percent of the world's population and is demonstrating the most increase in infection, thus it could become the region with the most HIV infections. Research has previously focused on certain high-risk groups to include drug users, sex workers, and migrants; however, the epidemic now includes the general population with women making up around 42 percent of the world's HIV/AIDS population. Monogamous married women are just as vulnerable as sex workers to become contracted with the disease. Women in Asian countries face cultural and political restrictions and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 37 tend to have a lower rate in extramarital affairs and have sex with only with their husbands. On the other hand, men in Asian countries do not have these restrictions and this allows for increased sexual behavior outside of the marriage, which puts husbands at risk and would be easily contractible to their wives. Asia and other developing regions continue to deal with inadequate local health care systems and economic barriers against current HIV treatment availability; it is estimated that 10% of HIV/AIDS victims live in rich countries with access to modern HIV care while 90% comprise the rest of the population living in developing countries with no access to these treatments. Cultural and religious barriers also inhibit public awareness of the HIV/AIDS facts. Asian countries are reported as being among the group of countries which are fighting for acceptance of homosexuals and HIV education (Asia Source, 2002) . The Population Reference Bureau (2002) reports that the 1999 population for South Korea was 48.8 million, the percent urban was 79%, less than .5% of the population, ages 15 to 49 years, had HIV/AIDS by the end of 1999, and 77% of the married women ages 15 to 49 years used contraception. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 38 Table 9 South Korea Statistics for 1999 Population Percent Urban Percent of Pop. 15-49 with HIV/AIDS Percent of Married Women 15-49 Using Contraception 48.8 million 79 less than .5 77 Source: Population Reference Bureau (2002). Given the findings regarding those traveling abroad, and the findings regarding the age groups most likely to be at risk for contraction, it seems reasonable to wonder whether young South Koreans currently living in America (many of whom are probably college students) might be one of the groups still showing an increase in HIV/AIDS transmissions in this country. The next section of this review examines the research that has been conducted on this group as well as the general studies on HIV/AIDS and South Koreans. HIV/AIDS and South Koreans The literature on AIDS among South Koreans can be divided into two broad categories: (1) research conducted on people in South Korea; and (2) research conducted on South Koreans living in other countries. Both categories of research are examined in this section of the review. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 39 HIV/AIDS in South Korea Two indices of a country's overall risk for HIV/AIDS are the behavior and attitudes of prostitutes toward the disease. In an effort to examine these indices for South Korea, Sohn and Jin (1999) assessed the impact of AIDS- related knowledge and attitudes of prostitutes on condom use. The sample of prostitutes was drawn from diverse sex markets in South Korea. The data in Sohn and Jin's (1999) study were collected by interviewers at five different sex markets during March of 1993 for the Institute of Health Services Research. In total, 371 prostitutes visiting sexually transmitted disease (STD) clinics were interviewed. Multiple regression methods were used to identify the determinants of condom use. The level of condom use was then regressed on personal characteristics of prostitutes, AIDS- related perceptions, and market type. In the study, prostitutes' level of condom use turned out to be different across the markets featuring diverse types of services and fees. Neither perceived vulnerability nor perceived seriousness of AIDS had significant effects on condom use. Based on their findings, Sohn and Jin (1999) concluded that many AIDS-preventive educational efforts by STD clinics are ineffective, and that there is a need for these clinics to develop AIDS-preventive education programs which are Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 40 suitable for the unique circumstances of their respective sex markets. Thus, this study indicates that South Korea is not developing effective programs for one of the highest risk groups for HIV/AIDS transmission and contraction. In a similar study, Chang (1994) explored HIV/AIDS related knowledge, attitudes and safe sex behaviors among South Korean women of childbearing ages. Subjects were 751 women, all of whom were of childbearing ages. They were selected by convenient, cluster sampling. The knowledge, attitudes and preventive behaviors were measured by a self- reported questionnaire with an instrument that had been verified for psychometric soundness through pre-study conducted by the researcher. Findings observed for analyses performed on collected data were said to show high levels of knowledge related to risk factors but lower levels of knowledge about transmission modes for HIV/AIDS. It was also observed that most subjects showed avoidance towards HIV/AIDS persons and acceptance of HIV/AIDS prevention measures. The preventive behavior level observed in Chang's (1994) sample was comparatively higher than the general prevention behavior of the region from which subjects were drawn -- a region considered to have a relatively high prevalence for HIV/AIDS. It was concluded that knowledge of HIV/AIDS transmission modes needs to be better integrated Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 41 into HIV/AIDS prevention programs. Thus, this study also indicates that prevention efforts in South Korea are, at best, failing to reach optimal goals. Similar findings were reported by Chang and Hill (1996) in a study conducted a few years following the foregoing research. Once again the authors sought to assess HIV-AIDS- related knowledge, attitudes, and preventive behavior; however, the examination was narrowed to South Korean women who were pregnant. The research consisted of a cross- sectional survey using convenience sampling. Subjects were 409 women drawn from six prenatal clinics in Seoul, Korea. All study participants completed self-administered questionnaires related to HIV-AIDS-related knowledge, attitudes, and preventive behavior. Findings were said to show that subjects showed fairly high levels of knowledge about HIV and AIDS risk factors but less knowledge about transmission of the virus. Subjects also exhibited rejecting attitudes toward unrelated people with HIV/AIDS. Approximately 16 percent of sample females provided condoms for their husband's use in extramarital sex, the primary risk behavior. It was concluded that South Korean women are at risk for heterosexual transmission of HIV despite knowledge of risk factors, and that Korean education programs for women should focus on modes of heterosexual Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 42 transmission, care of individuals with HIV or AIDS, self- assessment of HIV-AIDS risk, and self protection. On the other hand, the general levels of HIV/AIDS transmission in Korea are low. In this regard, the World Health Organization (see: Poumerol, Omit, Ghee & Fee, 1998) reported that among the Pacific region in general, HIV/AIDS transmission continues at very low levels in the Philippines, Japan, Korea and most Pacific Islands. However, the organization states that at least part of this low rate is due to incomplete official reporting of HIV and AIDS. Moreover, it is known that in general, HIV/AIDS continues to increase in the Western Pacific Region. Also, adding to the notion that HIV/AIDS is increasing in South Korea are studies showing that those who contract the disease are not adapting well to it but rather engaging in at least some behaviors that pose a risk for transmission to others. For example, Chang and Kim (1996) conducted a study in which they explored the adaptation process of patients living with HIV/AIDS in South Korea. In the study, 64 HIV-infected men and women were interviewed to identify the changing adaptation process upon learning that they were HIV-positive using a single open- ended question. Data were analyzed using content analysis. According to the authors, study participants had experienced shock, wandering, abandonment, and acceptance stages. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 43 Shock Stage In general, the HIV-positive subjects had initially shown psychological isolation with seclusion if they were homosexuals. However, if they were heterosexuals, their predominant initial reactions were confusion and conflict. Most of those infected showed anger and resentment with unstable or impatient behavior. Some said they deliberately had sex without disclosing their infection. Wandering Stage & Abandonment Stage In this stage, most sample subjects used up all their money as they roamed about. They did eventually try to disclose their HIV+ status to someone in order to be released from the tension and to get some support from a peer group during the abandonment stage. They became nervous and insecure in trying to keep the balance between the disclosure and closure about their HIV+ status. Acceptance Stage Some tried to get a proper job, and better information related to the HIV treatment or health maintenance as they reached the acceptance stage. It was concluded that the most dangerous stage was the wandering stage, and recommended that all health care workers and their helpers assess the adaptation period of the HIV-infected patient for more effective care and for better prevention of transmission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 44 Rogers (1999) has discussed the adaptation process for South Koreans with HIV/AIDS within a psychospiritual context. In this regard, it is noted that although the number of persons living with AIDS in Korea is increasing, most are still ostracized and condemned by society; a consequence of this is that few programs for helping AIDS victims have been developed. According to Rogers, one of the reasons for this lack of effective support programs is that traditional religions in Korea have usually held the view that sexual sin must be punished by both people and gods. Since AIDS is often related to sexual behavior, many people believe it is the fault of AIDS victims themselves that they are sick. Rogers (1999) also notes that sin is related to shame in the Korean context. AIDS victims are shamed by society, and often, fearing such treatment, keep their disease a secret to the point of damaging their health even more. Moreover, in terms of Christianity, it is noted that churches in South Korea have also tended to blame AIDS victims for their disease based on a narrow approach to theological and biblical issues. It was recommended that religious agencies attempt to work with health care officials in HIV/AIDS programs in order to provide comfort to victims that they would not otherwise receive. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 45 The World Health Organization (1997) (WHO) has examined the sexual activity behavior of teens and young people in several countries including the Republic of Korea. Since college students tend to be of these age groups, this study is relevant to the concerns of the proposed research. Findings of the WHO studies revealed that in most South Asian countries, including South Korea, young males are at the highest risk for contraction of HIV. WHO (1997) also noted that in a survey they conducted regarding sexual behavior among university students between the ages of 15 and 23 years who were living in the Kwangju metropolitan area, around 23 percent of males and about 10 percent of females were having sexual intercourse -- this was true regardless of differences in socioeconomic and religious backgrounds. Survey responses also showed that two out of three sexually experienced males and one in three sexually experienced females claimed to have had more than one sexual partner. Four males actually reported having had more than 25 sexual partners, while the highest number of sexual partners reported by females was six. The WHO (1997) further noted that despite these numbers reported by a few individuals, the proportion of young people reporting that they had never had sexual intercourse was quite high (almost eight out of 10 males and nine out of 10 females). However, it was suggested that there may be a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 46 bias towards under-reporting because premarital sex for adolescents is considered very undesirable in the Korean social setting. In another survey conducted in the Republic of Korea, the WHO (1997) surveyed 1039 male students and 1103 male industrial workers to determine the frequency of sexually active behavior. Demographically, it was determined that, overall, the students were younger than the industrial workers. The average age of the industrial workers was 25.3 years and 53 percent were between the ages of 25 and 29 years while the average age of the students was 22.1 years and 60 percent were between the ages of 2 0 and 24 years. Seven out of 10 industrial workers had completed their military service, compared with four out of 10 students. The study found that the industrial workers were more sexually active than the students, with 78 percent of the former reporting sexual experience compared with 3 6 percent of the later -- WHO noted that a study of college students throughout the country in 1977 also found a rate of 3 6 percent for sexual experience among college students. The age of first sexual intercourse in the recent study was 2 0 years for industrial workers and 21 for students. Those who had served in the army and those who lived independently of their parents showed higher rates of sexual experience than the others. In general, it can be noted Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 47 that the studies conducted by the World Health Organization indicate that South Korean college students are sexually active and may, therefore, be at risk for contraction of HIV/AIDS. HIV/AIDS among South Koreans Living in Other Countries There has not been much research examining HIV/AIDS for South Koreans living in other countries in general or America in particular. However, Nakajima and Rubin (1992) attempted to analyze demographic data concerning AIDS among Asian and Pacific Islanders (A&PIs) living in New York City. Data in the study were obtained from the CDC AIDS Surveillance forms compiled by the NYC Department of Health. Results showed that as of June, 1991, there were 219 NYC adult AIDS cases in the A&PI communities, making New York City the city with largest number of A&PI cases reported. It was, however, noted that the incidence of AIDS is significantly lower in A&PIs compared to other racial groups. However, it was still noted that since 1988, AIDS has been growing at a more rapid rate among A&PIs (158%) compared to whites (86%) , African Americans (135%) and Hispanics (136%). Diagnosis of AIDS is highest for gay and bisexual A&PIs (55%) , followed by African Americans (52%), whites (49%), and Hispanics (48%). It was also noted that Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 48 20 percent of A&PI AIDS cases in NYC are among those U.S. born. According to Nakajima and Rubin (1992) the largest number of A&PI AIDS cases were among those born outside the US: from China, 35; Philippines, 34; Japan, 11; India, 10; Thailand, 9; and Korea, 7. It was concluded that AIDS prevention education may not be reaching A&PIs, causing a disproportionate increase in the number of AIDS cases. Denial about AIDS and the lack of knowledge about early intervention among A&PIs were also said to account for their higher rate of PCP. Although indirect, a study conducted by Choi, Catania, Coates and Hearst (1992) has implications for the risk of HIV/AIDS for South Korean groups in America. The authors examined the HIV/AIDS risk among Korean men in Korea applying for international travel, hoping to suggest a strategy for AIDS prevention for this group. Methods used in the study involved a self-administered survey of Korean men planning international travel to determine knowledge, attitudes, and behaviors related to AIDS. A total of 571 men (89% response rate) completed survey questionnaires at the beginning of a three-hour workshop required of prospective travelers before the receipt of passports. The sample consisted mostly of individuals in their 20s (44%) and 30s (27%). Approximately 45 percent of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 49 these men had never been married. Further, 4 5 percent were college graduates. The main purpose of travel was business (39%) , pleasure (33%), study (14%), or family visit (11%) . The most popular destinations of travel were Japan (35%) , the United States (28%), Southeast Asia (22%), and Europe (13%) . Findings of the study indicated that most South Korean men planning international travel were aware of sexual (97%) , needle (96%), and perinatal transmission (91%) of HIV but many still were confused about HIV transmission through casual contact. In general, the sample believed that AIDS is transmitted by sharing silverware with someone with HIV (66%) , working near someone with HIV (55%) , and mosquitoes or other insects (39%). Most people believed they had little or no risk (97%) for HIV infection and did not worry about getting infected with HIV when abroad (83%). In the past 5 years, 81 percent of the sample had been sexually active (mean number of sex partners = 6). Among the sexually active, 59 percent reported having sex with their spouse; 48 percent with girlfriends; 24 percent with female prostitutes; and 8 percent with male casual partners. Among the married men, 46 percent reported having extramarital relations in the same five-year period. In the past year, 73 percent were sexually active (mean number of sexual partners = 2). Of those sexually active, only 15 percent always used condoms; and 78 percent reported alcohol Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 50 use during sexual intercourse. Among men with multiple sex partners in the past year, only 17 percent were consistent condom users; and 96 percent perceived little or no risk of HIV infection. Based on findings, Choi, Catania, Coates and Hearst (1992) concluded that: A majority of Korean men planning international travel seemed misinformed about AIDS, perceived low AIDS risk, and engaged in high risk sexual behavior. Future interventions should enhance knowledge of HIV transmission routes, perception of AIDS risk, and safer sexual behavior (p. C347). Chou, Chin and Rodriquez (1998) provided additional information regarding AIDS knowledge in U.S.-born South Koreans and immigrants. In order to measure the effect of HIV 101 workshops on HIV knowledge, condom use self- efficacy, as well as intention to practice safer sex among immigrant and U.S.-born Asians in New York City, the authors conducted a quasi-experimental, pretest-posttest design. Subjects in the study consisted of Chinese, Filipino, Indian, Korean, and Japanese workshop 101 participants. Outreach staff at the clinic where the workshops were conducted used a purpose sampling strategy to recruit subjects during street outreach to participate in the HIV 101 workshop. A total of 235 people agreed to participate in the workshop sessions which were conducted in 1996. Training used a standardized HIV prevention curriculum that was specifically designed for Asians. In this regard, the curriculum was developed by the Asian and Pacific Islander Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 51 Coalition on HIV/AIDS (APICHA), the largest Asian community- based AIDS organization on the East Coast of the United States. All participants were given a pretest questionnaire that contained questions on HIV/AIDS knowledge, condom use self-efficacy, intention to practice safer sex, and demographic background. Immediately after the workshop, a posttest questionnaire was given to participants. A total of 205 Asians completed both the pretest and posttest questionnaires. These were divided into two groups: U.S.- born South Asians and non-U.S.-born South Asians. Findings of the study revealed that U.S.-born Asians had both higher HIV/AIDS knowledge and condom use self- efficacy baseline scores than did immigrant Asians. Paired t-test and Chi-square analyses were used to compare pre- and post-training scores of immigrant and U.S.-born South Asians. Data revealed that, after training, both groups significantly increased their HIV/AIDS knowledge and their intention to practice safer sex (p < 0.001). However, condom use self-efficacy increased significantly only in the immigrant group. What Chou et. al's (1998) study shows is that once again, there may be a problem regarding safe sex practices among non U.S.-born Asian groups including Chinese, Filipino, Indian, Korean, and Japanese. The foregoing studies provide at least some support for the notion that South Korean college students' studying in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 52 America may be at high risk for the contraction and/or transmission of HIV/AIDS and may lack adequate AIDS education. The proposed research will test this possibility. If the conducted study does show that these students are at higher risk, this would indicate a need for steps to be taken to develop effective prevention programs for them. In this regard, a study by Janz (1996) may provide some direction. Janz conducted a meta-analysis of the effects of over 37 AIDS prevention and service projects, most of which were geared toward young adults. All of the examined studies targeted efforts at persons whose behaviors and other life experiences placed them at risk for HIV infection. Interestingly, Janz (1996) concluded that no single HIV prevention strategy will universally lead to reductions in high-risk sexual and drug-use behavior. However, it was determined that most of the programs that scored positive results had certain common characteristics. These characteristics can be summarized as follows: 1. Successful prevention programs had culturally relevant and language appropriate interventions. These projects paid attention to the norms, values and traditions of the target population. This is a particularly important component as it relates to the development of an HIV/AIDS prevention program for college students from South Korea who Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 53 are studying in America. Care will have to be taken to make sure that any developed program is sensitive to the cultural values and norms of this group. 2. Successful prevention programs embedded AIDS information into broader contexts; in most cases, project staff reported increased success when AIDS education was blended with other issues. For example, some programs discussed HIV/AIDS within the broader category of health. 3. Successful prevention programs provided creative rewards and enticements, which were said to be important for recruiting and retaining participants. 4. Successful prevention programs built in opportunities for program flexibility; this was achieved in a number of ways, including varying the intervention's content, format, schedule, process and delivery systems. 5. Successful prevention programs promoted integration into and acceptance by the community; community integration helped publicize efforts, enhance recruitment, aid credibility and bolster success. 6. Successful prevention programs consistently repeated essential HIV prevention messages. 7. Successful prevention programs created a forum for open discussions which was said to give participants increased control over the intervention. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 54 8. Successful prevention programs solicited participant involvement, having participants engage in a variety of activities including working on planning and advisory boards, serving as peer educators, assisting with recruitment and completing evaluations. Summary and Conclusions The review of literature presented here examined the nature of AIDS, current trends in both the United States and South Korea regarding HIV/AIDS cases, and studies of HIV/AIDS among South Koreans living in both their country of origin and in the United States, which may reflect their AIDS knowledge and education. Based on the reviewed literature, the following conclusions can be formulated: 1. It can be concluded that in the United States, the epidemic is showing signs of slowing but this general decline is not uniform among all groups. Indications are that immigrants in general and South Koreans in particular who are living in the United States may be at greater risk than the norm for contraction and transmission of the disease. 2. Regarding studies that have been conducted on South Koreans, it can be concluded that studies have shown that while the overall number of infected individuals is relatively low, it is increasing. There are clear Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 55 indications that HIV/AIDS education prevention programs in South Korea may not be working at optimal efficiency. Further, there are indications that South Koreans living in other countries may be at significant risk for contraction of the HIV virus. 3. It may also be concluded that in the United States, Asians from the Western Pacific may be at a high risk for contraction of the HIV virus due to misconceptions about the disease and to their lowered access to health care services. Interestingly, studies conducted on Korean samples indicated that this group may not be low on AIDS knowledge; however, there are indications that there are misconceptions about how HIV/AIDS is transmitted and that it is these misconceptions that may be contributing to a higher level of risk for this group. If these misconceptions are prevalent among South Korean college students studying in the United States, then it can be expected that they also will be at higher risk for HIV/AIDS. The foregoing conclusions suggest that existing research regarding South Korean AIDS education is lacking. South Korean college students studying in America appear to lack adequate AIDS knowledge and may be at high risk for the contraction and transmission of HIV/AIDS. If this study should observe findings that support this notion, implications will be that AIDS education in South Korean Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 56 needs to be improved, with possible increases in formal school classroom education, nonformal school education such as with educational booklets and guest speakers, and informal education (in and out of school) such as peer group discussions and relevant videos or movies. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 57 CHAPTER III METHODS Restatement of the Research Problem This study examined whether knowledge regarding HIV/AIDS knowledge and safe sex knowledge are the same or different for three groups of students: (1) South Korean- born college students currently taking courses in Korea; (2) South Korean-born college students currently taking courses in the U.S. and (3) U.S.-born South Korean college students currently taking courses in the U.S. Further, the study examined any observed differences between the three groups related to AIDS education. Design Variables The study's independent variables are Country of Birth with two levels: South Korean-born or U.S.-born Korean Americans and current place of study: U.S. or Korea. There was a control for the time spent in the U.S. as well as Korea. The study has three dependent variables: HIV/AIDS knowledge, safe sex knowledge, and AIDS education. Research Approach The proposed research is descriptive in nature. According to Best (1991) , descriptive research can be Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 58 distinguished from other forms of research based on the following five characteristics: 1. Descriptive studies are nonexperimental in that they deal with the relationships between nonmanipulated variables in a natural rather than artificial lab setting. Since the events or conditions have already occurred, the researcher selects the relevant variables for an analysis of their relationships. In this study, the independent variable, Country of Birth, has already occurred. 2. Descriptive studies involve hypothesis formulation and testing. This study tests three hypotheses predicting significant differences in HIV/AIDS knowledge, safe sex knowledge, and HIV/AIDS education between the three student groups. 3. Descriptive studies use logical methods of inductive-deductive reasoning to arrive at generalizations. An attempt will be made to generalize the findings of the study to South Korean college students studying in the U.S. and Korea. 4. Descriptive studies employ methods of randomization so that errors can be estimated when inferring population characteristics from observations conducted on samples. 5. All of the variables and procedures used in descriptive research are described as accurately and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 59 completely as possible so that the study can be replicated by other researchers. Subject Selection Methods A list was developed of the names of all South Korean students currently studying in several major California Universities, to include UCLA (University of California, Los Angeles, USC (University of Southern California), CSUN (Cal State University, Northridge and CSLB (Cal State Long Beach). A list was developed of U.S.-born Korean American college students from the same schools' directories. Further a list was also developed of Korean-born students studying in several major universities in Korea such as Yonsei Universtiy, Seoul University, Koryo University, and Hanyang University by, also using school directories as well. This study utilized a sample which represented large urbanized universities in Southern California and Korea. The sample is urbanized because Southern California is a populated place where many people from around the country migrate and attend school. The same idea applies for the universities in Seoul, Korea. This is true because all the top schools are located in the capital of Korea. A random numbers table was then used to select 100 students from each list, 50 of whom were females and 50 of whom were males. Thus, the initial sample size consisted of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 60 300 students (150 males and 150 females). All of these students in the U.S. were mailed a copy of the instrumentation packet assessing their HIV/AIDS knowledge and safe sex knowledge and their HIV/AIDS education. Those returning their completed instrumentation packet constituted the final subject sample. The same procedure was applied to South Korean students studying in Korea and the research was conducted in Korea. Instrumentation An education information questionnaire and a questionnaire to measure sexual risk knowledge and AIDS knowledge were used in this study. Each of these instruments is discussed here. AIDS Education Information Questionnaire The AIDS Education Questionnaire was developed by the investigator and asked students to provide information regarding their education with regard to formal, nonformal, and informal types of education. A Likert-type scale was used for this instrument to yield scores for 25 questions, which were summed and divided by 25, to yield a total score for statistical comparison (see Appendix 4). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 61 Asian and Pacific Islander Coalition on HIV/AIDS (APICHA) The test instrument used to measure HIV/AIDS Knowledge and Sexual Risk was the APICHA, by Chou, Chin and Rodriquez (1998) that was specifically developed for their HIV/AIDS studies conducted using Asian populations. Permission was 6given to utilize these questions from this survey regarding AIDS Information Knowledge and Sexual Risk Knowledge and data gathered were used to assess these variables for this study. This instrument was chosen since it was the only appropriate survey found which was relevant to the present study and it had been utilized by he Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), which is the largest Asian community-based AIDS organization on the East Coast of the United States. Although validity was not reported, the APICHA questionnaire includes questions on HIV/AIDS knowledge, condom use self-efficacy, intention to practice safer sex, and demographic background. Numbers of correct answers were compared for each group. Since both test instruments lacked validity information, they were pre-tested with a small group of Korean students (the Korean version) at a USC meeting for KISA (Korean International Student Association). The English versions were pre-tested with a small group at KSA (Korean Student Association). This pre-testing allowed the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 62 researcher to determine if answers appeared to be related to the questions, demonstrating face/content validity. Interview Protocol A more detailed interview protocol was developed by the investigator. This protocol was designed to provide deeper detail and richer context for discussing the findings of this study. McBurney (1994) states that the face-to-face interview has the advantage of allowing for the establishment of a rapport with those being interviewed. Attention can be directed to certain material and motivation can be provided to assist the respondents in participating. This modality allows for the researcher to obtain more complete answers. The interview included the use of open and closed-end questions. The interview questions were pre-tested; the Korean questionnaires were pre-tested at the KISA (Korea International Student Association) and the English questionnaires were pre-tested at the KSA (Korean Student Association), both at the University of Southern California. The questions from the AIDS Education Information Questionnaire were asked during individual interviews, to allow for more complete answers to be made. This was followed by an informal discussion regarding the topic. Five females and five males from each of the three groups Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 63 were randomly selected from those returning their interview cards, until a total of 25 participants were involved in the interviews. These subjects were contacted regarding their participation in the interview session. The group and one- on-one interviews therefore included both males and females. Koreans answered in Korean. During the informal interview session, questions such as: 1. How do you feel about HIV/AIDS in general? 2. Do you know anyone who has the disease? 3. Do you know anyone who is taking care of a relative or friend with AIDS? 4. Do you use condoms to avoid catching the disease? 5. Are you comfortable talking about HIV/AIDS? 6. Do you worry about getting HIV/AIDS? 7. Do you know all of the ways it can be transmitted? 8. Did you know that the disease has reached epidemic proportions, worldwide? 9. How do you think all of those people ended up with HIV/AIDS? The comments from the interview were recorded in written form and by tape recorder by the researcher. Data Gathering Procedures All students in the study were mailed an instrumentation packet containing the study's test instruments, an education information questionnaire, a cover Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 64 letter briefly explaining the nature of the study (Appendix 6) , an insert asking for volunteers to do an interview (Appendix 7), and a stamped and addressed manila folder in which to return copies of their completed instruments to the investigator. Once the first mailing went out to students, the investigator waited two weeks for students to return their completed questionnaires in the provided self- addressed, stamped envelope. Those students who did not return their completed questionnaires were sent a second mailing. This second mailing re-emphasized the importance of the study and the need for students to return data. After another two weeks, those students who still had not returned their completed instruments were contacted by telephone. During this telephone contact, the investigator stressed how important it is for students to provide data and attempted to get each student to agree to fill out the forms. When the students agreed, a new mailing was sent to him or her. The reason for these persistent attempts to get students to complete their questionnaires was to make sure that at least 60 percent of those receiving the mailing return their completed instruments. This is important because, according to Kiess and Bloomquist (1985), at least a 60 percent return rate is needed if a sample is to be representative of the population to whom a questionnaire is mailed. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 65 Additionally, a sub-sample of n=25, consisting of five males and five females from each of the three groups was randomly selected from those returning their interview cards. These subjects were contacted regarding their participation in a more detailed interview session. The session took about 45 to 60 minutes to complete. All students from the main sample were included as possible members of this sub-sample. These subjects were separated by gender and group and given random numbers. Students were contacted randomly until the total number of 25 interview participants was reached. The subjects were interviewed one-by-one and in group format. Interviews were held in comfortable settings around the campus. Questions from the AIDS Education Information Questionnaire and additional questions related to the topic were asked. The study's test instruments were translated into the Korean language and an English and a Korean version of each instrument were mailed in the instrumentation packet, leaving students to decide whether to complete the instruments in English or in Korean. In this way, it was possible to eliminate difficulty reading English as a contributor to response variance on the study's dependent measures. The U.S. students responded in English, the Korean students in the U.S. responded in Korean, and 18 Koreans in Korea responded in both languages. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 66 Data Analysis Plan Both descriptive and inferential analyses were conducted on collected data. The methods and procedures involved in each type of the proposed analyses are described and discussed below. Descriptive Analyses Descriptive analyses consisted of the computation of measures of central tendency, as well as weighted distribution or proportional frequency of occurrence and percentages observed for the sample population and the groups regarding AIDS Information, Sexual Risks, and AIDS Education. These measures were calculated for three groups: (1) Korean-born South Korean college students studying in Korea (2) Korean-born South Korean college students studying in the U.S.; and (3) U.S.-born Korean American college students studying in the U.S. The descriptive information is also presented in Table 10. Inferential Analyses The study's hypotheses were analyzed using the one-way ANOVA for three independent samples. Specifically, each dependent measure (HIV/AIDS Knowledge, Sexual Risk Knowledge, and HIV/AIDS Education) was compared between the three groups. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 67 The one-way ANOVA scale on which the dependent variable is measured has: the properties of an equal interval scale; the measures within each of the groups are independent of each other (the independent-samples ANOVA also assumes the measures are independent or non-correlated across the groups); the source populations from which the samples of measures are drawn can be reasonably supposed to have a normal distribution; and the groups of measures have approximately equal variances. A Post Hoc analysis was used to further describe the differences between groups. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 68 CHAPTER IV Results This chapter describes the research findings of the study as follows: the general description of the sample and groups followed by the results of the data relating to the research hypotheses, to include statistical analysis of data and qualitative analysis of interviews. Description of the Sample Descriptive statistical analysis of the sample included a frequency distribution regarding gender. The sample consisted of 289 participants. All participants were required to meet specific research criteria, specifically, they were students who were either U.S.-born Korean American or Korean-born and were studying in either the U.S. or South Korea. Participant Gender Information The majority of the participants in this study reported their gender to be female (n = 159; 55 percent); males were 130 in number (45 percent). For this table, 1.00 represents males and 2.00 represents females, for the statistical analysis. The number 100.00 under cumulative percent represents the total percent that is cumulated, 100% (Table 10) . Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 69 Table 10 Sample Gender Frequency GENDER Frequency Percent Valid Percent Cumulative Percent Valid 1.00 130 45.0 45.0 45.0 2.00 159 55.0 55.0 100.0 Total 289 100.0 100.0 Description of the Groups Descriptive statistical analysis of the groups included a frequency distribution regarding gender and the mean score for each variable, AIDS knowledge, Sexual Risk, and AIDS Education. When reported in text, means are rounded off to the nearest hundred. The frequency findings show the number and percent of males and females for each group. The mean scores for each variable show the average score for each variable, which are later compared with each other (ANOVA) to test the hypotheses. Group 1 Findings from Group 1 (Korean-born, Korean-study) demonstrated that there were 45 males (45.9 percent) and 53 females (54.1 percent) totaling 98 participants (Table 11). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 70 Table 11 Group 1 Gender Frequency Table GENDER GENDER Frequency Percent Valid Percent Cumulative Percent Valid 1.00 45 45.9 45.9 45.9 2.00 53 54.1 54.1 100.0 Total 98 100.0 100.0 The mean score for AIDS Education was 3.5, which means that the average score was 3.5 out of a minimum score of 1 and a maximum score of 7. The mean score for Sexual Risk was 3.6, which means that the average score was 3.6 out of a minimum score of 1 and a maximum score of 8. The mean score for AIDS Knowledge was 3.8, which means that the average score was 3.8 out of a minimum score of 1 and a maximum score of 7 (Table 12). Table 12 Descriptive Statistics for Group 1 Descriptive Statistics N Minimum Maximum Mean EDUC 98 1.00 7.00 3.5000 RISK 98 1.00 8.00 3.6020 KNOW 98 1.00 7.00 3.7653 Valid N (listwise) 98 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Group 2. Findings from Group 2 (Korean-born, U.S.- study) demonstrated that there were 40 males (42.1 percent) and 55 females (57.9 percent) totaling 95 participants (Table 13) . Table 13 Group 2 Gender Frequency Table GENDER Frequency Percent Valid Percent Cumulative Percent Valid 1.00 40 42.1 42.1 42.1 2.00 55 57.9 57.9 100.0 Total 95 100.0 100.0 The mean score for AIDS Education was 4.15, which means that the average score was 4.15 out of a minimum score of 0 and a maximum score of 7. The mean score for Sexual Risk was 4.12, which means that the average score was 4.12 out of a minimum score of 0 and a maximum score of 8. The mean score for AIDS Knowledge was 4.28, which means that the average score was 4.28 out of a minimum score of 1 and a maximum score of 8 (Table 14). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 72 Table 14 Descriptive Statistics for Group 2 Descriptive Statistics N Minimum Maximum Mean EDUC 95 .00 7.00 4.1474 RISK 95 .00 8.00 4.1158 KNOW 95 1.00 8.00 4.2842 Valid N (listwise) 95 Group 3. Findings from Group 3 (US-born, US-study) demonstrated that there were 45 males (45.9 percent) and 51 females (53.1 percent) totaling 96 participants (Table 15). Table 15 Group 3 Gender Frequency Table GENDER Frequency Percent Valid Percent Cumulative Percent Valid 1.00 45 46.9 46.9 46.9 2.00 51 53.1 53.1 100.0 Total 96 100.0 100.0 The mean score for AIDS Education was 4.66, which means that the average score was 4.66 out of a minimum score of 1 and a maximum score of 8. The mean score for Sexual Risk was 4.38, which means that the average score was 4.3 8 out of a minimum score of 1 and a maximum score of 8. The mean score for AIDS Knowledge was 4.44, which means that the average score was 4.44 out of a minimum score of 2 and a maximum score of 8 (Table 16). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 73 Table 16 Descriptive Statistics for Group 3 Descriptive Statistics N Minimum Maximum Mean EDUC 96 1.00 8.00 4.6562 RISK 96 1.00 8.00 4.3750 KNOW 96 2.00 8.00 4.4375 Valid N (listwise) 96 Tables 12, 14, and 16 are combined to show a summary of the means for the differ groups with regard to the variables (Table 17). Table 17 Means of the Groups for Each Variable Group 1 Group 2 Group 3 EDUC 3 . 5 4 .15 4 . 66 RISK 3.6 4 .12 4.38 KNOW 3 . 8 4 .28 4 .44 Findings Regarding Hypotheses Hypothesis 1 The hypotheses stated the following: South Korean-born college students currently studying in Korea will score significantly different from South Korean-born and U.S.-born Korean American students studying in the U.S. on AIDS Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 74 Knowledge. The ANOVA compared the means of Groups 1, 2, and 3 for the variable AIDS Knowledge. ANOVA findings demonstrated significant results with a df of 2 and 286. For AIDS Knowledge F = 3.9, significant at p = .02. This demonstrated that there was a significant difference between South Korean-born college students currently studying in Korea and South Korean-born and U.S.-born Korean American students studying in the U.S. with regard to AIDS Knowledge (Table 18). Hypothesis 2 The hypotheses stated the following: South Korean-born college students currently studying in Korea will score significantly different from South Korean-born and U.S.-born Korean American students studying in the U.S. on Sexual Risks. The ANOVA compared the means of Groups 1, 2, and 3 for the variable Sexual Risk. ANOVA findings demonstrated significant results with a df of 2 and 286. For Sexual Risk F = 3.8, significant at p = .02. This demonstrated that there was a significant difference between South Korean-born college students currently studying in Korea and South Korean-born and U.S.-born Korean American students studying in the U.S. with regard to Sexual Risk (Table 18). Hypothesis 3 The hypotheses stated the following: South Korean-born college students currently studying in Korea will score significantly different from South Korean-born and U.S.-born Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Korean American students studying in the U.S. on AIDS Education. The ANOVA compared the means of Groups 1, 2, and 3 for the variable AIDS Education. ANOVA findings demonstrated significant results with a df of 2 and 286. For AIDS Education F = 11.07, significant at p < .01. This demonstrated that there was a significant difference between South Korean-born college students currently studying in Korea and South Korean-born and U.S.-born Korean American students studying in the U.S. with regard to AIDS Education (Table 18). Table 18 ANOVA Findings ANOVA Sum of Squares df Mean Square F Siq. RISK Between Groups 30.073 2 15.036 3.820 .023 Within Groups 1125.706 286 3.936 Total 1155.779 288 KNOW Between Groups 24.125 2 12.062 3.909 .021 Within Groups 882.553 286 3.086 Total 906.678 288 EDUC Between Groups 65.194 2 32.597 11.071 .000 Within Groups 842.093 286 2.944 Total 907.287 288 Post Hoc Analysis Post Hoc Tests of multiple comparisons revealed findings regarding the significant differences found between Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 76 groups. An alpha level of p = .05 is required for findings to be considered statistically significant. "P" stands for the probability of occurrence, thus if p = .05, the probability is that findings are 5% due to chance and 95% due to being real. Therefore any findings at a p < or = to .05 are significant and any findings that are at a p > .05 are not significant. Table 19 lists the mean differences and standard errors for each of the group comparisons and whether these differences were significant or not (indicated by *). Table 19 also shows the p value which corresponds to the significance level, for comparisons between the different groups. For AIDS Education, significant differences were found between Groups 1 and 2 at p = .03, and Groups 1 and 3 at p < .01, and differences were not significant between groups 2 and 3 at p = .124. For Sexual Risk, significant differences were found between Groups 1 and 3 at p = .03, and differences were not significant between groups 1 and 2 at p = .20 and Groups 2 and 3 at p = .666. For AIDS Knowledge, significant differences were found between Groups 1 and 3 at p = .03, and differences were not significant between groups 1 and 2 at p = .13 and Groups 2 and 3 at p = .834 (Table 19). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 77 Table 19 Multiple Comparisons of Group Differences Multiple Comparisons Scheffe Dependent Variable (1 ) GROUP (J) GROUP Mean Difference (l-J) Std. Error Sig. RISK 1.00 2.00 -.5137 .2856 .200 3.00 -.7730* .2849 .026 2.00 1.00 .5137 .2856 .200 3.00 -.2592 .2871 .666 3.00 1.00 .7730* .2849 .026 2.00 .2592 .2871 .666 KNOW 1.00 2.00 -.5189 .2529 .124 3.00 -.6722* .2523 .030 2.00 1.00 .5189 .2529 .124 3.00 -.1533 .2542 .834 3.00 1.00 .6722* .2523 .030 2.00 .1533 .2542 .834 EDUC 1.00 2.00 -.6474* .2471 .034 3.00 -1.1563* .2464 .000 2.00 1.00 .6474* .2471 .034 3.00 -.5089 .2483 .124 3.00 1.00 1.1563* .2464 .000 2.00 .5089 .2483 .124 * ■ The mean difference is significant at the .05 level. Findings Regarding Interviews A detailed interview was designed by the investigator to provide deeper detail regarding the test instruments. Interview findings with participants are listed below. Group 1: Korean-born Korean Students Studying in South Korea i 1 - ! i i i M i i —r i i i i HIV/AIDS Knowledge. The following represent the content in the majority of statements regarding HIV/AIDS Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 78 knowledge for this group: "I know that condoms are important." "I'm not sure of all the ways that HIV/AIDS can be transmitted." Sexual Risks. The following represent the content in the majority of statements regarding sexual risk knowledge for this group: "I know that you can get it from sex and condoms protect you." "I'm not sure about kissing someone with AIDS." "I'm not comfortable to talk about it." HIV/AIDS Education. HIV/AIDS education is broken down into formal, nonformal, and informal methods. The following represent the content in the majority of statements regarding formal HIV/AIDS education for this group: "I received most of my formal education in high school classes, and some in junior high." "I learned some facts in college, but most in high school." (Learned through text materials, but not studied in depth.) The following represent the content in the majority of statements regarding nonformal HIV/AIDS education for this group: "There were a lot of pamphlets handed out in school." "I learned from presentations in school." The following represent the content in the majority of statements regarding informal HIV/AIDS education for this group: "I received most of my information from my friends." "I have seen some information on the internet." Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 79 Informal Interview Comments. Informal discussion by individual group members revealed several comments such as the following: "I don't feel that comfortable talking about AIDS, neither do my friends." "I sure wouldn't want to know anyone with AIDS, I'd be afraid of catching it." "I would be afraid of catching it from being around someone with AIDS, even without sex." "I never think about it, no one does, no one I know about thinks about it." "It doesn't really affect my sex habits, I guess I'm like everyone else, I never think it will happen to me." "I don't talk about it much to anyone, not my parents that's for sure." "No, I never talk about it to my sex partner, I don't think of it. " "I've thought about it because of the pamphlets, but I don't know anyone who has it or worries about it." "I know I should use condoms but I don't, maybe I will now, I should." "I use condoms, but more for pregnancy than AIDS, I know that's wrong." "My friends and I talk about it sometimes, mostly if we hear about it from school." Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. "I'm not sure of all of the ways you can get it, besides sexual contact." "I didn't know that it was an epidemic or anything, I thought it was just a bad disease." "It's scary to find out how many people have it, or that normal people have it." Group 2: Korean-born Korean Students Studying in the U.S. HIV/AIDS Knowledge. The following represent the content in the majority of statements regarding HIV/AIDS knowledge for this group: "Condoms are the most important thing." "I don't know anyone with AIDS, I don't like to talk about it with someone I am about to have sex with but I don't mind talking about it with friends." Sexual Risks. The following represent the content in the majority of statements regarding sexual risk knowledge for this group: "I know more about it, anyone can get it, but I'm not sure about kissing." "I practice safe sex." HIV/AIDS Education. HIV/AIDS education is broken down into formal, nonformal, and informal methods. The following represent the content in the majority of statements regarding formal HIV/AIDS education for this group: "I received most of my formal education in high Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 81 school." "I learned more on the subject in college but from informal sources like pamphlets." The following represent the content in the majority of statements regarding nonformal HIV/AIDS education for this group: "I got most of my nonformal education from pamphlets handed out in school." "I learned a lot from guest speakers in Junior High and courses in high school and pamphlets." "Lately I hear more people talking about it, worrying about getting it with sex." The following represent the content in the majority of statements regarding informal HIV/AIDS education for this group: "I learned things from my friends." "I received most of my information from my friends and siblings." "In America it is everywhere, TV, movies, everyone talks about it, it is much more open here." Informal Interview Comments. Informal discussion by group members revealed several comments such as the following: "I don't like to talk about AIDS, neither does anyone I know." "I don't know anyone with AIDS, I wouldn't want to be near them." "I would not want to be around someone with AIDS, I might catch it." "I think about it sometimes, but not much, no one talks about it much." Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 82 "It doesn't affect my sexual behaviors, I don't do anything about it." "Since I've been in America, it's different, not like everyone talks about all the time, but it does come up more and when it does, it's no big deal to talk about it." "I don't usually talk about it with my sex partner, maybe I will." "I've thought about it, everyone thinks about it, but then I forget about it." "I don't use condoms, everyone is young and I don't think they have AIDS." "I want to know more about it, things are different here, the U.S. is more open about it." "It's everywhere on the TV, I'm learning a lot, it's a terrible disease." "I did not know that it was an epidemic, so many people have it." "It's scary to find out that so many normal people have it, babies too." Group 3: U.S.-born Korean American Students Studying in the U.S. HIV/AIDS Knowledge. The following represent the content in the majority of statements regarding HIV/AIDS knowledge for this group: "I know that it is transmitted through sex, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 83 needles, and blood." "I know that anyone can get it and it's not just about needles, safe sex is important." Sexual Risks. The following represent the content in the majority of statements regarding sexual risk knowledge for this group: "Safe sex is important unless it is your spouse or something." "It's everywhere, everyone talks about it, I don't use a condom always but I know I should." HIV/AIDS Education. HIV/AIDS education is broken down into formal, nonformal, and informal methods. The following represent the content in the majority of statements regarding formal HIV/AIDS education for this group: "I received most of my formal education in high school, but AIDS education began in junior high." "By college the topic was not taught unless it was part of your major." "I learned the facts from course material in high school, but I learned more facts from the TV." The following represent the content in the majority of statements regarding nonformal HIV/AIDS education for this group: "I was probably in junior high before I started paying attention to information about AIDS, but for sure by high school." "I got most of my nonformal education from pamphlets handed out in school." The following represent the content in the majority of statements regarding informal HIV/AIDS education for this Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 84 group: "I can't remember a time when I wasn't aware of AIDS, it's all over the place, the news, the magazines, the TV, the movies." "I received most of my information from my friends and the TV shows and magazines." Informal Interview Comments. Informal discussion by group members revealed several comments such as the following: "It's on TV a lot, everyone knows about it, but no one my age that I know has it." "I feel sorry for the people that have AIDS, but I still wouldn't want to be around them." "I wouldn't want to have to take care of someone with AIDS, are they sure of all the ways of catching it?" "Sure, I've thought about it, hasn't everyone, they teach it in school, it's on the TV, you can't avoid it." "It doesn't make me use condoms, I don't think my friends have it." "I've talked about it to my friends, it's not a big deal at all to talk about it." "I don't discuss it with my sex partner, I don't want to I guess." "I've thought about it, I know about it, but I don't worry about it or getting it." "I use condoms, but I don't do it to be safe from AIDS, I do it to be safe from pregnancy." Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 85 "My friends and I have talked about it, we talk it over if we see a TV show or something." "No, I'm don't know all of the ways you can get it, I only know about sex and drug needles and transfusions, is there more?" "I had no idea that it was a world wide epidemic, affecting so many people." "How can it be so bad all over, it seems like they must be exaggerating." "I didn't ever think about it happening to a normal person, I thought it was due to drugs or bad sex habits." "I see it on TV, that it can happen to anyone, but still you think it must be due to a blood transmission or something." "If it can happen to so many people, how is this possible, is it from not using condoms?" "Are the other countries worse than the U.S., maybe it is due to poverty or something." "I can't help it, I just think clean living is the answer, except for babies, they can't help catching it." "I know it's due to needles and bad sex habits, or bad blood transferred, it can't affect everyone if you stay away from these things." Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 86 CHAPTER V Summary, Discussion, Conclusion This section presents a summary of research objectives and hypotheses and findings related to each. The discussion explains the significance of the findings and their relevance to previous research as well as study limitations. The conclusion addresses implications of the results and recommendations for future studies. Summary Research Objective The general research objective was to identify and target certain groups at higher risk for HIV/AIDS by examining whether foreign students from South Korea currently studying in the United States may be a group that remains at risk, due to a lack of HIV/AIDS education. The specific research objective was to empirically answer the following research questions through the testing of the hypotheses: 1. Do U.S.-born Korean American college students differ in their degree of knowledge regarding HIV/AIDS and safe sex practices when compared to foreign college students from South Korea who are currently studying in the United States as well as those currently studying in South Korea? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 87 2. Does HIV/AIDS formal, nonformal, and informal education among U.S.-born Korean American college students differ from that of college students from South Korea who are currently studying in the United States as well as South Korea? Summary of Findings Related to Hypotheses Hypothesis 1 The first hypothesis stated that South Korean-born college students currently studying in Korea would score significantly different from South Korean-born and U.S.-born Korean American students studying in the U.S. on AIDS Knowledge. The study results showed that groups were significantly different from each other regarding AIDS Knowledge, thus supporting the hypothesis. Hypothesis 2 The second hypothesis stated that South Korean-born college students currently studying in Korea will score significantly different from South Korean-born and U.S.-born Korean American students studying in the U.S. on Sexual Risks. The study results showed that groups were significantly different from each other regarding Sexual Risk, thus supporting the hypothesis. Hypothesis 3 The third hypothesis stated that South Korean-born college students currently studying in Korea will Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 88 significantly differ from South Korean-born and U.S.-born Korean American students studying in the U.S. on AIDS Education. The study results showed that groups were significantly different from each other regarding AIDS Education, thus supporting the hypothesis. Summary of Group Findings Related to Interviews Group 1 Findings for Group 1 regarding AIDS Knowledge and Sexual Risk reflected that most participants understood the importance of using condoms but lacked understanding regarding AIDS transmission. This group reported receiving their AIDS education in high school in the form of pamphlets and lectures, and they also received most information from friends and some from the internet. Findings regarding informal comments demonstrated that Group 1 members did not feel comfortable talking about AIDS. They also did not tend to believe that it affected them personally or anyone that they knew personally. They did not tend to discuss it with their sex partners and did not tend to take precautions to guard against catching AIDS. Even following the presentation of AIDS information, they failed to relate possibilities to themselves. They remained unsure about AIDS transmission and stated that they would not want to be around someone with AIDS, for fear of catching it. In addition, participants reported that they Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 89 were not aware of the magnitude of the problem or that it had reached epidemic proportions. They also reported their lack of awareness that AIDS truly could affect anyone, including "normal people." Group 2 Findings for Group 2 regarding AIDS Knowledge and Sexual Risk reflected that most participants also understood the importance of using condoms but lacked understanding regarding AIDS transmission. This group reported receiving their AIDS education in high school and in the form of pamphlets and lectures, and they also received most information from friends and some from the internet. In addition, this group reported that in America, more information was available from TV, movies, and other media and that the subject was discussed more openly. Findings regarding informal comments demonstrated that Group 2 members also did not feel comfortable talking about AIDS; however, their comfort level increased to some degree after being in America. This group's participants also reported that they did not tend to believe that HIV/AIDS affected them personally or anyone that they knew personally. Participants did not tend to discuss HIV/AIDS with their sex partners and they also did not tend to take precautions to guard against catching AIDS. Some reported that they wanted to know more about the subject, now that Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 90 they were in a more comfortable place to discuss AIDS (U.S.). Participants reported receiving more exposure to AIDS due to TV presentations. However, as with Group 1 participants, most failed to relate AIDS possibilities to themselves. This group's participants also reported that they were not aware of the magnitude of the problem or that it had reached epidemic proportions. They too related that they were unaware that AIDS could affect anyone and everyone, including what they thought of as "normal people." Group 3 Findings from Group 3 regarding AIDS Knowledge and Sexual Risk reflected that most participants understood the importance of practicing safe sex, and they also demonstrated more knowledge regarding AIDS transmission. This group reported receiving their AIDS education in high school and junior high, and from friends and TV. In addition, this group reported that they had been aware regarding AIDS for a long time since information is plentiful and found in multiple types of media including magazines, TV, and movies. Findings regarding informal comments demonstrated that Group 3 members tended to feel more comfortable overall, talking about AIDS. However, they also did not tend to believe that it affected them personally or anyone that they knew personally. They reported that they did not tend to Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 91 discuss AIDS possibilities or protection methods with their sex partners and did not tend to take precautions, such as using condoms, to guard against catching AIDS. This group reported that they were aware of AIDS since it was on TV and taught in school. Members appeared to be more comfortable discussing AIDS, as viewed by the interviewer; statements were more casually made and discussion of discomfort was less. Participants reported that they had talked it over with their friends and that it was not a big deal to talk about it. However, as with Group 1 and Group 2 members, most tended not to relate AIDS information to themselves. They also remained unsure about AIDS transmission. Participants also reported that they were not aware of the epidemic proportions that AIDS had reached, worldwide. For all of their awareness, they failed to understand that AIDS could affect anyone, including "normal people" or "clean people." They tended to believe that although the problem may be profound, it still could not affect a "clean" person or a person with "good" habits. In summary, it appears that Group 3 demonstrated the most overall knowledge regarding HIV/AIDS, due to being raised and schooled in the U.S. It also appears that Group 2 stated overall that their HIV/AIDS education increased once attending school in the U.S. due to increased media exposure to the disease and more open discussion among friends. A unique finding from the interviews was that Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 92 informal education appeared to be an important factor increasing overall HIV/AIDS knowledge, since Groups 2 and 3 reported that media exposure increased overall awareness of the disease. A unique finding from the informal interview comments was that, overall, U.S. exposure to AIDS information was greater, leading to increased comfort levels regarding AIDS discussions. However, this did not lead to a comprehensive understanding of AIDS transmission, the magnitude of the AIDS problem, and AIDS information was not personally related. Summary of Findings Related to Research Questions - — - -* 1 — ' — - - Research Question 1 Regarding the first research question, findings showed that U.S.-born Korean American college students did differ significantly in their degree of overall knowledge regarding HIV/AIDS and safe sex practices, compared to the other two groups. In fact there was a significant difference between all groups on all variables. However, further breakdown of the data demonstrated that significant differences were only found between Groups 1 and 3 for Sexual Risk and significant differences were only found between Groups 1 and 3 for AIDS Knowledge. Thus the greatest difference was between U.S.- born and schooled Korean Americans and Korean-born and schooled Koreans. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 93 Research Question 2 Regarding the second research question, findings showed that U.S.-born Korean American college students did differ significantly in their degree of overall HIV/AIDS Education, compared to the other two groups. In fact there was a significant difference between all groups on this variable. However, further breakdown of the data demonstrated that significant differences were only found between Groups 1 and 2 and 1 and 3 for AIDS Education. Thus U.S.-born and schooled Korean Americans and Korean-born but U.S.-schooled Koreans both differed from Korean-born and Korean-schooled with regard to HIV/AIDS Education. A unique finding from this study was indicated by interview findings. Students reported more media exposure in the U.S. regarding HIV/AIDS, thus indicating that informal education was a factor in HIV/AIDS Knowledge and Sexual Risk. Discussion Significance of Findings Related to Literature The findings from this study represented a quantitative and qualitative analysis of surveys and interview questions regarding HIV/AIDS education. A formal analysis of cognitive processes and behavioral patterns was not performed; however, groups responded (answered survey questions, responded to interview questions) with consistent Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. replies within each group, and differed in responses between groups, demonstrating differences in HIV/AIDS knowledge. Findings showed that South Korean-born and schooled individuals scored significantly different than both groups receiving U.S. education (South Korean-born and U.S.-born Korean American). Findings also showed that U.S.-born and educated Korean Americans scored the highest of all groups as indicated by mean scores for this group. These findings indicate that exposure to HIV/AIDS information in the U.S. resulted in higher levels of knowledge than exposure to HIV/AIDS information in South Korea. This finding is consistent with previous literature regarding AIDS-related knowledge and attitudes of different populations in South Korea. For example, Sohn and Jin (1999) assessed the impact of AIDS-related knowledge and attitudes of prostitutes in Korea. Findings were that neither perceived vulnerability nor perceived seriousness of AIDS had significant effects on condom use. The authors concluded that many AIDS-preventive educational efforts by STD clinics were ineffective, and there is a need for these clinics to develop AIDS-preventive education programs which are suitable for the unique circumstances of their respective sex markets. Chang's findings indicated that, consistent with the findings of the present study, South Korea is not developing effective Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 95 programs regarding HIV/AIDS transmission and contraction and students lack this awareness. In addition Chang (1994) explored HIV/AIDS related knowledge, attitudes and safe sex behaviors among South Korean women of childbearing ages. Findings showed high levels of knowledge related to risk factors but lower levels of knowledge about transmission modes for HIV/AIDS. It was concluded that knowledge of HIV/AIDS transmission modes needs to be better integrated into HIV/AIDS prevention programs. Chang's findings again indicated that prevention efforts in South Korea are failing to reach optimal goals and these findings are further supported by the current study's results. Thus a problem regarding safe sex practices among non U.S.-born Asian groups including groups from South Korea was indicated in the literature and this study provides further support for this assumption. However, this study also presented the unique finding that although previous research has concluded that formal HIV/AIDS education in South Korea is lacking, it may be informal education that is resulting in the differences from other forms of education, in overall HIV/AIDS knowledge. In addition, this study also presented the informal finding that even when AIDS knowledge is increased, this knowledge may not be reflected in personal behaviors since individuals may not relate the information Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 96 to themselves. Study participants demonstrated a lack of overall awareness that AIDS had reached epidemic proportions or that it could affect anyone, regardless of habits such as "cleanliness" or appropriate lifestyles. The effects of education on HIV/AIDS knowledge, are reported by Chou, Chin and Rodriquez (1998). The authors studied AIDS knowledge among U.S.-born South Koreans and immigrants and the effects of HIV 101 workshops on HIV knowledge, condom use self-efficacy, as well as the intention to practice safer sex among immigrant and U.S.- born Asians in New York City. Findings revealed that U.S.- born Asians had both higher HIV/AIDS knowledge and condom use self-efficacy baseline scores than did immigrant Asians. After training, both groups significantly increased their HIV/AIDS knowledge and their intention to practice safer sex (p < 0.001). Thus increased education was concluded to be a factor in increased HIV/AIDS knowledge. This is not entirely consistent with the present study findings, which imply that although this type of formal education demonstrated increased HIV/AIDS knowledge, education may also need to come in the form of informal methods that allow for increased acceptance and awareness of the disease and its consequences. In addition, inconsistent with Chou, Chin, and Rodriquez, this study's findings were that not only did Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 97 participants fail to recognize the magnitude of the AIDS epidemic, but even when faced with this and other AIDS knowledge, they failed to relate their AIDS awareness to themselves. Thus this study's findings imply that HIV/AIDS knowledge and education must also provide an element that assists students in personally relating the information. Also, Chou et al. stated that their study group reported increased intentions for safer sex practices, which may or may not reflect actual future sex practices, further implying a need for this factor to be further explored. Limitations Study limitations included the use of a volunteer sample which may have yielded findings unique to this population which are not generalizable to other populations. Since this study was exploratory and descriptive in nature, causal relationships can not be concluded. A significant limitation of this study includes the survey instruments used. Although attempts were made to utilize a previous survey which was used to assess HIV/AIDS issues, reliability and validity of the test instruments was lacking and may have limited findings. Since this is a self-report measure, findings may also reflect bias or tendencies for social acceptance rather than correct information. However, despite this limitation, the survey used to assess HIV/AIDS Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 98 education presented unique findings regarding the different types of education. Conclusions It is concluded that regarding AIDS knowledge and education Korean-born and schooled South Koreans differ from those either U.S.-born or U.S.-schooled. Thus the education found in the U.S. resulted in greater overall HIV/AIDS knowledge. Students demonstrated that this education resulted more from informal methods such as media exposure, compared to formal education. Most individuals stated that they failed to relate to the disease or believe that it could affect them; they reported being unaware of the magnitude of the AIDS epidemic and stated that they believed that it could not affect them as long as they were "clean" or lived "right." This study's findings imply that HIV/AIDS sexual risk behaviors may be related to a lack of appropriate education. Regarding sexual risk behaviors, studies have shown that HIV/AIDS is increasing in South Korea and those who contract the disease are not adapting well and they are engaging in at least some behaviors that pose a risk for transmission to others. For example, Chang and Kim (1996) conducted a study in which they explored the adaptation process of patients living with HIV/AIDS in South Korea. According to the authors, study participants had experienced shock, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 99 wandering, abandonment, and acceptance stages before adaptation occurred. HIV-positive subjects had initially shown psychological isolation with seclusion if they were homosexuals. However, if they were heterosexuals, their predominant initial reactions were confusion and conflict and most of those infected showed anger and resentment with unstable or impatient behavior such as deliberately having sex without disclosing their infection. Thus it appears that this group lacks the education necessary for appropriate behaviors to occur. Implications of the current findings are that education, particularly informal education, may be a factor in controlling these and other risk behaviors. In addition, HIV/AIDS education must include an element which allows for the knowledge to be personally related to the individual. The current study findings imply that results are particularly important for the young Korean males, a group found on the U.S. campus. The World Health Organization (1997) (WHO) has examined the sexual activity behavior of teens and young people in several countries including the Republic of Korea. Research findings revealed that in most South Asian countries, as well as in South Korea, young males are at the highest risk for contracting HIV. This study's findings also imply that results are important for other groups such as those described by Choi, Catania, Coates and Hearst (1992) . These authors examined Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 100 the HIV/AIDS risk among Korean men in Korea applying for international travel. Of the group studied 45 percent were college graduates. Results of the study indicated that most South Korean men planning international travel were aware of sexual (97%), needle (96%), and perinatal transmission (91%) of HIV but many still were confused about HIV transmission through casual contact. Most people believed they had little or no risk (97%) for HIV infection and did not worry about getting infected with HIV when abroad (83%). The finding that most people believed that they were not at risk is consistent with this study's informal findings that students tended to believe that the problem was not related to them personally and they were not at risk for HIV/AIDS. Again the need for HIV/AIDS education to provide information that is personally related to each individual is implied. Thus previous research has indicated that South Korean college students' studying in America may be at high risk for the contraction and/or transmission of HIV/AIDS and may lack adequate AIDS education. The findings from this study support this conclusion and further imply the effects of nonformal education on overall HIV/AIDS knowledge. UNAIDS (2001) reports that the impact of AIDS is felt worldwide and those countries experiencing less of an impact should not be complacent but must continue to determine adequate prevention methods to avoid epidemic increases. Effects include personal tragedy as well as devastation to Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 101 the country. Annual per capita growth is falling in countries hardest hit, families lose income earners and are faced with additional expenses and dependents to care for. Health care and other professionals are becoming ill thus resulting in shortages of personnel needed to fight the epidemic's onslaught. Life expectancy is dropping in some countries and numbers of orphaned infants and children are increasing. This study's informal findings demonstrated that participants tended to lack awareness of the impact of HIV/AIDS and even when confronted with this information, individuals continued to relate the tragedy to others and not themselves. This finding implies the need for students to become aware that HIV/AIDS has reached epidemic proportions, how it reached this magnitude, and that the disease potentially could affect everyone. Findings of this study provide information relevant to the goals resulting from the United Nations General Assembly Special Session on HIV/AIDS in 2001. This assembly met to determine a framework for resolving the HIV/AIDS crisis. Resulting goals included the development of strategies to be in place which address factors that make individuals vulnerable to HIV infections, such as lack of education or information regarding self-protection. Findings of the current study imply that informal education and individually-related knowledge are important factors to be Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 102 considered for the goals of the General Assembly to prevent HIV/AIDS epidemic escalation. Recommendations for Future Research The conducted study showed that Korean-born students are at higher risk, indicating a need for steps to be taken to develop effective prevention programs for them. Since education was shown to be a factor, it is recommended that future studies examine components of a successful educational intervention. While previous research has indicated that formal education results in increased disease awareness, future studies will need to further explore improving the effectiveness of this factor. Since this study revealed the importance of informal education, it is recommended that future studies also investigate this variable. A study is needed to empirically examine the effects of informal education, compared to other types of education such as formal and nonformal. In addition, this study showed that participants failed to relate their knowledge to their own life experience. They did not understand that HIV/AIDS had reached epidemic proportions worldwide, and even when faced with this fact, they remained unable to relate the information to themselves. They tended to relate the problem to others who were possibly more "unclean" or "improper." Therefore, it is recommended that Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 103 a future study empirically explore this tendency and its relation to the effectiveness of education or increased knowledge. Further, it is recommended that multiple measures be used to assess the informal education variable to ensure reliable, valid, and comprehensive results. 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Immigrants in Japan in the context of the HIV/AIDS epidemic. International Conference on AIDS, 12, 976-977. Lapin, L. (1990). Statistics: Meaning and methods. NY: Harcourt Brace. Lindgren, H.C. & Harvey, J.H. (1996). An introduction to social psychology (6th ed.) St. Louis: Mosby Year Book. Linton, M. & Gallo, P.S. (1975). The practical statistician: Simplified handbook of statistics. Monterey, CA: Brooks/Cole. McBurney, D. H. (1994). Research methods, third edition. Pacific Grove, CA: Brooks/Cole Publishing. Moy, E., Kim, Y., Chu, K., Henderson, L., Hu, S., Chai, Y.F. & Yeh, P.H. (1998). AIDS prevention information on the Internet in east Asian languages--Chinese, Japanese and Korean. International Conference on AIDS, 12, p. 685. Nakajima, G.A. & Rubin, H.C. (1992). Epidemiology of AIDS in the Asian & Pacific Islander communities in NYC. International Conference on AIDS, 8^(3), p. 178. Population Reference Bureau. (2002) . HIV/AIDS statistics. Document available at: www.prb.org. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 106 Poumerol, G., Omit, S.O., Ghee, A.E. & Fee, N.F. (1998). Reported and estimated HIV and AIDS in the WHO Western Pacific Region. International Conference on AIDS, 12, p. 111.13. Rogers, F. (1999). Spiritual and psychological healing of persons living with AIDS through education in the Korean Christian context. Dissertation Abstracts International, 60(A-5), p. 1628. Rosenberg, P.S. (1995). Scope of the AIDS epidemic in the United States. Science, 270, 1372-1375. Shah, D., Thornton, S. & Burgess, A.P. (1997). Sexual Risk Cognitions Questionnaire: A reliability and validity study. AIDS Care, 9(4), 471-480. Sohn, M. & Jin, K. (1999). AIDS-related perceptions and condom use of prostitutes in Korea. Yonsei Medical Journal, 40(1), 9-13. Stryker, J., Coates, T.J., DeCarlo, P., Haynes-Sanstad, K., Shriver, M. & Makadon, H.J. (1995). Prevention of HIV infection: Looking back, Looking ahead. Journal of the American Medical Association, 273, 1143-1148. UNAIDS. (2001). AIDS epidemic update. WHO. Document available at: www.who.org. World Health Organization. (1997). HRP: Progress 41: Sexual behavior of young people: data from recent studies. Document available at: www.who.org. Youandaids (2002). HIV-AIDS spreads along Asias drug routes. UNAIDS. Document available at: www.youandaids.org. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 107 A P P E N D IX 1 HIV/AIDS Knowledge Questionnaire Please fill-in or circle the one choice that best expresses your opinion. Please remember - you do not have to answer any question that makes you feel uncomfortable. First, please tell us your birthday: Your Birthday: / / m m / d d / yy 1. Please answer the following questions by circling TRUE or FALSE. a) Using a dental dam during sex reduces your chances of getting AIDS. True False b) The blood test for HIV is a very good way to find out if you have the AIDS virus (HIV). True False c ) A person can get the AIDS vims from donating blood. True False d) Sharing needles/syringes is an extremely risky thing to do. True False e ) A positive blood test for HIV means the person has AIDS. True False f) AIDS is only a problem for gay men and injecting drag users. True False Kissing someone who has AIDS places you at high risk for infection. True False h ) Using a condom during sex reduces your chances of getting the AIDS virus. True False 0 A person can be infected with the virus that causes AIDS and have no symptoms. True False 2. Given what you know about HIV and AIDS, how risky do you think you have been in the past 3 months? □ N ot at a ll □ S lig h tly □ Somewhat □ V e ry □ D o n ’t K now 3. What do you think your chances are of getting HIV? □ N o chance □ A sm all chance □ Some chance □ A very b ig chance □ D on’t Know 3a. Why? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 108 continued... 4. Please answer the remaining questions using the following scale: Neither Agree nor Disagree Strongly Agree 1 2 3 4 5 1. I find it hard to talk about safer sex issues with my lover. _______ 2. Condoms are clean. _______ 3. You know you can keep from getting affected with HIV if you want to. _________ 4. I find it hard to talk about safer sex issues with someone I just picked up. _________ 5. Condoms are an annoyance to use. _______ 6. People who carry condoms are just looking for sex. _______ 7. You don’t have control over whether or not you become HIV positive. __________ 8. A condom is not necessary when you know enough about the person to trust her or his word about his past. ----------- 9. Having m ultiple sexual partners makes it more like ly that someone w ill get a sexually transmitted disease. ---------- 10. You wouldn’t keep condoms at home because someone (your parents, roommate, friends, etc.) might find out you were having sex. — ------- 11. Using condoms takes all the fun out of sex. _______ 12. If my sex partner does not want to use a condom there is little I can do about it. _______ 13. Condoms are messy. _______ 14. I find it hard to talk about safer sex issues when I have had alcohol or used drugs. _______ 15. You’d be embarrassed to buy condoms. _______ Strongly Disagree Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. □ 0 i i o 109 APPENDIX 2 HIV/AIDS Knowledge Questionnaire-Korean 3 ° i 013 i i x i a H 3 3011 m n m \ s a i s ^ a i s . 33101 l h s 3 i m s si i s oil e a s i x i ^9.m ^ e n a . O l . / / g / m / a 0 1 E H C H I M S O il C H 0 H SE3 S i ! 0 1 1 § 3 £ 1 0 | §141 A |S . a) 3 2 At 3 3 3 ( 3 3 3 2 A| 2 3 3 X |g 3 3 2 3 2 ) § A lg § 1 3 3 3 AIDS 3 3 2 1 2 S S 3 3 AI2L1. or = Z * Z C = D j^ai S CD b) S ^ S A l* g & H IV 2 A 1 3 L H J 1 AIDS(HIV) b l0 |L |2 * D V £2 . ^ a i & CD 01X13 213X1 2 3 213 S 3 3 3 0 1 Cl. c) S1SS f§ S H A H E E AIDS bl0|EH20ll 3 3 1 3 21 Cl. □ 1 - Q t: cd ^ a i ^ CD d) b lS OIL! ^ A l» 3 3 S 1 3 3 3 0H3 20IL1. □ l-S X CD ^ a i 5 CD e) HlVfflew b ts o ig f AIDSOH 3SEI21C 13 2 0 1 0 1 LI. I 7 C CD ^ a i 5 CD f) AIDS3 3 3 3 3 3 OHXILI ^ A P IS 0 |g & 3 1 OlgXIOICl. □ 1-^ Z K . CD mat 5 CD g) AIDS 33X121 312313 3 3 3 3 ® M 0| 0H3 SCI. □ 1 - lS L D K Z CD ^ a i 5 CD h) 3 3 Al 3 3 1 A lg S lb 3 3 AIDS 3 3 2 J 3 S S 3 3 AI2L1. D io CD ^ai S CD i) AIDSS 3 3 3 1 3 b!0|E1301l i f a s 0 1 ^011 E E 0 1 3 3 g 3 0 | OIS A C OlfL t d A S T~ -d AA I —f . 2 . X|3 33H S2 3301 HIV 21 AIDS O il 33 S 31 S 3 3 ? □ SSI SI Cl. □ 32 21 LI. □ L12 si Cl. □ O H 3 3 L1 . □ S ^ Q . Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 110 continued... 3. 2 2 0 1 H IV 0 || 2 2 ! □ 2 § l SICK □ 2 2 SICK □ C IS SICK □ 0 H 2 b C K □ 2 H C K 3a. 0 | ^ g ? _________________________________________________________________ 4. 2 b u s o ii pish oib hsi ? i ? 2 § e a s H ^ a i s : a g ^ g g g s y g s o F y a g g g 1 2 3 4 5 i. c i g 2 a m s a 2 2 2 a moil chsh o io p i s i b a o i o i g c i . ____ 2. ? § 8 l 5 8 i a . _ _ 3. m a g 22 cia Hivmmmamci iiA!m a s m a s i b ! mu sick 4. u f e m s n m m a c i 2 2 2 m m o ii chsh o io p i s i a s o i o i^ c k _ 5. 2 g A | g b M 2 5 | C K 6. g g l - 2 1 1 2 C IL Ib A | 2 b 2 2 m m 2 ! §101 c i a c i . 7. m s b s s n H i v m m o i a s a a s m a s i c K 8. m a i m n i i a m m o ii chsh m a m a e g g A i g s i ms.? i s ic k 9. Old g £ | * |S El b. Li S 2 b 2 b mm 2 2 SJ-MOI gCK io. m s b a s n c m a m m aK g m a,2 a a p i2 aoi m m ssicia 3 1 ! monmmsi son g § i n i i2 s in mci. _ _ 11. 2 ! ! A l g s l b 3 1 b 2 2 2 1 2 b g 2 s S 2 0 I 2 C K 12. 2 ^ L|S| *»± E |2 L i7 | 2 = A |g g S I | 2 b Cl 2 L |g C H 2 ! 7 1 1 1 2 Si Cl. _ _ 13. g 3 H 2 3101CK 14. L i b £ 0 1 U m g m g ^ 2 C | 2 2 2 £ 2 0 1 1 CHSH 0 | 0 P I S I b 3 i 0 | C H 2 CK ------ 15. 2 2 b b b 2 2 Al b x | » 2 2 C K — Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. 1. When were you born? (mm/w) 2. What is your home zip code? ________ 3. What is your gender? O Male O Female O Other:_______ 4. What is your marital status? O Single O Married O Divorced 5. What is the highest level of education you have had? O Less than high school OGED O High school graduate O Some college O College degree O Graduate degree 6. What is your nationality?__________________ 7. Were you bom in the United States? O YES O NO 8. If you were NOT born in the United States, where were you born?_____________________________ 9. What year did you come to the United States? 10. What language are you most comfortable speaking?______________________ APPENDIX 3 Sexual Risk Questionnaire 11. 12. 13. Have you ever heard of HIV/AIDS? O YES O NO Where do you get information on HIV or AIDS? O Friends O Boyfriend/girlfriend O Mother O Father O Brother/sister O Other relatives O Your doctor O School O Printed materials in English O Printed materials in Asian language O The Internet/World Wide Web O None / Don’t Know How would you describe your sexual behavior? O Sex with men only O Sex with women only O Sex with both men and women O Never had sex 14. How much money did you make last year? O $41,000 to $50,000 O $51,000 to $60,000 O $61,000 to $70,000 O More than $71,000 O Less than $10,000 O $10,000 to $20,000 O $21,000 to $30,000 O $31,000 to $40,000 15. I sometimes have a problem getting condoms. Strongly Agree Agree O O Neither agree nor disagree.. Disagree Strongly Disagree 17a. When was the last time you took an HIV test? O In the last 6 months O In the last year O In the last 3 years O More than 3 years ago 17b. What was your last HIV test result? O HIV Positive O HIV Negative O Don’t Know 17c. Where did you last take the HIV test? O Doctor’s office O Hospital O Home test O Department of Health O Clinic O Other:____________ 18. What is your sexual orientation? O Heterosexual / Straight O Questioning / Unknown O Other:_____________ O O 16. Have you ever taken an HIV test? O YES O NO Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. 19. tn the last SIX MONTHS, about how many times have you had vaginal sex w ithout a condom w ith... 1 1 or 0 1 -5 6-10 more times Your regular partner or o O O O spouse? .............................. ......................... .. Other sex partners ____ <5____O..... ..... O.... .......<5.... Someone you paid for q q o O sex 20. In the last SIX MONTHS, about how many times have you had anal sex without a condom with... i _ n<x 0 e 6-10 more 5 times O Your regular O O O .. Other sex partners O O J5 __ O____ Someone you paid q q q q for sex 21. In the last SIX MONTHS, how often did you drink beer, wine or liquor? Less than Once Once once a a a 3 times Once Never month month week a week a day O O O O O O 22. How many drinks did you usually have on those days when you did drink? 1 2 3 4 5 More than 5 o o o o o o APPENDIX 3 Sexual Risk Questionnaire continued... 23. In the last SIX MONTHS, how often did you use: Marijuana? Never O Less than once a month O Once a month O Once Once a a week day O O Cocaine and/or Crack? O O O O O Methamphetamine (ic e , c ra n k , c ry s ta l, sp e e d ? ) O O o O O Heroin / Speedball O 0 0 O O Ecstasy? 0 O 0 O O Special K? O O o O O Thank You! 112 Sexual R isk Questionnaire - Korean 113 R c m m m < 3 SO O | m _ P < (O 5 - 1 O < o N- KJ o 3 3 5 0 0 0 53 3J 51 t- CO CO 0 0 0 SO 010 > X O 3 oO w x tH n o o iS p - < 1 JU Oh S f i< SO k J S O _ _ 3 ® SO nO dJ < oT 10 3 J S J n ® o o o o o d o 53 3 o 10 ul O f r\ O O O (V on ® 0 so sr so oT S O O O e o SO J O o 5 3 SO SO 5 B 3 5 3 5J SO SO WO oO O O O 0 8 R S I 3 a L H O ^ 3 3 o 5 3 0 K o J mo a ® ±3= r * \ or S 3 w 5 5 5 < 0 X o 1 < 0 < 0 1 m m so s ? mo O o o o O O O o o K 0 h £ ■ K J o o o o § g 3 3 3 _ « J K 1 1 ?!? o o ik3 5of 0 0 0 0 0 » o3 DU Sr p< ( 1 3 1 on 5 3 m 5 3 § oT oJ o 0|j or ft- 5 p? IK 0 3 3 -< < j p= kJ 5 T O K (- 50 o 11-R Rjj A --O T O il TO iff o 3 5 < 3 « 0 53 f f l 30 SlUOOOOOOOO sr so so 3a st sr SiW 30 o 3 * 5 a J <0 Pj 3 0 1 0 SO U3 a 3 tH 0 SO SO TO 5 5 f ® s r 5 ) p i W 3d so O O O 0 - o u u i r L M 3 3 Sr 3 3 30 I I I l 1 i 1 o OOOO o o .88 O i < ( O Q O O OOOO OOOO o" O T - " r- * 5 - S 818- OOOO 30 o 5 3 rJ Jl O i l 010 75 3 c 5 3 1 3 i i O rf 0 1 1 W o 1 1 3 g o 3 J I J 01 So ^ m wo MS 3 0 o m T H So Wo o o o o C H 3 £: o 3 ° - O T a o TO r a > < ra _ x O 0- 13 3 i 33 0 p * I n k s ilO l 53 S 3 0 H on 3 o !8 K 53 Kl- S O 3 3 QJ O o p - m so K 5 o 3 30 O « .« 1 1- £ 5 O o 3 ( O U « U a o < m m PI HQ g f j SO i o T i o f SO 3 5 O O O c - 5 0 s r o TO m W «) «0 H O PI S (HOOO p» 0 1 3 m o o3 3 <3 30 R 3 - i l l m 3 3 55 5 e S rtr a ou _ S3 Z5 30 o EJ 3 oi 69 K 3 3 m 5 s | n a n - r Sr SO □3 * p s SV R 3 1 3 3 5 S I B 33 3 1 3 CH i i o S O j O IK 0 5 g i i o W S3 53 SO S* 3 oi d £■ k = 3 1 3 o sr W J 3 « O i 3 O § § > R 3 _ ■ d i s- a o Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 114 C 1 § . I 03 ■= X M D S M CU Oi ril (0 : e i l l i o § .*£ < n E " m 3 X 03 C O SF no Oil OH SO Q mo ffU 3 o 5J ® K oJ m o < v . ®8 R * — i otr ^ < 8 ^ <0 o To < 0 < n i O o O o ft TJ 01- UJI 1 a n- -<i SJ w 5 o u o o o o £; SO 3 •® o t U ® f wi K f - «0 i ' 5 HH 0 1 0 a a KS- Kl-10 h? s 3 a § B 5 1 1 S? -O oi ^ 5 mo i § 3 n i ° 0 «o S 3 5 no ~ w u o £; R 3 m S a o a 3 a 5 1 1 1 n o so oJ mo aJ R o T 5P « s l C M <0 o O io w O 't O co O CM O O mo < w w of S o H h K 3 a 51 ) 5 o J mo s c o ru m a s a 3 5 C K i ss i i o f r- § a) 6 B I a . MU ? 3 o o o o o o o o o o o o o o o o o o o o o o o o o o o o o 0 < X w 2 p? oJ 3 s R OH - < 1 m 3 m *10 W sr <\ Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. sum UCK A P P E N D IX 5 AIDS Education Information Questionnaire DIRECTIONS: The following questions pertain to HIV/AIDS education sources. Please rate the questions on a scale of zero (no education) to five (most education). Formal Education Information 1. I received HIV/AIDS education in a formal elementary school classroom setting. zero one two three four five 2. I received HIV/AIDS education in a formal junior high school classroom setting. zero one two three four five 3. I received HIV/AIDS education in a formal high school classroom setting. zero one two three four five 4. I received HIV/AIDS education in a formal college/university classroom setting. zero one ' two three four five Nonformal Education Information 5. I received HIV/AIDS education from elementary school guest speakers. zero one two three four five Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. continued. 6. I received HIV/AIDS education from elementary school auditorium lectures. zero one two three four five 7. I received HIV/AIDS education from junior high school guest speakers. zero one two three four five 8. I received HIV/AIDS education from junior high school auditorium lectures. zero one two three four five 9. I received HIV/AIDS education from high school guest speakers. zero one two three four five 10. I received HIV/AIDS education from high school auditorium lectures. zero one two three four five 11. I received HIV/AIDS education from college/university guest speakers. zero one two three four five 12. I received HIV/AIDS education from college/university auditorium lectures. zero one two three four five 13. I received HIV/AIDS education from professional seminars. zero one two three four five 14. I received HIV/AIDS education from professional pamphlets. zero one two three ___ four five Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 117 continued... 15. I received HIV/AIDS education from doctors. zero one two three four five 16. I received HIV/AIDS education from professionals on the Internet/World Wide Web. zero one two three four five Informal Education Information 17. I received HIV/AIDS education from nonprofessionals on the Internet/World Wide Web. zero one two three four five 18. I received HIV/AIDS education from my mother. zero one two three four five 19. I received HIV/AIDS education from my father. zero one two three four five 20. I received HIV/AIDS education from my sibling. zero one two three four five 21. I received HIV/AIDS education from my other relatives. zero one two three four five 22. I received HIV/AIDS education from my friends. zero one two three four five Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 118 continued... 23. I received HIV/AIDS education from the TV media. zero one two three four five 24. I received HIV/AIDS education from the Radio media. zero one two three four five 25. I received HiV/AIDS education from magazines. zero one two three four five Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. H e r 119 A P P E N D IX 6 AIDS n m § g S: O hS H ^I HIV/AIDS £Sr §£011 H S 51E J L| C h . 0 (IH ^ g*g § g ig ) ei n m & a sn ^ § a i£ . jhai 7 7 ) S r 5! ^ C> ~I 4P. 3 S 5 - - = f c = . 1 . Ufe § § £ S S SoH HIV/AIDS i m s g*2tCK 0 1 2 3 4 5 2. L fe § § g s |jn gsH hiv/aids n m e mvtQ. 0 1 2 3 4 5 3. U £ § § £ g s tI2 HIM S5H HIV/AIDS g*2itt. 0 1 2 3 4 5 4. Ufe § § HIM 4 ^ § SSH HIV/AIDS H ^ S g*2iCh 0 1 2 3 4 5 m^Aj n m § s 5. L fe S g s ^ o n /d £ § § A ^£ ¥ E I HIV/AIDS £ ^ S =h 2iP-. 0 1 2 3 4 5 6. L fe § S' 0 || A H HIV/AIDS H m S ^ 2 iQ . 0 1 2 3 4 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 120 continued... 7. 14 te gstmOllAH HIV/AIDS I2 ¥ M ¥ g m . 0 1 2 3 4 5 8. I4 ¥ USOIIAI HIV/AIDS 2 2 ¥ S g ^ C K 0 1 2 3 4 5 9. U fe H ^ M I A l 2 M t ¥ ¥ E I HIV/AIDS I 2 ¥ S gt&CK 0 1 2 3 4 5 10. u b nmmm gm oun hiv/aids g>gm. 0 1 2 3 4 5 11. 14 fe CHstmOllAi £ M M ¥ E I HIV/AIDS I 2 ¥ S ¥910. 0 1 2 3 4 5 12. 14 ¥ a m 12 gt&OllAi HIV/AIDS I 2 ¥ g ¥ & E K 0 1 2 3 4 5 13. L4¥ A ll □ I uCHI A H HIV/AIDS 12 g*St(4. 0 1 2 3 4 5 14. 14 ¥ ¥ ¥ ¥ & J mxim S6H A H HIV/AIDS 22^ g g>gm . 0 1 2 3 4 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. continued... 15. L |b °|A|0HH HIV/AIDS H m S ^9 1 0 . 0 1 2 3 4 5 121 16. L |b 21E]L J1 &0HH SbOIOIimi HIV/AIDS H Ig t& C I . 0 1 2 3 4 5 m gj& aiei mm § a 17. L ib gJEiy! &0IIAI til S b moil nil HIV/AIDS ^atEI. 0 1 2 3 4 5 18. U b L|£| C H C H L| O il m i HIV/AIDS g*&C|. 0 1 2 3 4 5 19. U b L|£| 0 1 tH II O il m i HIV/AIDS ^ E l . 0 1 2 3 4 5 20. U b u r n s n s b iioh oil mi h i v / a i d s u r n s ^ m c i . 0 1 2 3 4 5 21. U b 5! Sj o il m i HIV/AIDS ¥910. 0 1 2 3 4 5 continued... Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 22. U b a b M HIV/AIDS Hm m ^ & U . 0 1 2 3 4 5 23. U b TV II s m HIV/AIDS ^ 2 m . 0 1 2 3 4 5 24. U b U U 2 S S5H HIV/AIDS &&CK 0 1 2 3 4 5 25. u-hr S IIS S0H HIV/AIDS g|gm . 0 1 2 3 4 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 123 APPENDIX 7 PARTICIPANTS' LETTER OF INTRODUCTION Dear Volunteer: I am currently conducting a research project aimed at investigating AIDS knowledge and education for South Korean-born students attending Korean colleges and U.S.- born Korean Americans and South Korean-born students attending U.S. colleges. To conduct this study, I will need the participation of men and women who will be asked to complete the AIDS Education Questionnaire developed by the Asian Pacific Islander Coalition on HIV/AIDS (APICHA). This letter is to inform you that your participation in this study will involve selecting statements that pertain to these and demographic issues. Your participation is totally voluntary, anonymous. and confidential. Results of this project may be obtained by sending a self-addressed envelope to the researcher. Should you have any questions, please feel free to contact me. Address : 4082 Via Arbolada #238, Los Angeles, CA 90042 Email : lchon@usc.edu Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 124 APPENDIX 8 § o r q i i eh§ o u h s x r s r Oi : £ 2 J £ £XH £ R E H £ 2 ) § R IH CHS!- XHsRHH- O R E H § °| X H O R A L m \H S R EH ££| O R L H E1R X H s R S [ H ^ ° I 0 )|0| £ § g X R £ | §£011 £ § i § R B-lAHx| £ £ * ) £ « t ^ R 2 R U C L 0 1 2R S M 5R ? R A ), £ 2! £ O hAIO h s tlE H S § A R a r 21 & ( apicha) oil ah e m o i s oil o i £ i R g § £ o i i e s t r y-L=t ° i § 01 # I f i g § r ° R U CL £ 2 1 L H § £ S O I d R £0)10)1 01 £ £ 0 ) | CH& g o R o )|O R Si 2 1 £ SOjRRoj ° X )I £ 0 ) 1 £ R A R £ |0| ? |& 5R S §£££01 £ £ 5 1 2 JUCL g<M2| & £ j§| xm^21 51010 ), ° R £ § 1 d |§0l £§1 5 1 2 J L| CL 0 1 £ £ * t R ° | SLUR £ £ £ £ 0 1 1 0 ) 1 1 S@ A H £LHA|0 j| S 5! 2 ) L| CL E R §£01 S R A IC R 2 R £ £ 210 )1 0 ) 1 0R ° J 2 R R £ £ £ 6|-A|0| O RCICL : 4280 Via Arbolada #238, Los Angeles, CA 90042 Email : lchon@usc.edu Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 125 APPENDIX 9 Interview Volunteer Card I am currently conducting a research project aimed at investigating AIDS knowledge and education for South Korean-born students attending Korean colleges and U.S.- born Korean Americans and South Korean-born students attending U.S. colleges. To conduct this study, I will need the participation of men and women who will be asked to participate in a detailed interview process regarding the topic. For those subjects who are interested in participating in this interview session, please return this interview card. Your participation in this interview will be totally voluntary, anonymous, and confidential. Thank you. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 126 APPENDIX 10 gjeh^ d m mw § r eh^£| § r lh eh^ x h s re i- o r eh^£| x h o r m , h e ih e r EH<a£i o r lh eh^ x h ^ r s e h § > rs 0 1 I0R £ R X R £ | *ROH E|AHx| H E R 2 R U C L 0 1 2R « Emm °l§HAJ, g ° js 5R ^XIIOil E R XI-AH I& e ie -ro ii s - o r e i i f i s i e r g § £ i mjm i r e m u s r l i e l 0 1 o il EO\m 0 1 API- 919.E £J)\\ME g 2 J E R 3 R B SI&oKH ^ A R t lliL I EL gAj£| X[EEE 3J0ICH, 2 ig ^ S J OR El O il S S I 5 1 2 JLICL H A R L IE L Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX 11 Cross Tabulation There were a total of 289 students in the entire sample. In the three groups, these broke down as: Group 1: Korean-born, Korean study Group 2: U.S.-born, U.S. study Group 3: Korean-born, U.S. study GROUP Frequency Percent Valid Percent Cumulative Percent Valid 1.00 98 33.9 33.9 33.9 2.00 95 32.9 32.9 66.8 3.00 96 33.2 33.2 100.0 Total 289 100.0 100.0 The frequencies for age in the entire group: AGE Frequency Percent Valid Percent Cumulative Percent Valid 17.00 44 15.2 15.2 15.2 18.00 29 10.0 10.0 25.3 19.00 33 11.4 11.4 36.7 20.00 71 24.6 24.6 61.2 21.00 47 16.3 16.3 77.5 22.00 30 10.4 10.4 87.9 23.00 24 8.3 8.3 96.2 24.00 11 3.8 3.8 100.0 Total 289 100.0 100.0 How gender broke down: Male = 1 Female = 2 GENDER Frequency Percent Valid Percent Cumulative Percent Valid 1.00 130 45.0 45.0 45.0 2.00 159 55.0 55.0 100.0 Total 289 100.0 100.0 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. The crosstabs of group by age: AGE * GROUP Crosstabulation Count GROUP Total 1.00 2.00 3.00 AGE 17.00 14 12 18 44 18.00 13 7 9 29 19.00 10 8 15 33 20.00 27 23 21 71 21.00 12 20 15 47 22.00 12 9 9 30 23.00 10 8 6 24 24.00 8 3 1 1 Total 98 95 96 289 The crosstabs of group by gender: GENDER ‘ GROUP Crosstabulation Count GROUP Total 1.00 2.00 3.00 GENDER 1.00 45 40 45 130 2.00 53 55 51 159 Total 98 95 96 289 The crosstabs of group by risk behavior (in this tabl is an invalid response): Crosstab Count GROUP Total 1.00 2.00 3.00 RISK .00 8 8 1.00 1 1 11 3 25 2.00 17 8 9 34 3.00 26 4 21 51 4.00 15 24 18 57 5.00 16 12 21 49 6.00 7 7 12 26 7.00 14 9 23 8.00 6 7 3 16 Total 98 95 96 289 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 129 Finally, the crosstabs of groups by AIDS knowledge: Crosstab Count GROUP Total 1.00 2.00 3.00 KNOW 1.00 5 8 13 2.00 27 19 12 58 3.00 20 3 12 35 4.00 13 16 21 50 5.00 9 24 33 66 6.00 15 12 12 39 7.00 9 8 3 20 8.00 5 3 8 Total 98 95 96 289 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 130 APPENDIX 12 Table 1 Sexual Orientation Sexual Orientation All Groups Group 1 Group 2 Group 3 Homosexual/ gay 17 6 4 7 Lesbian 19 5 6 8 Heterosexual /straight 250 87 84 79 Bisexual 3 0 1 2 Total 289 98 95 96 Table 2 Highest Education Level Highest Education Level All Groups Group 1 Group 2 Group 3 Less than high school 0 0 0 0 GED/ High school graduate 0 0 0 0 Some College 130 53 35 42 Graduated College 0 0 0 0 Some Graduate School 117 35 44 38 Masters Degree 42 10 16 16 Total 289 98 95 96 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 131 continued... Table 3 Sexual Risk Behavior: Condom Use Sexual Behavior: Condom Use All Groups Group 1 Group 2 Group 3 Never 17 7 6 4 Some of the time 165 72 51 42 About half of the time 41 5 15 21 Almost always 36 5 13 18 Always 23 4 8 11 I never had sex 7 5 2 0 Total 289 98 95 96 Table 4 Sexual Risk Behavior: Alcohol or Drug Use Sexual Behavior: Alcohol or Drug Use All Groups Group 1 Group 2 Group 3 Never 74 42 21 11 Some of the time 137 36 48 53 About half of the time 61 15 23 23 Almost always 6 0 1 5 Always 4 0 0 4 I never had sex 7 5 2 0 Total 289 98 95 96 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 132 continued... Table 5 HIV/AIDS Transmission: You cannot get HIV if you are only having sex with one partner HIV/AIDS Transmission One Partner All Groups Group 1 Group 2 Group 3 True 47 33 8 6 False 240 63 87 90 Don11 Know 2 2 0 0 Total 289 98 95 96 Table 6 HIV/AIDS Transmission Risk: Kissing someone with HIV Risk rated from 1 to 5 HIV/AIDS Transmission Kissing All Groups Group 1 Group 2 Group 3 Low Risk 1 13 1 2 10 2 15 3 5 7 3 131 44 43 44 4 65 28 23 14 High Risk 5 65 22 22 21 Total 289 98 95 96 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 133 continued... Table 7 HIV/AIDS Transmission Risk: Someone performing penetrative sex without a condom rated from 1 to 5 HIV/AIDS Transmission no condom All Groups Group 1 Group 2 Group 3 Low Risk 1 10 5 3 2 2 1 1 0 0 3 34 9 12 13 4 88 40 25 23 High Risk 5 156 43 55 58 Total 289 98 95 96 Table 8 HIV/AIDS Comfort Level: I find it hard to talk about safer sex issues with my lover Comfort Level Talk with lover All Groups Group 1 Group 2 Group 3 Strongly Agree 1 224 86 72 66 2 44 10 17 17 3 10 2 2 6 4 7 0 3 4 Strongly Disagree 5 4 0 1 3 Total 289 98 95 96 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 134 continued... Table 9 HIV/AIDS Belief: I consider myself to be at risk of getting the HIV virus Belief of Risk All Groups Group 1 Group 2 Group 3 Strongly Agree 1 230 0 0 0 2 1 1 0 0 3 9 2 3 4 4 56 7 22 27 Strongly Disagree 5 223 88 70 65 Total 289 98 95 96 Table 10 HIV/AIDS Comfort Level: Using condoms takes all the fun out of sex Comfort Level Using Condoms All Groups Group 1 Group 2 Group 3 Strongly Agree 1 160 42 57 61 2 38 8 11 19 3 17 7 4 6 4 11 10 0 1 Strongly Disagree 5 63 31 23 9 Total 289 98 95 96 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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Chon, Linda Kyung-Rae
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AIDS knowledge and education for South Korean-born college students attending Korean colleges and United States-born Korean American and South Korean-born students attending United States college...
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Graduate School
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Rideout, William M. (
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