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2013 KNOWLEDGE, ATTITUDES, BEHAVIOUR & PERCEPTIONS (KABP) Sint Maarten SEX, SEXUALITY AND FAMILY PLANNING KNOWLEDGE, ATTITUDES, BEHAVIOUR AND PERCEPTIONS (KABP) SEX, SEXUALITY AND FAMILY PLANNING BASELINE STUDY 2013 SINT MAARTEN Website: http://www.qureltd.com Office: 1 (868) 224-3479 ACKNOWLEDGEMENTS This report is a product of the collective efforts of the Government of Sint Maarten under The Ministry of Public Health, Social Development and Labour, the people of Sint Maarten and QURE International. I sincerely wish to thank Mrs. Rose Pooran-Fleming, the Policy Advisor and Project Coordinator of Social Security and Pensions at the Department of Social Development, who spent tireless hours providing invaluable feedback during the planning and implementation phases of this project. To Ms. Margje Troost, Project Officer at the HIV/AIDS Programme Management Team who reviewed and commented on the draft document, my gratitude to you. To all other members of the working team, thank you for your comments along the way. Special thanks to the Head of the Department of Statistics, Ms. Makini Hickinson and Senior Statistical Analyst Ms. Maurette Antersijn, who assisted in the development of the sampling strategy and the selection of the sample. I wish to acknowledge Mrs. Veronica Webster and her team of Webster International who played a critical role in the recruitment and training of enumerators, the organization of focus groups and more importantly the collection of the data, without which this report would not have been possible. Many thanks to Mr. John O’Connor who unreservedly provided his expertise in scouting the various locales needed to access specific members of the target populations. This undoubtedly facilitated the successful completion of this project. His interpretation skills with the Spanish speaking population was also greatly appreciated. In addition, my deepest thanks to all the respondents who openly answered the questions asked of them, some of which were personal and sensitive. Understandably, a project of this scope and depth involved many persons contracted at different periods. And though I was unable to name each person, I would like you to know that this report is a product of your hard work and commitment, and for that, I thank you. Joel Joseph Director QURE International ii TABLE OF CONTENTS ABBREVIATIONS V LIST OF TABLES VI SECTION I 1.0: INTRODUCTION AND BACKGROUND 1 1.1: DEMOGRAPHICS 9 SECTION II 2.0: KNOWLEDGE & AWARENESS 17 2.1: STI/STD TESTING 31 2.2: BELIEFS 39 2.3: SEXUAL BEHAVIOUR 47 2.4: SEXUALITY 59 2.5: FAMILY PLANNING 65 2.6: GENDER ROLES 77 2.7: MEDIA 81 2.8: CONCLUSION 87 SECTION III 3.0: FOCUS GROUP 91 iii SECTION IV 4.0: COMMUNICATION PLAN 103 APPENDICES APPENDIX A- KNOWLEDGE ITEMS I APPENDIX B- ACCEPTABILITY OF SEXUAL ACTS III iv ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome BCC Behaviour Change Communication HIV Human Immunodeficiency Virus MSM Men who have Sex with Men STD Sexually Transmitted Diseases STI Sexually Transmitted Infections SW Sex Worker SXM Sint Maarten VCT Voluntary Counselling and Testing WSW Women who have Sex with Women v LIST OF TABLES TABLE 1.0.1 SEX 3 TABLE 1.0.2 SEXUALITY 6 TABLE 1.0.3 FAMILY PLANNING 7 TABLE 1.1.1 DISTRIBUTION OF SAMPLE BY ZONE 9 TABLE 1.1.2 DISTRIBUTION OF SAMPLE BY GENDER 10 TABLE 1.1.3 DISTRIBUTION OF SAMPLE BY NATIONALITY 10 TABLE 1.1.4 DISTRIBUTION OF SAMPLE BY COUNTRY OF BIRTH 10 TABLE 1.1.5 REGISTERED AT THE CIVIL REGISTRY 11 TABLE 1.1.6 DISTRIBUTION OF SAMPLE BY AGE 11 TABLE 1.1.7 DISTRIBUTION OF SAMPLE BY MARITAL STATUS 12 TABLE 1.1. 8 DISTRIBUTION OF SAMPLE BY RELIGION 12 TABLE 1.1.9 DISTRIBUTION OF SAMPLE BY LEVEL OF EDUCATION 13 TABLE 1.1.10 DISTRIBUTION OF SAMPLE BY EMPLOYMENT STATUS 13 TABLE 1.1.11 DISTRIBUTION OF SAMPLE BY MAIN SOURCE/S OF INCOME 14 TABLE 1.1.12 DISTRIBUTION OF SAMPLE BY MONTHLY INCOME 15 TABLE 1.1.13 POSSESSIONS 15 TABLE 2.0.1 AWARENESS OF STIS/STDS & HIV/AIDS 21 TABLE 2.0.2 AWARENESS OF SPECIFIC STIS/STDS 21 TABLE 2.0.3 RISKS OF IGNORING STI/STD SYMPTOMS 22 TABLE 2.0.4 MEASURES TO PROTECT ONESELF FROM CONTRACTING STIS/STDS 23 TABLE 2.0.5 PERCEIVED WAYS OF CONTRACTING HIV/AIDS 23 TABLE 2.0.6 PROTECTING YOURSELF FROM CONTRACTING HIV/AIDS 25 TABLE 2.0.7 TESTING FOR STIS/STDS 26 TABLE 2.0.8 WHERE VISIT TO BE TESTED FOR STIS/STDS 27 TABLE 2.0.9 WHY WOULD YOU CHOOSE THIS PLACE TO VISIT TO BE TESTED FOR STIS/STDS? 27 TABLE 2.0.10 PERSONALLY KNOWN SOMEONE WITH STIS/STDS OR HIV/AIDS 28 TABLE 2.0.11 KNOWLEDGE ITEMS 28 TABLE 2.1.1 EVER TESTED FOR STI/STD 33 TABLE 2.1.2 REASONS FOR NOT GETTING TESTED FOR STI/STD 33 TABLE 2.1.3 REASONS FOR GETTING TESTED FOR STI/STD 34 TABLE 2.1.4 MOST RECENT STI/STD TEST 34 TABLE 2.1.5 NUMBER OF TIMES TESTED FOR AN STI/STD 34 TABLE 2.1.6 RECEIVED THE RESULTS OF STI/STD TEST 35 TABLE 2.1.7 EVER TESTED FOR HIV 35 TABLE 2.1.8 MOST RECENT HIV TEST 35 TABLE 2.1.9 LOCATION OF MOST RECENT HIV TEST 36 TABLE 2.1.10 RECEIVED THE RESULTS OF HIV TEST 36 vi TABLE 2.1.11 NUMBER OF TIMES TESTED FOR HIV 36 TABLE 2.2.1 BELIEFS ABOUT SEXUAL PARTNERS 42 TABLE 2.2.2 BELIEFS ABOUT WHO SHOULD CARRY CONDOMS 42 TABLE 2.2.3 RELIGIOUS BELIEFS AND SEX 43 TABLE 2.2.4 MEDIA PROMOTING SEXUAL PROMISCUITY 43 TABLE 2.2.5 BELIEFS ABOUT CONTRACTING AN STI/STD 43 TABLE 2.2.6 TREATMENT OF PERSONS WITH STIS/STDS 44 TABLE 2.2.7 EFFECT ON CHILDREN WHO ARE FORCED TO HAVE SEX WITH AN ADULT 44 TABLE 2.2.8 ACCEPTANCE OF HOMOSEXUALITY BY POPULATION 44 TABLE 2.2.9 RISKS OF CONTRACTING AN STI/STD 45 TABLE 2.3.1 FREQUENCY OF SEXUAL INTERCOURSE 52 TABLE 2.3.2 USE OF ALCOHOL OR DRUGS PRIOR TO HAVING SEXUAL INTERCOURSE 52 TABLE 2.3.3 SEX ACTS ENGAGED IN 53 TABLE 2.3.4 OTHER SEX ACTS ENGAGED IN 53 TABLE 2.3.5 FORCED TO ENGAGE IN SEX ACTS 54 TABLE 2.3.6 CONDOM USE 54 TABLE 2.3.7 AGE OF FIRST SEXUAL ENCOUNTER AND THE AGE OF PARTNER 55 TABLE 2.3.8 NUMBER OF SEXUAL PARTNERS 56 TABLE 2.4.1 SEXUAL ATTRACTION 61 TABLE 2.4.2 DEFINITION OF SEXUAL ATTRACTION 61 TABLE 2.4.3 ATTITUDES TOWARD HOMOSEXUALITY 62 TABLE 2.4.4 EVALUATION OF HOMOSEXUALITY 62 TABLE 2.4.5 VIOLENCE BASED ON SEXUAL ORIENTATION 63 TABLE 2.4.6 ACCESS THERAPY AND HEALTH SERVICES AS IT RELATES TO SEXUALITY 63 TABLE 2.5.1 OBTAIN A CONDOM WHEN NEEDED 71 TABLE 2.5.2 AWARE OF CONTRACEPTIVES & FAMILY PLANNING METHODS 71 TABLE 2.5.3 OBTAIN OTHER CONTRACEPTIVES WHEN NEEDED 71 TABLE 2.5.4 LOCATION TO ACCESS CONTRACEPTIVES OTHER THAN CONDOMS 72 TABLE 2.5.5 USE OF FAMILY PLANNING 72 TABLE 2.5.6 REASON FOR USING FAMILY PLANNING 73 TABLE 2.5.7 ACCESS FAMILY PLANNING SERVICES 73 TABLE 2.5.8 DISCUSSED FAMILY PLANNING WITH PARTNER 73 TABLE 2.5.9 KNOW PERSON/S WHO HAVE HAD AN ABORTION 74 TABLE 2.5.10 HAVE HAD OR CONSIDERED HAVING AN ABORTION 74 TABLE 2.5.11 LEGALIZING ABORTION 74 vii TABLE 2.6.1 CONDOM AND OTHER CONTRACEPTIVE USE 78 TABLE 2.6.2 SEXUAL ACTS 79 TABLE 2.7.1 MEDIA EXPOSURE 82 TABLE 2.7.2 TYPE OF SEX ACTS AND MEDIA EXPOSURE 82 TABLE 2.7.3 SEX TOYS AND MEDIA EXPOSURE 83 TABLE 2.7.4 SEXUAL BEHAVIOUR AND MEDIA EXPOSURE 83 viii ix SECTION I INTRODUCTION & BACKGROUND SXM KABP 1.0: INTRODUCTION & BACKGROUND SXM KABP 1.0: INTRODUCTION AND BACKGROUND The Department of Social Development undertook a Knowledge, Attitude Behaviour and Perception (KABP) study on sex1, sexuality and family planning for the general population 18-59 years old. In addition to knowledge, attitude, behavior and perception, this study was also geared towards measuring the target group’s practices and reactions to sex, sexuality and family planning. QURE International a research company, was commissioned to undertake the KABP study of sex, sexuality and family planning among the population age 18-59 years old for the Ministry of Social Development under the Government of Sint Maarten. This study was coordinated by the Department of Social Development in collaboration with various executing agencies within the Ministry of Public Health, Social Development and Labor. RESEARCH GOAL The goal of this research was to investigate the knowledge, attitude, behavior and perception of sex, sexuality and family planning among the age groups 18-59 years old. The information provided from the investigation will be used to: 1. Develop policies geared towards increasing knowledge of sex, sexuality and family planning, 2. Strengthen of health care services to be in better alignment to the needs of the adult population ages 18-59 years old. 3. Ensure that sex, sexuality and family planning information and instruments (condoms, birth control) are more readily available and easily accessible. 4. Increase positive attitudes about sex, sexuality and family planning, heightened protection and family planning behavior and a more informed, tolerant and positive perception of sex, sexuality and family planning. The latter is to be fostered through publishing the report and awareness/sensitization campaigns.

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