Vol 5 No 4 full text fix.indd Althea Medical Journal. 2018;5(4) 179 Knowledge, Attitude, and Behavior Regarding Homosexualilty among New Students in Universitas Padjadjaran Ade Nea,1 Rudi Wisaksana,2 Enny Rohmawaty3 1Faculty of Medicine Universitas Padjadjaran, Indonesia, 2Department of Internal Medicine Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, Indonesia, 3Department of Biomedical Sciences Faculty of Medicine Universitas Padjadjaran, Indonesia Correspondence: Ade Nea, Faculty of Medicine, Universitas Padjadjaran. Jalan Raya Bandung-Sumedang Km. 21, Sumedang, Indonesia Email: adenea952013@gmail.com Introduction Homosexuals refer to individuals who are having sex orientation towards same sex.1 Homosexual men are termed gays, while homosexual women are called lesbians. Issue of homosexuality draws controversy around the globe. Several countries accept homosexuality, and still many more reject the concept. In 2013, Pew Research Center reports that 93% of Indonesians reject homosexuality.2 Homosexuals are rejected by the community as they are regarded as sinful, amoral, and abnormal.3 This negative attitude deters homosexual from access to health care.4 This in turn lead homosexuals to commit high risk sexual behaviors such as unprotected men who have sex with men (MSM) and men who have sex with men and woman (MSMW).5 High- risk sexual behavior in homosexuals increases the risk of sexually transmitted diseases and human immunodeficiency virus (HIV) in this population.6 Homosexuals commit high-risk sexual behavior, which could give rise to health issues. Students have been an integral part of the health system and have a role in generate positive impact at community level and as agents of change directly and indirectly.7 Their role as agents of change is by influencing knowledge, attitudes, and practices within community.7 New students are needed as the young generation are regarded as agents of change that are responsible in educating the AMJ. 2018;5(4):179–86 Abstract Background: Homosexualilty has raised a controversy in the society, which commonly has a negative attitude towards homosexual. It is important to develop knowledge and attitude about homosexuality in new students as agents of change. This study aimed to identify the knowledge, attitude, and behavior of new undergraduate students in Universitas Padjadjaran about homosexual. Methods: This was a descriptive quantitative cross-sectional study using primary data obtained from questionnaires, distributed not randomly to new undergraduate students of 2016/2017 academic year in Universitas Padjadjaran (n=122) from October to November 2016. Questions asked were demographic data, knowledge and attitude towards homosexualilty, and homosexual behavior. Results: Respondents had a good knowledge (18%; n=22), average (66.4%; n=81) and low knowledge (15.6%; n=19) about homosexuality and the majority (55.7%; n=68) of respondents had a negative attitude towards homosexuality. A heterosexual behavior had been showed in 92.6% (n=113) respondents, and 7.4% (n=9) had a heterosexual dominant behavior. Conclusions: In our new undergraduate students’ community, the majority has average knowledge, however, with a negative attitude towards about homosexuality. The role of new students as agents of change is to educate the community to prevent potential health issues. The developing of knowledge, attitude, and behavior towards homosexual through a holistic education from health workers should be promoted. Keywords: Attitude, behavior, homosexual, knowledge Althea Medical Journal. 2018;5(4) 180 AMJ December 2018 community as a prevention to potential health problems. Their knowledge and attitude towards homosexuality are vital in shaping opinions in the community. High population of young people are expected to solve health problems. Therefore, studies assessing the knowledge, attitude, and behavior of new students regarding homosexuals are needed. The academic year of 2016/2017 in Universitas Padjadjaran are attended by 6.148 students.8 The aim of this study was to assess the knowledge, attitude, and behavior of new undergraduate (Strata-1) students of Universitas Padjadjaran from academic year 2016/2017 regarding homosexuals. Methods This was a descriptive, quantitative, cross- sectional study conducted from October– November 2016 in 16 faculties of Universitas Padjadjaran. Subjects involved in this study were new undergraduate (Strata-1) students of Universitas Padjadjaran from academic year 2016/2017. Total final sample used in this study was 122, which was obtained according to minimal total sample proportion from 16 faculties in Universitas Padjadjaran, utilizing Solvin equation.9 This study was not randomized due to time constraints. There were more female subjects than men due to female was a majority population in Universitas Padjadjaran, but no special treatment in this study. Subject that consent to participate signed the consent sheet and filled the questionnaire of the study. If the questionnaire are not completed or not returned, the subject would not be included in this research. Questionnaires used in this study were the adaptation from Sex Education and Knowledge about Homosexuality (SEKH), Attitude toward Homosexual Questionnaire (AHQ), and Homosexual Experience from World Health Organization year 2005.10,11 Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ) and AHQ had been used by Dunjić-Kostić et al.10 The adapted questionnaire was translated by four oathed and certified linguist from Cultural Science Faculty, Universitas Padjadjaran, and was validated. Validation process in this study was performed in new students of 16 faculties. This process was done three times with different subjects in each process and this study used the last validated questionnaire. Subjects who have followed the validation process are not permitted to take part in this study. Data collected were analyzed with statistical software. Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ) was a validated 15-questions questionnaire measuring knowledge about homosexual with reliability score of 0.793. Respondents answered questions about knowledge with “true,” “false,” or “don’t know”. In data analysis, “false” and “don’t know” answers are given score “0”, while “true” answers are given score “1”. Fifteen was the score for all true answers. In the end of the analysis, knowledge scores were categorized as “good”, “average”, and “low”. Good knowledge was designated if respondent scored above average score of all respondent. Average knowledge was designated if respondent scored in average of all respondent. Low knowledge was designated if respondent scored below average score. Attitude towards Homosexual Questionnaire was a validated 12-questions questionnaire measuring attitudes toward homosexual with reliability score of 0,714. Attitude questions were composed with 6 positive and 6 negative inquiries utilizing Likert scale from 1 (“strongly agree”) to 5 (“strongly disagree”). High score indicated a negative attitude towards homosexual. Behavior was measured with Homosexual Experience, a 9-questions questionnaire which was not validated. It was composed with general questions, questions for male respondents, and questions for female respondents. Behaviors was categorized in two groups, heterosexual and dominant heterosexual or sexual orientations other than heterosexual.12 This research was approved by The Health Researches Ethics Commitee Faculty of Medicine Universitas Padjadjaran (592/ UN.C1.3.2/KEPK/PN/2016), Rector of Universitas Padjadjaran, and representatives of dean in all faculties in Universitas Padjadjaran to be conducted on new students from academic year 2016/2017. Results All 122 respondents in this study returned the completed questionnaire. The total of respondents was in accordance with the calculated sample size from proportional random sampling calculation in each faculty. The majority of respondents were female, and all respondents declared themselves as heterosexual. The sociodemographic characteristic data of respondents are detailed in Table 1. Althea Medical Journal. 2018;5(4) 181 Table 1 Sociodemographic Characteristic of New Undergraduate Students Characteristics Total (n) Percentage (%) Age (years) Median 18 Minimum 16 Maximum 20 Sex Male 47 38.5 Female 75 61.5 Faculty Law 9 7.4 Economy and Business 8 6.6 Medicine 6 4.9 Mathematics and Natural Sciences 15 12.3 Agriculture 8 6.6 Dentistry 4 3.3 Social and Political Sciences 12 9.8 Cultural Sciences 15 12.3 Animal Husbandry 7 5.7 Communication Sciences 12 9.8 Nursery 3 2.5 Fishery and Naval Sciences 7 5.7 Agricultural Industry Technology 6 4.9 Geological Engineering 4 3.3. Pharmacy 3 2.5 Psychology 3 2.5 Based on the retrieved data, 18% (n=22) of respondents had a “good” knowledge about homosexual, 66.4% (n=81) had an “average” knowledge, and 15.6% (n=19) had a “low” knowledge. A total of 68% (n=83) respondents answered “true” in the question “In some cultures, same-sex intercourse among boys is a common practice”, meanwhile 95% (n=116) respondents answered “false” in “A majority of homosexuals were seduced when they were teenagers by a person of the same sex, usually a few years older than they were then”. Data related to the knowledge of new students regarding homosexuals are reported in Figure 1. A total of 55.7% (n=68) respondents show a negative attitude, while 44.3% (n=54) show a positive attitude towards homosexuals. A Ade Nea, Rudi Wisaksana, Enny Rohmawaty: Knowledge, Attitude, and Behavior Regarding Homosexualilty among New Students in Universitas Padjadjaran total of 71% (n=87) respondents “strongly agree” that “Celebrations such as “Gay Pride Day” are stupid because they assume that a person’s sexual orientation is something that they can be proud of ”, and 55% (n=67) respondents “strongly disagree” if same-sex marriage among homosexuals are permitted. Most of the respondents disagree with homosexuality. However, most respondents agree with homosexuals having social equality and having equality in job opportunity. Data regarding attitudes of new students towards homosexuals are reported in Figure 2. From the respondents of this study, 92.6% (n=113) respondents were heterosexual and 7.4% (n=9) was heterosexual dominant. A total of 2% (n=1) of male respondents had been doing same-sex intercourse (MSM). Data Althea Medical Journal. 2018;5(4) 182 AMJ December 2018 Figure 1 Knowledge Regarding Homosexuals Althea Medical Journal. 2018;5(4) 183 Figure 2 Attitudes Towards Homosexuals Ade Nea, Rudi Wisaksana, Enny Rohmawaty: Knowledge, Attitude, and Behavior Regarding Homosexualilty among New Students in Universitas Padjadjaran Althea Medical Journal. 2018;5(4) 184 AMJ December 2018 regarding behavior towards homosexual are explained in Figure 3. Discussions Most respondents had an average knowledge regarding homosexuals, and only a few respondents had a good knowledge. This finding is in concordance with previous study in students of medicine in Zagreb13, which found that the level of knowledge of most students about homosexuals is inadequate. This study agreed with the previous study that showed having a good level of knowledge about homosexuals in new students is expected to reduce discrimination in health services and to increase awareness in the society about causes and concequences of homosexuals.4,14. This study discovered that negative attitude towards homosexuals was found to be higher than positive. However, although most respondents disagree with homosexuality, they do not prohibit homosexuals from having equal social and occupational rights. This is in concordance with a study by Dunjić- Kostić et al.10 that used same questionnaries which states that generally medical students supported employment equality. Many factors could affect the attitude towards homosexuals, one of them is the level of knowledge about homosexuals. Previous studies utilizing the same questionnaire with this study showed that the level of knowledge about homosexuals was a strong predictor of attitude expressed to homosexuals, and better knowledge leads to a more positive attitude towards homosexuals.15 Sexual orientation could also affect the attitude towards homosexual. Teenagers with heterosexual orientation had a more negative attitude towards homosexuals.16 In the previous studies, teenagers that hold the believe to traditional values and gender role show a more negative attitude towards homosexuals.16 In this research, all respondents stated themselves as heterosexuals, however there is a possibility of stigma about homosexual in society affecting respondents, leading to partial disclosure while filling questionnaires, although the name of respondents was not required in the questionnaire.17 Study results showed that most respondents had a heterosexual behavior, and interestingly, new students with heterosexual dominant behavior Figure 3 Behavior Regarding Homosexualilty among New Undergraduate Students Althea Medical Journal. 2018;5(4) 185 was detected. Students in this group mostly did sexual contact such as hugging with same sex and touching the genitals of their peers. There were several respondents who admit they had been attracted to same sex, and one student had been doing same sex intercourse. This is in concordance with past studies in young adults, which found that most of the respondents were heterosexuals, followed by heterosexual dominant.18 This study discovered that a negative attitude towards homosexuals was found to be higher than positive. Although most respondents disagree with homosexuality, they do not prohibit homosexuals from having equal social and occupational rights. This is in concordance with a study conducted by Dunjić- Kostić et al.10 that used same questionnaires which states that generally medical students supported employment equality. Many factors could affect the attitude towards homosexual, one of them is the level of knowledge about homosexuals. Previous studies utilizing the same questionnaire with this study showed that the level of knowledge about homosexuals was a strong predictor of attitude towards homosexuals and better knowledge leads to a more positive attitude towards homosexuals.15 Sexual orientation could also affect the attitude towards homosexuals. Teenagers with heterosexual orientation had a more negative attitude towards homosexuals.16 In the previous studies, teenagers that hold the belief to traditional values and gender role shows a more negative attitude towards homosexuals.16 In this study, all respondents stated themselves as heterosexuals, however there is a possibility of stigma about homosexuals in society affecting respondents, leading to partial disclosure while filling questionnaires, although the name of respondents was not required in the questionnaire.17 Study results showed that most respondents had a heterosexual behavior and interestingly, some new students with heterosexual dominant behavior was detected. Students in this group mostly did sexual contact such as hugging with same sex and touching the genitals of their peers. There were several respondents that admitted that they had been attracted to the same sex and one student had been doing same sex intercourse. This is in concordance with past studies in young adults, which found that most of the respondents were heterosexuals, followed by heterosexual dominant.18 The limitation of this study was the misunderstood question in the questionnaire. Respondents that had been experiencing physical contacts such as hugging and touching with their peers did not assume that their peers were homosexuals. In past studies it was shown that physical contacts such as hugging could be done with peers without sexual attraction.19 New students as agents of change that could educate the society in the effort of solving health problem should have a good knowledge, good attitude and good behavior towards homosexual. This study discovered that new students having good knowledge about homosexuals are still a minority, and there are still new students with low level of knowledge. A comprehensive educational effort to new students regarding homosexual is needed, so that there is a similar level of knowledge about homosexual among new students. This study also found a new student that had been doing same sex intercourse. This is expected to be a basis for administering counsel and education by educational institutions and health workers about homosexual, particularly regarding health problems which could rise due to risky sexual behavior. Further studies are recommended to identify factors affecting the level of knowledge, attitude and behavior about homosexual. Other studies are also expected to find correlation between knowledge, attitude and behavior about homosexual. References 1. Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Philadephia: Lippincott Williams & Wilkins; 2015. p. 564–72. 2. Kohut A. 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