Voluntary Counseling And Testing Among Youth Ages Essay Example

Established in 1952, the Council is governed by an international board of trustees. Its New York headquarters supports a global network of regional and country offices. Copyright © 2001 The Population Council Inc. Table of Contents Executive Summary Methods Key findings Building on research Introduction Background Methods Study site and population Findings Youth testing experiences do not always match VCT model Most tested youth intend to practice safer sex Young people want to know their HIV status Youth appreciate counseling Several factors deter youth from seeking HIV tests. Peers play an important role for youth VCT study sites are not equipped to respond to youth issues Youth want confidential services and full disclosure of test results Building Interventions Based on Research References 31 HIV VCT Among Youth Executive Summary Voluntary counseling and testing (VCT) programs have increased the adoption of safe sexual behavior and the use of care and support services among adults (Coates et al. 1998). Are VCT programs appropriate for young people, who account for the majority of all new HIV infections in East and southern Africa?

To find out, researchers conducted exploratory research to identify opportunities for and barriers to providing VCT for youth. The first phase of the study, completed in May 2000, indicates that youth would like access to HIV testing and counseling services if the services are confidential and inexpensive and if the results are reported honestly. Methods In Nairobi, Kenya, and Kampala and Masaka, Uganda, researchers conducted focus group discussions and in-depth interviews with youth, parents, service providers, and community members and administered a survey among a convenience sample of young people ages 14–21.

In Uganda, the survey sample consisted of 135 youth who had taken an HIV test and 210 untested youth; in Kenya, researchers interviewed 105 tested and 122 untested youth. Although convenience samples cannot be used to generalize to larger populations, the respondents provided valuable comments and suggestions for improving services for young people. During a second phase, we will test different service delivery and promotional strategies identified in the exploratory phase to determine whether they increase the use of and satisfaction with VCT among young women and men. Key Findings

Most tested youth intend to practice safer sex. Among young people who had taken an HIV test, most said they would adopt safer behaviors, such as abstaining from sexual intercourse, practicing monogamy, using condoms, or reducing the number of sexual partners. Males and females reported similar intentions, except in Uganda, where the proportion of females who intend to practice monogamy is significantly greater than that of males. Counseling is a valued part of HIV testing. When asked to name the satisfactory aspects of their testing experience, clients mentioned the counseling more than any other component.

This happened even though the quality of counseling varied from service to service. One 21-year-old Kenyan woman commented positively on her experience: 1 “[The counselors who] gave me courage to go for the test were so friendly. They encouraged me that whatever the results I should not give up. I liked the fact that they told me to go back to them after the test. ” Yet some youth were disappointed with their testing experience, primarily because they did not receive counseling with the test. This occurred less often in Uganda than in Kenya, where fewer testing facilities provide truly voluntary services and good counseling.

Notably, one in four tested youth in the Nairobi group did not talk with a service provider before the HIV test. The same proportion of youth did not receive posttest counseling, and instead got their test results either as a written report or from a third person such as a parent. A 21-year-old Kenyan woman who found out she is HIV-positive expressed disappointment with the way she was dismissed after her test: “They should have sat me down and explained my status and counseled me on how I should take care of myself instead of treating me as if I were the first one to be diagnosed HIV-positive.

They made me feel as if I would die tomorrow. Most youth disclose their HIV test results. Only two young people in Uganda and ten in Kenya who got tested told no one about their serostatus. The most frequent response to the question “With whom did you share your test results? ” was partners/spouses and peers. Fewer than one-fourth told parents about their test results. Some said that they did not want their parents to know that they are sexually active. Others feared that their parents, especially their mothers, would worry if they knew about the testing.

The majority of untested youth would take an HIV test. Seventy-seven percent of untested respondents in Kenya and more than 90 percent in Uganda said they would like to be tested for HIV at some point in the future. Young people said they would be attracted to VCT if the services are confidential and inexpensive and if the results are reported to them honestly. Service providers are not equipped to respond to youth issues. Service providers interviewed in Kenya and Uganda reported that counseling young people requires special training and improved, youth-oriented referral services.

Because many youth do not easily open up when asked to explain their problems or answer sensitive questions, providers require training to develop the skills needed to work with these clients. However, some youth tell them so much about their personal lives that it is often difficult for counselors to respond. Counselors reported frustration when youth do not return for follow-up or ignore such advice as discontinuing unprotected sex. 2 HIV VCT Among Youth More support services are needed for counseled youth in Uganda.

Ugandan providers said they want to be able to refer youth who have been raped, threaten suicide, plan to leave home or school, or plan to harm their partners, but few youth-appropriate services or support groups exist. Providers in one clinic formed posttest clubs for youth to help them maintain safe behavior. Building on Research In Uganda, service delivery organizations have used the data from the formative research to design VCT programs that are youth-friendly and provide high-quality voluntary counseling and testing.

The program improvements include:

  • Increased training of service providers in counseling skills for youth about HIV.
  • Use of a separate room and alternative locations so that youth do not have to risk seeing familiar adults or family members when seeking VCT.
  • Reduced price of testing service.
  • Establishment of a referral system for young clients that providers can use at all locations.
  • Improved outreach to schools and youth groups.
  • Introduction of VCT at a youth reproductive health center.
  • A multimedia campaign to inform youth about VCT.

In Kenya, project partners are planning to develop and implement special services for youth, including:

  • Opening an adolescent counseling and recreational center where youth have access to free VCT, among other services.
  • Introducing youth-friendly VCT services at existing facilities, such as fast-tracking youth seeking VCT.

By helping clients learn their HIV serostatus and creating a personalized HIV risk reduction plan, VCT can provide the information and support necessary to change risky behaviors that could lead to HIV infection or transmission (CDC 1994). Counseling, both before and after the test, and a risk reduction plan are the key features that distinguish VCT from other HIV testing services. VCT has become a widely advocated HIV/AIDS prevention strategy among adults. Most clients of VCT services are in their mid- to late twenties (Coates et al. 998; Ladner et al. 1996; Allen et al. 1992). Sixty percent of all new HIV infections in sub-Saharan Africa, however, occur among young people between the ages of 10 to 24 (UNAIDS 1998). Will VCT work as well for youth? Because few young people use any health services, using VCT as a strategy to reduce risk behaviors among young people appears to be more challenging than it would be among adults. Findings from exploratory research at two sites in Uganda and one site in Kenya provide some answers to this question.

Specifically, researchers sought to understand young people’s experiences with HIV testing and the factors that inhibit or motivate youth to use testing services. Researchers, in partnership with service-providing organizations, used these findings to develop strategies to reach youth with VCT services. Methods Teams of researchers and service providers conducted the study in Nairobi, Kenya, and in Kampala and Masaka, Uganda. The research team conducted a survey, in-depth interviews, and focus group discussions among convenience samples of youth, parents and community leaders, and service providers.

Uganda Project Partners AIDS Information Center (AIC) Buganda Kingdom Youth Project Center Kitovu Hospital Mobile Home Care Programme Makerere University Naguru Teenage Information and Health Center The AIDS Support Organization (TASO) 4 HIV VCT Among Youth not ask survey respondents to disclose their HIV status. Given the focus of the study on services that youth had received, regardless of their HIV status, the research team felt that asking about a youth’s HIV status was invasive and not necessary to enhance our understanding of young people’s testing experiences.

However, several HIV-positive youth disclosed their status during in-depth interviews. Study Site and Population For the purposes of this study, youth is defined as being between the ages of 14 and 21 years. The survey sample sizes are, in Kenya, 105 tested youth and 122 untested youth and, in Uganda, 135 tested youth and 210 untested youth. All quantitative findings in this report are based on these convenience samples.

Although convenience samples cannot be used to generalize to larger populations, the findings do reveal important insights into youth experiences with HIV testing. Youth respondents also provided valuable suggestions for improving services for young people. Because the convenience sample did not include equal numbers of girls and boys at all sites and because sex-disaggregated sample sizes were subsequently small, we present data analyzed by sex only when there were interesting differences between males and females.

As part of the study, the research team interviewed staff at seven of the inventoried sites that provide youth services as well as at six additional HIV testing facilities in Kibera that young people themselves identified. Most of these organizations provide general health services to fewer than ten young clients per month. Only four organizations serve more than 20 young people on average per month, although two services see an average of 500 female and 800 male clients of all ages per month for their general health care services.

Each testing service—including the project partners and the other services used by youth in the study—provides a slightly different configuration of HIV testing and counseling. For example, some services provide pretest counseling but refer youth elsewhere for the blood test and ask them to return with the result for posttest counseling. Other services provide testing but not counseling. HIV testing as part of antenatal care may not always be voluntary at all services. Some youth attended a VCT day organized at their school.

Many youth in the sample had taken an HIV test at a center separate from the location where they were recruited for this study. These variations reflect the realities of HIV testing services in Nairobi and should be kept in mind while interpreting the study results. Kampala and Masaka, Uganda Research partners again helped recruit young people for the study in Uganda. Tested youth in Kampala were recruited through the main branch of the AIDS Information Center (AIC), the Naguru Teenage Information and Health Center, and the Buganda Kingdom Youth Project Center.

In Kampala, researchers found it was relatively easy to identify tested youth without going through the providers’ networks. Most tested youth in Kampala had their test at a clinic, although hospitals, youth centers, and blood banks were also common places for testing. We recruited untested youth 7 from the Naguru Teenage Information and Health Center, the Nakawa marketplace, secondary schools, and elsewhere in the Naguru community. We recruited parents for focus groups and interviews from the Nakawa marketplace, parent-teacher associations, and two churches.

In Masaka, the research team depended more heavily on the providers’ networks to locate tested youth. We recruited tested youth in Masaka from the mobile clinic network and a farming school where the Kitovu Hospital Mobile Home Care Programme operates. Therefore, most tested youth reported they had their test at a school or hospital, and some reported having it at a clinic. We recruited untested youth from communities in the catchment areas of the Kitovu Hospital Mobile Home Care Programme. We recruited parents from parent-teacher associations and from those who brought their children for counseling at The AIDS Support Organization (TASO).

In both Masaka and Kampala, it was difficult to recruit younger participants, especially those between the ages of 14 and 15. For tested youth, it was easier to recruit tested males in Masaka because most farming school students are male. In Kampala the research team identified more tested females, and service providers in Uganda confirmed the tendency for higher numbers of females to request HIV testing in the city and more males to request HIV testing up-country. Separate HIV testing first became available in Uganda in 1990 in response to the growing number of people seeking to learn their HIV status through donating blood.

Various public facilities offer HIV testing, including the major district referral hospitals, the STD Clinic at Mulago Hospital, the Nakasero Blood Bank, Kampala City Council Health Centers (in Naguru, Kawempe, and Kiswa), and the Uganda Virus Research Institute. Testing in Kampala and Masaka is also available through private practitioners and nongovernmental organizations (NGOs), including the project partners. HIV testing is generally available to both adults and young people throughout Uganda. As in Kenya, however, these are not necessarily youth-focused services.

One existing directory, compiled by the Makerere Institute of Social Research and AIC, lists the major HIV-related service providers in Kampala, but no up-to-date record of the institutions offering such services specifically for young people is available. Youth in Kampala have more options than youth in Masaka for facilities that offer HIV testing, including AIC’s main branch, the Naguru Teenage Information and Health Center; other private facilities; and major hospitals. AIC youth-specific activities include free testing days in Kampala and educational outreach in schools and youth groups.

In Masaka, youth may seek an HIV test at TASO, Kitovu Hospital, or AIC’s indirect site at Masaka Hospital. In both cities, youth centers, which often provide HIV/AIDS counseling, also refer youth to AIC and hospitals for pretest and posttest counseling and the HIV test. The number of youth going to these services varies. The Naguru Teenage Information and Health Center, for instance, reports seeing an average of 350 youth per month for various health concerns; 60 percent of these youth are between the ages of 14 and 19.

The research team was interested in determining how closely the testing experiences of Kenyan and Ugandan youth match the VCT model (see Box 2). Since pretest and posttest counseling are distinguishing elements of VCT, researchers asked tested youth about the counseling components of their testing experience. Researchers also asked young people how they received their test results and whether follow-up care was offered. Researchers found that many young people’s testing experience did not closely match the VCT model. Box 2 What is the VCT model?

VCT is the process by which a person undergoes counseling enabling him or her to cope with stress and make informed choices about HIV testing. Confidentiality of counseling sessions, test results, and the voluntary choice to test are emphasized. Decision to seek testing Pretest counseling The test process The implications of testing Risk assessment & risk prevention Coping strategies Decision to test Preventive counseling No Yes Posttest counseling HIV-negative News given Risk reduction plan made Discussion about disclosure of HIV status HIV-positive News given Risk reduction plan made Discussion about disclosure

Follow-up counseling and support Medical care Emotional support Social support 10 HIV VCT Among Youth Nearly 20 percent of all tested youth did not talk to a health worker before taking the test. According to a 16-year-old female from Nairobi, “Nobody counseled me and I was afraid. ” As shown in Table 2, in Masaka, more young people had posttest counseling than pretest counseling , while in Kampala and Nairobi the reverse is true. In general, counseling appears to be more common among our sample in Uganda than in Kenya, with more Ugandan youth reporting pretest or posttest counseling than their Kenyan counterparts.

HIV transmission Abstinence Condoms STIs infections Limiting number of sexual partners Monogamy Confidentiality of counseling session Second test Partner notification/discussion of VCT and HIV Bringing sexual partner for testing How the test is done Stages of HIV Returning for results Possibility of refusing the test Implications of being HIV-positive How to seek support if HIV-positive Who to tell HIV status to if HIV-positive How to tell someone you are HIV-positive * This table is based on convenience samples at selected sites.

These findings indicate that young people’s experiences with counseling are uneven. Young people may miss opportunities to develop personalized risk reduction plans. Although many youth received some form of counseling, such counseling is not universal and may not cover the range of topics recommended in VCT. Additionally, the lack of follow-up referrals is of particular concern. Without adequate referrals, young people may not have adequate access to health care and support services. 12 HIV VCT Among Youth Most Tested Youth Intend to Practice Safer Sex

Among the 235 young Figure 1 Behavioral intentions of tested youth people who have taken an HIV test, Since having an HIV test, do you intend to: 100% most intend to adopt safer sexual behaviors 80% after the HIV test. Kampala (n=84) 60% These include Masaka (n=46) abstaining from 40% Nairobi (n=105) sexual intercourse, 20% practicing monogamy, 0% using condoms, or reducing the number Decrease Abstain Use Practice number of condoms monogamy of partners with partners whom they have sexual intercourse. Both males and emales report similar intentions, except in Kampala, where the proportion of females who intend to practice monogamy is greater than that of males (84 and 72 percent, respectively).

Researchers asked youth only about their intentions and not whether they actually adopted these behaviors. We therefore could not measure the impact of HIV testing on actual behaviors. During in-depth interviews in Kampala, several girls indicated that they would encourage their partners to also have an HIV test, and that they might break off the relationship if the partner refused. This decision is, perhaps, another risk-reducing behavior.

Below are some examples of what these females said about this topic: “I will talk to my boyfriend about the results. I will also request him to come for the HIV test. If he refuses we may have to separate. ” [18-year-old female, Kampala] “I didn’t tell my boyfriend [my results] because I had asked him to come with me and test, but he had persistently refused to listen to me. I am just going to leave him because he might infect me later. ” [20-year-old female, Kampala] It is interesting that some youth intend to practice safer sex even though they did not receive counseling.

Respondents Young People Want to Know Their HIV Status Survey results show that youth have a strong interest in knowing about their HIV status. More than 75 percent of untested youth in Kenya and about 90 percent in Uganda indicate they would like to be tested in the future. Furthermore, of those youth who have already had an HIV test, a similarly 13 large majority (74 percent in Kenya, 84 percent in Uganda) indicate they intend to repeat the test. Some have already proceeded with a second test. Untested youth are aware of existing testing services.

A majority of untested youth—more than eight out of ten—in all three samples can correctly name at least one facility that provides HIV testing services. However, they do not always name the nearest site or sites that provided youth-friendly services. Only 11 percent of untested youth in Nairobi named a service provider within their communities. Additionally, many untested youth who named hospitals as a source for testing services said that they assumed that such large facilities automatically provide HIV testing and counseling among their services. This assumption may or may not be the case.

Young people seek HIV tests while healthy. Young people usually seek an HIV test while they are healthy. Having HIV symptoms and feeling ill are seldom reasons that tested youth give for finding out their serostatus. Rather, the most commonly cited reason that tested youth give for getting an HIV test is to “know their HIV status in general. ” This reason is given by 84 percent of Ugandan youth. Reasons cited less frequently in Uganda include “distrust of partner” (30 percent), “being worried” (21 percent), and “exposure to HIV risk” (22 percent), and in Kenya, “pregnancy” (21 percent) and “service provider referral” (10 percent).

In Kenya, 7 percent of the sample report that the decision to have a test was not theirs but a parent’s or doctor’s, and several say they were not informed they had been tested for HIV. Few youth in any site mentioned “plans to marry” as a reason for the HIV test. Among tested youth, some 10 percent to 30 percent report that they have never had sexual intercourse (see Table 1). This finding suggests that young people may know little about how HIV is transmitted, or that they use VCT services to get accurate information about HIV.

Service providers’ perceptions of the reasons young people give for having an HIV test are somewhat different than those that youth reported. According to our in-depth interviews, service providers believe youth seek HIV tests because of exposure to HIV risk. This reason was given by two-thirds of the Kenyan service providers interviewed in the study. “To know one’s status” is the least common reason given by service providers in Uganda, perhaps because this answer encompasses more specific answers.

Other common reasons that providers gave include distrust of a partner and having HIV symptoms. About 77 percent to 93 percent of untested youth say they want to be tested in the future, and these youth also plan to get tested while healthy. “Knowing one’s status in general” again emerges from the survey as the most common reason for wanting an HIV test. This response is given by approximately 80 percent of all untested youth. Untested youth less frequently cite “plans to marry” in both countries and “distrust of partner” in Uganda as reasons they would like an HIV 4 HIV VCT Among Youth test. Even fewer young people count exposure to HIV risk, having STD symptoms, or having HIV/AIDS–like symptoms among the reasons they would like an HIV test.

When asked why other youth probably go for an HIV test, Ugandan youth cited prevention. One male explained that the purpose of testing is “to know your status and plan accordingly depending on the results one gets. ” Another commented, “Some people who really care about their health, they deliberately go for medical check-up and even test for HIV. Having an HIV test while healthy usually opens up the possibility of using the testing experience as a preventive measure. A Ugandan youth stated simply how testing could be used as a tool for prevention, even if there has been prior exposure to risk: “You may just want to know your serostatus after messing up with so many women, then when you find that you do not have HIV, you may decide to abstain and wait for the time to marry and you go with your partner for the test. ” [male, 18 to 21 age group, Masaka] Youth Appreciate Counseling

When we asked young people what they liked about their testing experience, “advice” was the most common response (see Figure 2). In-depth interviews and focus group discussions give further insight into the importance of counseling. “These people, that is, the people who gave me courage to go for the test [the counselors], were so friendly. They encouraged me that whatever the results I should not give up. I liked the fact that they told me to go back to them after the test and tell them the results so that if there was something we needed to share, we would. [21-year-old female, Nairobi] “The counselor prepared us so that we could take the results well whether they were positive or negative. ” [19-year-old male, Nairobi] Yet some youth were disappointed with their testing experience, primarily because they did not receive counseling with the test. This occurred less often in Uganda than in Kenya, where fewer testing facilities provide counseling.

A 21-year-old Kenyan woman who found out she is HIVpositive expressed disappointment in the way she was dismissed after her test: “They should have sat me down and explained my status and counseled me on how I hould take care of myself instead of treating me as if I were the first one to be diagnosed HIV-positive. They made me feel as if I would die tomorrow. ” 15 Even though some young people did not benefit from VCT-quality counseling, counseling proved to be the cornerstone of the testing experience. Providing full-scale VCT, or at least strengthening existing counseling efforts, would go far to increase youth satisfaction with and demand for HIV testing.

Warm reception Quick service Confidentiality Free Professionalism entertainment of health care workers Advice/ information given Kampala (n=85) Masaka (n=48) Nairobi (n=105) Several Factors Deter Youth from Seeking HIV Tests Different patterns in the process of deciding to take an HIV test emerged in Kenya and Uganda. Between 45 percent and 53 percent of Ugandan youth in our survey took a month or longer—quite some time—from the time they made the decision to seek an HIV test to actually go to a testing facility. Many untested youth (32 percent to 44 percent) also said they are still thinking about taking the test.

Many Kenyan youth (41 percent), however, took the test the same day—often within hours—that they made the decision to do so. Half of these youth reported that they had the test in response to the referral of a service provider or because of a pregnancy. For some of these youth, the decision to have an HIV test may not have been theirs alone. Promoting the benefits of VCT among Kenyan youth may increase the number who request HIV tests without prompting from service providers. 16 HIV VCT Among Youth Kenyan youth think testing is only for the ill. Although most Kenyan youth ho had an HIV test did so while healthy, focus group discussions with youth and adults reveal that the community perceives that young people seek tests only when ill. In actuality, only 7 percent of tested youth had the test because they felt ill. Similarly, only 4 percent of untested youth surveyed in Kenya said they wanted a test because of HIV-like symptoms. When explaining why they believe other youth in their community have an HIV test, however, untested Kenyan youth clearly associate seeking an HIV test with finding the cause of an existing illness.

The youth considered the HIV test to be a tool for doctors to use in diagnosing a problem and determining appropriate treatment. Only those who suspect they have HIV or other illnesses seek a test. “If you feel you are healthy, there is no point of having your blood drawn and you don’t have that disease,” according to one Kenyan female. The parents and community leaders interviewed in Kenya concurred that testing is only for those who are ill. One pastor in a focus group discussion noted that “residents of this community don’t go for HIV tests.

They only go for treatment of opportunistic diseases. ” It is through the process of diagnosing an illness that young people are tested for HIV, according to community members in the study. Having an HIV test to know one’s status generally or to prevent the spread of HIV was mentioned only rarely. There is, then, a difference between why young people actually want to go for an HIV test and why the community (including youth) thinks youth decide to have an HIV test. This perception (that testing is only for the ill) may discourage some healthy youth who want an HIV test from seeking it.

A Kenyan male explained, “If you have sex with someone who has AIDS and you were planning to go for a test, you will not because if people learn about it, they will isolate you. ” In all focus groups and key informant interviews, parents and community leaders associated seeking an HIV test as an indication that a young person is sexually active. This may be a deterrent to young people who would like to know their HIV status but are not prepared to disclose sexual activity, since that behavior may be socially unacceptable. As a parent, especially for the boy, I would start imagining he has started moving out with women and I would get very worried. ” [mother, Uganda] “There is nothing you can do, but it surprises you because you had never expected such a child to be playing sex. ” [parent, Uganda] “In that age group you’ve mentioned, there is fear. According to the African culture, a child in that age group cannot tell his father that he wants to go for an HIV test. You know this will mean that he is indulging in immoral behaviors and this is not acceptable. [male community member, Nairobi] In contrast, during focus groups, young people said parents who know their child wants an HIV test could be a source of support for him or her.

However, these same youth acknowledged that it is a difficult subject to discuss and struggled with how to approach an adult. To request an HIV test requires acknowledging sexual activity, which many young people are not prepared to do. One boy could not imagine telling his father. “Father, even though I am in school, the devil entered me and I had sex with girls. [pause] I don’t know how I can tell him. No one suggested approaching parents directly. As a result of stigma and the association of testing with sex, youth are concerned about the confidentiality of services. Two 20-year-old females in Kampala described how important confidentiality was in their testing experiences. “[I] like it when they didn’t ask for my name,” one of them commented. The other said, 19 “What I liked best about the HIV testing service was the confidentiality. First of all, when you [go] for the test, you and your partner talk to a counselor alone; therefore you can tell him anything without fearing that others are listening.

And secondly, your results are given to you individually or with your partner if you wish. ” Twenty-one of 30 service providers interviewed in Kenya said they would ensure client confidentiality by not sharing a client’s medical records with anyone. Some, but not all, providers offered such protections as locked areas or restricted access to medical records. However, when given a hypothetical scenario of a friend’s child requesting an HIV test, five of the 30 service providers said they would inform the parent, and another five said they would determine whether the child planned to inform his or her parents.

Adults have conflicting attitudes about youth receiving confidential testing services. Parental and community attitudes in Uganda about young people testing for HIV are not generally supportive, perhaps because the test signals sexual activity. Young people reported disapproving responses and outright antagonism from their parents if they knew that their child had taken an HIV test. Parents were reluctant to support young people under the age of 18 to go for HIV testing without their consent. Kenyan parents had conflicting views about young people seeking HIV tests independently and keeping their results confidential.

Parents gave a variety of ages, ranging from 10 to 30 years, at which youth should be able to seek an HIV test without parental consent. One parent’s comment expressed a common attitude in the focus groups: “I feel at this age, they can make independent decisions about their life. If he/she wants to go for testing so be it. ” However, most parents feel that it is also the doctor’s responsibility to find the parents and inform them of their child’s positive or negative HIV status, even if they feel their child can make the decision to have an HIV test on their own.

Some parents seemed to believe that a service provider would inform the parents as a matter of course. “It is the doctor who will come to look for me. He will tell me about my child’s HIV status and I in turn will talk to my child about how he can protect himself, else he will infect so many. ” [mother, Nairobi] Service providers in Kenya echoed the sentiment that young people should tell their parents about having an HIV test, but 19 out of 30 also said they would not require parental consent before providing an HIV test to young clients aged 17 or younger.

Most service providers in Uganda felt that HIV tests should be provided with or without parental consent to any youth who is at an age when sexual activity is common. Service providers gave a variety of ages at which they thought youth may be sexually active. “The youth (14-21 [years old]) should have a right to services and information pertaining to their health, with or without consent in [the] case of minors. ” [female service provider, Kampala] 20 HIV VCT Among Youth Costs prohibit some youth from seeking an HIV test. Cost prevents a number of youth who want an HIV test from having one.

Thirty percent (28) of untested Ugandan youth and 13 percent of untested Kenyan youth cited cost as a reason they have not had an HIV test yet (see Table 4). Masaka youth (in a more rural area) were most likely to say cost prohibited them from seeking a test. Cost also emerged as a topic of concern during focus group discussions. The research team surveyed HIV testing facilities and found that the cost of an HIV test ranges from Ugandan shillings 500 to 9,0001 in Kampala and Masaka and from 410 to 1,600 Kenyan shillings2 in Nairobi.

These rates do not necessarily include counseling services, which may be an added expense. The major providers in Uganda, however, often have free testing days or provide exemptions in cases of financial need. For instance, AIC offers three free testing days a year in Kampala: one for youth, one for couples on Valentine’s Day, and one on World AIDS Day. The Kitovu Mobile Home Care team in Masaka also subsidizes the fee on a case-by-case basis. Most tested youth in both countries had their tests for free or at a subsidized rate.

Most who pay for the test do so with their own money. The next most common group to pay the fee for youth are partners or spouses in Uganda (for 16 youth) and mothers in Kenya (for 19 youth). One young person in Uganda explained how difficult it was to ask someone else for money: “Most youth have no money and the little they use they just ask [for] from parents, but how do youth start asking a parent that I want money to go for HIV testing? ” It is unknown how many tested youth would have been unable to have the HIV test if they had to pay the full rate.

In the latter case, the counseling and referrals for follow-up support that come with VCT may better prepare young clients to receive their results. Peers Play an Important Role for Youth Young people talk to one another about HIV testing. Young people usually learn about HIV from their peers in both Kenya and Uganda. These findings corroborate other research indicating that peers are young people’s primary information source about a range of reproductive health issues. Most youth have discussed HIV/AIDS issues in general with peers, as reported by two-thirds to three-quarters of youth surveyed.

The program improvements include: increasing training of service providers in counseling skills for youth about HIV. Training will combine acquiring skills for working with youth and knowledge of high-quality VCT counseling. A youth-specific VCT counseling curriculum will be developed. Using a separate room and alternative locations so that youth need not meet adult family members when seeking VCT. At one location, a teen center, VCT will be provided regularly during specific hours, and results will be available

Sample Marketing Plan


The following pages contain an annotated sample marketing plan for Blue Sky Clothing. At some point in your career, you will likely be involved in writing—or at least contributing to –a marketing plan. And you’ll certainly read many marketing plans throughout your business career. Keep in mind that the plan for Blue Sky is a single example; no one format is used by all companies. Also, the Blue Sky plan has been somewhat condensed to make it easier to annotate and illustrate the most vital features.

The important point to remember is that the marketing plan is a document designed to present concise, cohesive information about a company’s marketing objectives to managers, lending institutions, and others who are involved in creating and carrying out the firm’s overall business strategy. Five-Year Marketing Plan Blue Sky Clothing, Inc.


This five-year marketing plan for Blue Sky Clothing has been created by its two founders to secure additional funding for growth and to inform employees of the company’s current status and direction. Although Blue Sky was launched only three years ago, the firm has experienced greater-than-anticipated demand for its products, and research as shown that the target market of sport-minded consumers and sports retailers would like to buy more casual clothing than Blue Sky currently offers. They are also interested in extending their product line as well as adding new product lines. In addition, Blue Sky plans to explore opportunities for online sales.

The marketing environment has been very receptive to the firm’s high-quality goods—casual clothing in trendy colors with logos and slogans that reflect the interests of outdoor enthusiasts around the country. Over the next five year, Blue Sky can increase its distribution, offer new products, and win new customers.


Blue Sky Clothing was founded three years ago by entrepreneurs Lucy Neuman and Nick Russell, Neuman has an undergraduate degree in marketing and worked for several years in the retail clothing industry. Russell operated an adventure business called Go West! which arranges group trips to locations in Wyoming, Montana, and Idaho, before selling the enterprise to a partner. Neuman and Russell, who have been friends since college, decided to develop and market a line of clothing with a unique—yet universal—appeal to outdoor enthusiasts. Blue Sky Clothing reflects Neuman’s and Russell’s passion for the outdoors.

The company’s original cotton T-shirts, baseball caps, and fleece jackets and vests bear logos of different sports—such as kayaking, mountain climbing, bicycling, skating, surfing, and horseback riding. But every item shows off the company’s slogan: “Go Play Outside. Blue Sky sells clothing for both men and women, in the hottest colors with the coolest names—such as sunrise pink, sunset red, twilight purple, desert rose, cactus green, ocean blue, mountaintop white, and river rock gray.

Blue Sky attire is currently carried by small retail stores that specialize in outdoor clothing and gear. Most of these stores are concentrated in northern New England, California, the Northwest, and a few states in the South. The high quality, trendy colors, and unique message of the clothing have gained Blue Sky a following among consumers between the ages of 25 and 45.

Sales have tripled in the last year alone, and Blue Sky is currently working to expand its manufacturing capabilities. Blue Sky is also committed to giving back to the community by contributing to local conservation programs. Ultimately, the company would like to develop and fund its own environmental programs. This plan will outline how Blue Sky intends to introduce new products, expand its distribution, enter new markets, and give back to the community.


Blue Sky’s mission is to be the leading producer and marketer of personalized, casual clothing for consumers who love the outdoors. Blue Sky wants to inspire people to get outdoors more often and enjoy family and friends while doing so. In addition, Blue Sky strives to design programs for preserving the natural environment. During the next five years, Blue Sky seeks to achieve the following financial and nonfinancial goals:

  1. Obtain financing to expand manufacturing capabilities, increase distribution, and introduce two new product lines.
  2. Increase revenues by at least 50 percent each year.
  3. Donate at least $25,000 a year to conservation organizations.
  4. Introduce two new product lines—customized logo clothing and lightweight luggage.
  5. Enter new geographic markets, including southwestern and Mid-Atlantic States.
  6. Develop a successful Internet site, while maintaining strong relationships with retailers.
  7. Develop its own conservation program aimed at helping communities raise money to purchase open space.


Blue Sky seeks to use its core competencies to achieve a sustainable competitive advantage, in which competitors cannot provide the same value to consumers that Blue Sky does. Already, Blue Sky has developed core competencies in  offering a high-quality, branded product whose image is recognizable among consumers, creating a sense of community among consumers who purchase the products, developing a reputation among retailers as a reliable manufacturer, delivering the requested number of products on schedule. The firm intends to build on these competencies through marketing efforts that increase the number of products offered as well as distribution outlets.

By forming strong relationships with consumers, retailers, and suppliers of fabric and other goods and services, Blue Sky believes it can create a sustainable competitive advantage over its rivals. No other clothing company can say to its customers with as much conviction “Go Play Outside”!


The marketing environment for Blue Sky represents overwhelming opportunities. It also contains some challenges that the firm believes it can meet successfully. Table A illustrates a SWOT analysis of the company conducted by marketers to highlight Blue Sky’s strengths, weaknesses, opportunities, and threats.

The SWOT analysis presents a thumbnail sketch of the company’s position in the marketplace. In just three years, Blue Sky has built some impressive strengths while looking forward to new opportunities. Its dedicated founders, the growing number of brand-loyal customers, and sound financial management place the company in a good position to grow. However, as Blue Sky considers expansion of its product line and entrance into new markets, the firm will have to guard against marketing myopia (the failure to recognize the scope of its business) and quality slippages.

As the company finalizes plans for new products and expanded Internet sales, its management will also have to guard against competitors who attempt to duplicate to products. However, building strong relationships with consumers, retailers, and suppliers should help thwart competitors.


The outdoor retail sales industry sells about $5 billion worth of goods annually, ranging from clothing to equipment. The outdoor apparel market has many entries. L. L. Bean, REI, Timberland, Bass Pro Shops, Cabello’s, and Patagonia are among the most recognizable companies that offer these products.

Smaller competitors such as Title IX, which offers athletic clothing for women, and Ragged Mountain, which sells fleece clothing for skiers and hikers, also grab some of the market. The outlook for the industry in general—and Blue Sky in particular—is positive for several reasons. First, consumers are participating in and i8nvesting in recreational activities that are near their homes. Second, consumers are looking for ways to enjoy their leisure time with friends and family without overspending. Third, consumers are gaining more confidence in the economy and are willing and able to spend more.

While all of the companies listed earlier can be considered competitors, none offers the kind of trendy, yet practical products provided by Blue Sky—and none carries the customized logos and slogans that Blue Sky pans to offer in the near future. In addition, most of these competitors sell performance apparel in high-tech manufactured fabrics. With the exception of the fleece vests and jackets, Blue Sky’s clothing is made of strictly the highest quality cotton, so it may be worn both on the hiking trail and around town.

Finally, Blue Sky products are offered at moderate prices, making them affordable in multiple quantities. For instance, a Blue Sky T-shirt sells for $15. 99, compared with a competing high-performance T-shirt that sells for $29. 99. Consumers can easily replace a set of shirts from one season to the next, picking up the newest colors, without having to think about the purchase. A survey conducted by Blue Sky revealed that 67 percent of responding consumers prefer to replace their casual and active war more often that other clothing, so they are attracted by the moderate pricing of Blue Sky products.

In addition, as the trend toward health-conscious activities and concerns about the natural environment continue, consumers increasingly relate to the Blue Sky philosophy as well as the firm’s contributions to socially responsible programs.


The target market for Blue Sky products is active consumers between the ages of 25 and 45—people who like to hike, rock climb, bicycle, surf, figure skate, in-line skate, ride horses, snowboard or ski, kayak, and other such activities. In short, they like to “Go Play Outside. They might not be experts at the sports they engage in, but they enjoy themselves outdoors. These active consumers represent a demographic group of well-educated and successful individuals; they are single or married and raising families.

Household incomes generally range between $60. 000 and $120,000 annually. Despite their comfortable incomes, these consumers are price conscious and consistently seek value in their purchases. Regardless of their age (whether they fall at the upper or lower end of the target range), they lead active lifestyles. They are somewhat status oriented but not overly so.

They like to be associated with high-quality products but are not willing to pay a premium price for a certain brand. Current Blue Sky customers tend to live in northern New England, the South, California, and the Northwest. However, one future goal is to target consumers in the Mid-Atlantic states and Southwest as well.

All bear the company log and slogan, “Go Play Outside. ” The firm has researched the most popular colors for its items and given them names that consumers enjoy—sunset red, sunrise pink, cactus green, desert rise, and river rock gray, among others. Over the next five years, Blue Sky plans to expand the product line to include customized clothing items. Customers may select a logo that represents their sport—say rock climbing. Then they can add a slogan to match the logo, such as “Get over It. ” A baseball cap with a bicyclist might bear the slogan, “Take a Spin.

At the beginning, there would be ten new logos and five new slogans; more would be added later. Eventually, some slogans and logos would be retired, and new ones introduced. This strategy will keep the concept fresh and prevent it from becoming diluted with too many variations. The second way in which Blue Sky plans to expand its product line is to offer items of lightweight luggage—two sizes of duffel bags, two sizes of tote bags, and a daypack. These items would also come in trendy an basic colors, with a choice of logos and slogans. In addition, every product would bear the Blue Sky logo.


Currently, Blue Sky is marketed through regional and local specialty shops scattered along the California coast, into the Northwest, across the South, and in northern New England. So far, Blue Sky has not been distributed through national sporting goods and apparel chains. Climate and season tend to dictate the sales at specialty shops, which sell more T-shirts and baseball caps during warm weather and more fleece vests and jackets during colder months.

Blue Sky obtains much of its information about overall industry trends in different geographic areas and at different types of retail outlets from its trade organization, Outdoor Industry Association. Over the next three years, Blue Sky seeks to expand distribution to retail specialty shops throughout the nation, focusing next on the Southwest and Mid-Atlantic regions. The firm has not yet determined whether it would be beneficial to sell through a major national chain such as REI or Bass Pro Shops, as these outlets could be considered competitors.

In addition, Blue Sky plans to expand online sales by offering the customized product line via Internet only, thus distinguishing between Internet offerings and specialty ship offerings. Eventually we may be able to place internet kiosks at some of the more profitable store outlets so consumers could order customized products form the stores. Regardless of its expansion plans, Blue Sky fully intends to monitor and maintain strong relationships with distribution channel members.


Blue Sky communicates with consumers and retailers about its products in a variety of ways. Information about Blue Sky—the company as well as its products—is available via the Internet, direct mailings, and in person. The firms’ promotional efforts also seek to differentiate its products from those of its competitors. The company relies on personal contact with retailers to establish the products in their stores. This contact, whether in-person or by phone, helps convey the Blue Sky message, demonstrate the products’ unique qualities, and build relationships.

Blue Sky sales representatives visit each store two or three times a year and offer in-store training on the features of the products for new retailers or for those who want a refresher. As distribution expands, Blue Sky will adjust o meet greater demand by increasing sales staff to make sure it stores are visited more frequently. Sales promotions and public relations currently make up the bulk of Blue Sky’s promotional strategy. Blue Sky staff works with retailers to offer short-term sales promotions tied to event and contests.

In addition, Nick Russell is currently working with several trip outfitters to offer Blue Sky items on a promotional basis. Because Blue Sky also engages in cause marketing through its contribution to environmental programs, good public relations have followed. Nontraditional marketing methods that require little cash and a lot of creativity also lend themselves perfectly to Blue Sky. Because Blue Sky is a small, flexible organization, the firm can easily implement ideas such as distributing free water, skiers, and discount coupons at outdoor sporting events.

During the next year, the company plans to engage in the following marketing efforts:

  • Create a Blue Sky Tour, in which several employees take turns driving around the country to campgrounds to distribute promotional items such as Blue Sky stickers and discount coupons
  • Attend canoe and kayak races, bicycling events, and rock climbing competitions with our Blue Sky truck to distribute free water, stickers, and discount coupons for Blue Sky shirts or hats.
  • Organize Blue Sky hikes departing from participating retailers. Hold a Blue Sky design contest, selecting a winning slogan and logo to be added to the customized line.


As discussed earlier in this plan, Blue Sky products are priced with the competition in mind. The firm is not concerned with setting high prices to signal luxury or prestige, nor is ti attempting to achieve the goals of offsetting low prices by selling high quantities of products. Instead value pricing is practiced so that customers feel comfortable purchasing new clothing to replace the old, even if it is just because they like the new colors.

The pricing strategy also makes Blue Sky products good gifts—for birthdays, graduations, or “just because. ” The customized clothing will sell for $2 to $4 more than the regular Blue Sky logo clothing. The luggage ill be priced competitively, offering a good value against it competition.


Though its history is short, Blue Sky has enjoyed a steady increase in sales since its introduction three years ago. Figure A shows these three years, plus projected sales for the nest three years, including the introduction of the two new product lines.

Additional financial data are included in the overall business plan for the company. The timeline for expansion of outlets and introduction of the two new product lines is shown in Figure B. The implementation of each of these tasks will be monitored closely and evaluated for its performance. [pic] Blue Sky anticipates continuing operations into the foreseeable future, with no plans to exit this market. Instead, as discussed throughout this plan, the firm plans to increase its presence in the market.

At present, there are no plans to merge with another company or to make a public stock offering.  The executive summary outlines the who, what , where, when , how, and why of the marketing plan. Blue Sky is only three years old and is successful enough that it now needs a formal marketing plan to obtain additional financing from a bank or private investors for expansion and the launch of new products. The company description summarizes the history of Blue Sky—how it was founded and by whom, what its products are, and why they are unique.

It begins to “sell” the reader on the growth possibilities for Blue Sky. It is important to state a firm’s mission and goals, including financial and nonfinancial goals. Blue Sky’s goals include growth and profits for the company as well as the ability to contribute to society through conservation programs. This section reminds employees as well as those outside the company (such as potential lenders) exactly what Blue Sky does so well and how it plans to achieve a sustainable competitive advantage over rivals.

Note that here and throughout the plan, Blue Sky focuses on relationships. The situation analysis provides an outline of the marketing environment. A SWOT analysis helps marketers and others identify clearly a firm’s strengths, weaknesses, opportunities, and threats. Again relationships are a focus. Blue Sky has also conducted research on the outdoor clothing market, competitors, and consumers to determine how best to attract and keep customers.

Blue Sky has identified its customers as active people between the ages of 25 and 45. However, that doesn’t mean someone who is 62 and prefers to read about the outdoors isn’t a potential customer as wll. By pinpointing where existing customers live, Blue Sky can make plans for growth into new outlets. The strongest part of the marketing mix for Blue Sky involves sales promotions, public relations, and nontraditional marketing strategies such as attending outdoor events and organizing activities like day hikes and bike rides.


Internet Addiction Effect Research Paper

Internet Addiction The use of the Internet on school campuses and in society has increased dramatically in recent years. Whereas the academic use of the Internet is primarily intended for learning and research, the Internet is primarily intended for learning and research. However, from time to time, cases of over involvement with the Internet have been observed on different campuses. The internet is not a habit. It’s an indelible feature of modern life. Internet Addiction Disorder (IAD) was originally proposed as a disorder in a satirical hoax by Ivan Goldberg, M.

D. , in 1995. He took pathological gambling as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM- IV) as his model for the description of IAD. It is not however included in the current DSM as of 2009. IAD receives coverage in the press and possible future classification as a psychological disorder continues to be debated and researched. Online Activities which, if done in person, would normally be considered troublesome, such as compulsive gambling or shopping, are sometimes called net compulsions.

Others, such as reading or playing computer games, are troubling only to the extent that these activities interfere with normal life. Supporters of disorder classification often divide IAD into subtypes by activity, such as excessive viewing of pornography, overwhelming and excessive gaming, inappropriate involvement in online social networking sites or blogging, and internet shopping addiction. One counter argument is that compulsive behaviors may not themselves be addictive (http://en. wikipedia. rg/wiki/Internet_addiction_disorder). In some respects, addictive use of the Internet resembles other so-called “process” addictions, in which a person is addicted to an activity or behavior rather than a substance (mood-altering drugs, tobacco, food, etc). People who develop problems with their Internet use may start off using the Internet on a casual basis and then progress to using the technology in dysfunctional ways. Many people believe that spending large amounts of time on the Internet is a core feature of the disorder.

The amount of time by itself, however, is not as important a factor as the ways in which the person’s Internet use is interfering with their daily functioning. Use of the Internet may interfere with the person’s social life, school work, or job-related tasks at work. In addition, cases have been reported of persons entering to be a patient with that disorder in order to get attention or sympathy. Treatment options often mirror those for other addictions. Although only a limited amount of research has been done on this disorder, the treatments that have been used appear to be effective (http://www. inddisorders. com/Flu-Inv/Internet-addiction-disorder. html). Dr. Goldberg pointed out two main characteristics of IA: using the Internet leads to constant distress; and damages physical, interpersonal, social status. People believe IA is just like the drug or cigarette addiction, but the psychiatrists believe it’s just like the gaming addiction. About 83 million Americans were connected to Internet in August 1999, by the year 2000 the number of those increased by 12 million. As the number of internet users’ increase, the number of internet addicts increases, and problems it causes.

It is a disaster, because we only know a very few about the true nature of the internet addiction and treatment methods. According to statistic research every second internet user is an internet addict, they spend their lives at chats, forums, online games and other internet services. They cut their words and sentences to a couple of letters like AFK, BB, and MU, to save the time for internet searching. The majority of internet addicts are teenagers; people that are just have started their life, which need to stay outdoors as long as it is possible to grow up strong, smart and intelligent.

But they spent their time sitting in front of the gleaming monitor, talking to virtual friends about the virtual problems of virtual people whom they have never even seen with their own eyes, and probably never will. They recognize the world through Internet information, written by faceless someone for faceless anyone. When they need a book they never go to library, instead they go to Yandex or Google, write the name of the author and the novel they need and here you go, the digital copy of eternal Dostoevsky’s “Idiot” minimized from a hundreds of pages to a couple of kilobytes.

The glimmer of the monitor leads to the visual impairment, anorexia. Coffee, that helps internet users to keep their selves vigil, causes the stomach upset. It’s an irreversible process that changes the whole nature of human psychic and physic. As you can see the internet addiction is an extremely dangerous disease, and it’s very important to know how to recognize it, in order to help and save those you care about (http://www. thelanaddiction. com/index. html). According to Grohol (1999), si ce the aspects of the Internet where people are spending the greatest amount of time online has to do with social interactions, it would appear that socialization is what makes the Internet so “addicting”. That’s right—plain old hanging out with other people and talking with them. Whether it’s via e-mail, a discussion form, chat, or a game online (such as MUD), people are spending this time exchanging information, support, and chit-chat with other people just like themselves. Would we ever characterize any time spent in the real world with friends as “addicting”?

Of course not, teenagers talk on the phone for hours on end, with other people they see every day! Do we say they are addicted to the telephone? Of course not, people lose hours at a time, immersed in a book, ignoring friends and family, and often not even picking up the phone when it rings. Do we say they are addicted to the book? Of course not, if some clinicians and researchers are now going to start defining addiction as social interactions, then every real-world social relationship we have is an addictive one.

Also, in potential explanations for pathological use, Young (1996) initiated telephone surveys to formally study pathological Internet use (PIU) based upon modified criteria of Pathological Gambling defined in the DSM-IV (American Psychiatric Association, 1995). Case studies showed that Dependents classified used the Internet an average of thirty-eight hours per week for non-academic or non-employment related purposes which caused detrimental effects such as poor grade performance among students, discord among couples, and reduce work performance among employees.

This is compared to non-addicts in this study who used the Internet an average of eight hours per week with no significant consequences reported. Subsequent research on PIU based upon a self report determination of addiction was conducted utilizing online survey methods. Brenner (1996) received 185 responses in one month to his online survey regarding behavior patterns associated with the Internet. His survey showed that 17% used the Internet more than 40 hours per week, 58% said that others had complained about their excessive net usage, and 46% indicated getting less than 4 hours of sleep per night due to late night log ins.

Egger (1996) received 450 responses to his online survey. Self-professed addicts in this study often looked forward their next net session, felt nervous when offline, lied about their online use, easily lost track of time, and felt the Internet caused problems on their jobs, finances, and socially. Steve Thompson (1996) developed the “McSurvey” which yielded 104 valid responses. Among respondents to his online survey, 72% felt addicted and 33% felt their internet usage had a negative effect on their lives.

Surveys conducted on college campuses (Morhan-Martin, 1997; Scherer, 1997) also supported that students suffered significant academic and relationships impairment due to excessive and uncontrolled Internet usage. Formal Computer/Internet addiction treatment centers have been established at such clinical setting as Proctor Hospital in Peoria, Illinois and Harvard affiliate McLean Hospital in response to the serious impairment caused by PIU. The Internet itself is a term which represents different types of functions that are accessible online.

Therefore, before discussing addictive nature of the Internet, one must examine the types of applications being used. When dependents were asked “What applications do you most utilize on the Internet? ”, 35% indicated chat rooms, 28% MUDs, 15% News groups, 13% E-mail, 7% WWW, and 2% Information Protocols (e. g. gopher, ftp, etc. ). Upon examination, traditional information protocols and Web pages were the least utilized among Dependents compared to over 90% of respondents who became addicted to the two way communication functions: chat rooms, MUDs, news groups.

Or e-mail. This makes the case that the database searches, while interesting and often times time-consuming are not actual reasons Dependents become addicted to the Internet. Chat rooms and MUDs were the two most utilized mediums which both allow multiple online users to simultaneously communicate in real time; similar to having a telephone conversation except in the form of typed messages. Over 1,000 users can occupy a single virtual area. Text scrolls quickly up the screen with answers, questions, or comments to one another.

Privatized messages are another available option which allows only a single user to read message sent. Multi-user Dungeons, more commonly known as MUDs, differ from chat rooms as these are an electronic spin off the old Dungeon and Dragons games where players take on character roles. There are literally hundreds of different MUDs ranging in themes from space battles to medieval duels. In order to log into a MUD, a user maidens or buys weapons in a make believe role playing game (http://www. healthyplace. com/addictions/center-for-internet-addiction-recovery/what-makes-the-internet-addictive/menu-id-1105/page-2/).

The initial idea behind the internet started in 1961. However, in 1993 the Internet experienced one of its largest growths and today is accessible and used by people everywhere in the world (http://www. teen-beauty-tips. com/internet-addiction. html). 21st century is distinguished with the high rate of business person. High rate of technical progress demands from us quick reaction on external changes of the world, economy and the way of life. Things that are urgent today become totally unnecessary tomorrow, so it takes much time and powers to keep in line.

This constant wild race for new information, new welfare, and for being first leaves us no time for normal life, for going out with our friends, visiting the libraries, visiting our relatives, reading books, news papers, watching films, not only news. We have no time for all that, but we still have a desire to get it, so we’re looking for ways to get it with the minimal loss of time and maximal grant of pleasure. Modern science made it possible. Our dreams became true, we can buy books, films, cloth, visit different countries and our relatives, and reach our friend from the far away without leaving our flats, even without leaving our chairs.

We have an Internet. With the help of internet we fill the emptiness inside us, we compensate the lack of communication and attention we need. Internet saves us from the loneliness we feel. We spend too much time working hardly so we have no strength for our pleasures. But we always have time and strength for internet, because it’s fun, informative and easy, it relaxes us. Therefore, it’s just a one side of the medal. With the lapse of time it becomes integral part of our life, you keep thinking about persons you met there, and you have no other connection with, and you’re dying to chat with them again.

That’s how it starts. You may say its okay to care about someone, about your friends, and there’s nothing terrible they are just words at the contact list if behind them are real people, people you care about. Of course there’s nothing terrible, if it’s just like you say, but just for a minute try to think over, try to remember lust 6 months of your life. First you used internet to communicate with your friends because you were too exhausted to go out and had no time, but now, I bet, you missed a number of opportunities to go out with your friends in a favor of internet communication, don’t you?

I also bet that first there were only those you know in real life at your contact list, and now the number of those hardly reaches 20%. Psychiatrists says that those who are not addict use internet only in order to find necessary information and keep in touch with their friends they knew before, but the addicts constantly surfing internet, without any important reason and multiplies the number of virtual friends they’ve never met in the real life, and never will.

Thus, internet is very attractive for person as a way of escaping from the reality through the anonymous interactions, which gives an opportunity to express oneself without risk of being ridicule or misunderstood. It’s an opportunity to bring to life some fantasies and desires with a feedback, and, of course, unlimited access to the information, so called informational necrosadism (http://www. thelanaddiction. com/the_origin_of_internet_addiction. html).

The term “addiction” is borrowed from psychologist’s lexicon, to stress that internet attachment is a problem; it’s not just a hobby or the way to spend time and communicate, and it’s a serious disorder of mind and psychic. Internet is very attractive for teenagers as it’s totally anonymous. Teenagers often have an inferiority complex because of their appearance or other criteria’s, and internet gives them an opportunity to find soul mates, someone to share their feelings and pain with.

First it helps them not to feel lonely, but in time it turns them to hermit, and they lose their connection with real world, and may even become maniacs. Some scientists distinguish 5 types of Internet Addiction: Pornography Online games Online Gambling Online Shopping Chat rooms/Virtual dating addiction (http://www. thelanaddiction. com/types_of_internet_addiction. html). Over the past few decades, an immense industry for the production and consumption of pornography has grown, with the increasing use of the VCR, the DVD, and the Internet, as well as the emergence of social attitudes more tolerant of sexual portrayals.

Performers in pornography are referred to as pornographic actors (or actresses), or the more commonly known title “porn star” and are generally seen as qualitatively different from their mainstream counterparts. Amateur pornography has become widely popular and generally distributed via the Internet for free (http://en. wikipedia. org/wiki/Pornography). The second addiction is online games. Online games is defined as a common cause if computer addiction. It is consist of multi-player games via the internet. This is where the player assumes a character in the game and plays against other people from all around the world.

There are many internet games on the market and some of them have millions upon millions of players worldwide. The majority of the players involved enjoy just a casual game after school, work, or at weekends. A minority, however, have become so addicted, and alarmingly so, that they are spending upwards of 12 hours per day playing the game they are addicted to. Reports have come in that some people have been playing around the clock and not eating or sleeping for days and days because they do not want to leave the computer and the character they are pretending to be (http://ezinearticles. com/? Types-of-Computer-Addiction&id=551846).

Moreover, the rising of Flash and Java led to an Internet revolution where websites could utilize streaming video, audio, and a whole new set of user interactivity. When Microsoft began packaging Flash as a pre-installed component of IE, the Internet began to shift from data/information spectrum to also offer on-demand entertainment. This revolution paved by the way for sites to offer games to web surfers. Some online multiplayer games like World of War craft, Final Fantasy XI and Lineage II charge a monthly fee to subscribe to their services, while games such as Guild Wars offer an alternative no monthly fee scheme.

Many other sites relied on advertising revenues from on site sponsors, while others, like RuneScape, let people play for free while leaving the players the option of paying, unlocking new content for the members. After the dot-com bubble burst in 2001, many sites solely relying on advertising revenue dollars faced extreme adversity. Despite the decreasing profitability of online gaming websites, some sites have survived the fluctuating and market by offsetting the advertising revenue loss by using the content as a cross-promotion tool for driving web visitors to other websites that the company owns.

The term online gaming in many circles is being strictly defined to describe games that do not involve wagering, although many still use the term online gaming synonymously with online gambling (http://en. wikipedia. org/wiki/Online_game). The third one is, online Gambling. These are possibly the most damaging of all computer addictions. These millions of dollar a year businesses make their money by sucking addicts of their money. The thrill of possible winning by gambling is very real and has never been easier since the onset of online casinos and other forms of online gambling.

Serious debts have been incurred by these computer addicts. Some have even lost everything, their family, homes, possessions, and even more extreme, their lives. There are organizations that specifically deal with this kind of computer addiction and they have helped many thousands of people to get rid of this damaging addiction and have been able to give advice on helping to pull their lives back together again (http://ezinearticles. com/? Types-of-Computer-Addiction&id=551846). There are 4 types of Online gambling, these are, online casinos, online sports betting, online bingo and mobile gambling.

There are a large number of online casinos, in which people can play casino games such as roulette, blackjack, pachinko, baccarat and many others. These games are played against the “house”, which makes money due to the fact that the odds are in its favor. Online Sports Betting, bookmakers, spread betting firms and betting exchanges offer a variety of ways to wager over the Internet on the results of sporting events, the most popular being fixed-odds gambling. Online bingo is the game of bingo played on the Internet. Global betting and Gaming consultants estimates the global gross gaming yield of bingo was $0. billion USD in 2006; they forecast it will grow to $1. 0 billion USD by 2010. Unlike balls used in regular bingo halls, online bingo sites use a random number generator. The online bingo play works almost exactly like playing online poker or online casino games with everything being virtual. Most bingo halls also offer links to online poker and casino offerings. One notable feature of online bingo is the chat functionality. Successful online bingo sites foster a sense of community and interaction between players. And lastly, mobile gambling, it refers to gambling done on a remote wirelessly connected device.

These devices can include wireless tablet PC’s, mobile phones and other non traditional mid-level networked computing devices. Some online casinos and online poker card rooms offer mobile options. (http://en. wikipedia. org/wiki/Online_gambling). The Fourth internet addiction is online shopping, in this kind of addiction comes in the form of many kinds. There is the person who is addicted to buying items from the many online shops. Then there is the person who is addicted to auction type buying. Either one could put a person in debt in a matter of seconds.

Just one click the mouse could take money from their credit card and rack up enormous debts. This type of addiction usually starts with small purchases and paying with their credit card. Many small purchases of this kind then add up to many thousands of dollars. The thrill of bidding on an item in an online auction and then overbidding just to win the item (which they may not really want anyway) does cause addiction. Once the item has been bid on and won, a contract has been entered into. A very easy addiction to get into but very hard to get out once the debt has set in (http://ezinearticles. om/? Types-of-Computer-Addiction&id=551846). Furthermore, online shopping is the process of buying goods and services from merchants who sell on the Internet. Since the emergence of the World Wide Web, merchants have sought to sell their products to people who surf the Internet. Shoppers can visit web stores from the comfort of their homes and shop as they sit in front of the computer. Consumers buy a variety of items from online stores. In fact, people can purchase just about anything from companies that provide their products online.

Books, clothing, household appliances, toys, hardware, software, and health insurance are just some of the hundreds of products consumers can buy from an online store (http://www. wisegeek. com/what-is-online-shopping. htm). (http://ezinearticles. com/? Types-of-Computer-Addiction&id=551846). Also, Virtual Dating Addiction is a disease of outsiders. One can’t find person with the same interests, passions or views in real life, among schoolmates, so he is looking for them at chats, forums, ICQ. On the one hand it’s normal, it helps not to become a self-contain hermit, but on the other hand person lose connection with the real life.

He or she has no need in it anymore, one already have a true friends, who cares they’re just a letters and symbols if they are soul-mates, but in a few month we have the same problem – teenager becomes a hermit (http://www. thelanaddiction. com/types_of_internet_addiction. html). One symptom of Internet addiction is excessive time devoted to Internet use. A person might have difficulty cutting down on his or her online time when they are threatened with poor grades or loss of a job. There have been cases reported of college students failing courses because they would not take time off from Internet use to attend classes.

Other symptoms of addiction may include lack of sleep, fatigue, declining grades or poor job performance, apathy, and racing thought. There may also be a decreased investment in social relationships and activities. A person may lie about how much time was spent online or deny that they have a problem. They may be irritable when offline, or angry toward anyone who questions their time on the Internet (http://www. minddisorders. com/Flu-Inv/Internet-addiction-disorder. html). Skipping meals. When you skip a meal just because you’re enjoying what you are doing in front of the computer, your body reacts with what I like to call “famine mode”.

What I mean by that is that our internal workings tell us that we need food to survive, and if we don’t have it we must find it quickly. Even though we, ourselves, know that we can go at anytime of the day to get nutrients. Human nature hasn’t evolved in such a way that we don’t have primal human instincts and going too long without food makes us eat way too much at the next opportunity. Any food that we do eat, after skipping a meal, will be stored as fats so that in the even of another skipped meal (famine) we will be able to fall back on that stored fat for survival.

The problem with this stored fat is that we never reach the point that we can burn it off, so it translates on the scales in excess weight. There are three major consequences of skipping a meal: Poor Performance, Foggy Head and Binging (calorie loading). However, stress is another contributor to people skipping meals. Stress hormones can actually stop the feeling of “hunger”. This doesn’t mean that your body isn’t starving for nutrients (http://www. inchesweightloss. com/index. php? option=com_content&view=article&id=85:skipping-meals-is-never-a-good-idea&catid=12:blog&Itemid=82). Working with computers can sometimes be stressful.

And dealing with computer stress is really no different than dealing with any other type of stress in life. The more you understand and focus upon the underlying causes computer stress, the better you will fare in trying to cope with it. There are ten (10) common causes of computer related stress: Failing to Anticipate Problems Trying to Get by on the Cheap Failing to Ask for Help Failing to Relate to Stress as Feedback Trying to Cut Corners Unrealistic Expectations Beating Up On Yourself Unnecessarily Conflicts with Other People Failing to Do Your Homework and Compromising Your Own or Other’s Integrity http://stresscure. com/hrn/common. html). Stress symptoms commonly include a state of alarm and adrenaline production, short-term resistance as a coping mechanism, and exhaustion, as well as irritability, muscular tension, inability to concentrate and a variety of physiological reactions such as headache and elevated heart rate (http://en. wikipedia. org/wiki/Stress_(biology)))). Backache is one of the most common ailments prevalent today. Sedentary living habits, hazardous work patterns and psychological conditions associated with emotional stress, which bring about spasm of the muscles, cause backaches.

As the back bears the weight of the entire body, overweight persons feel the strain on the back when they have to carry an extra load. In most cases of backache, the pain is usually felt either in the middle of the back or lower down. It may spread to both sides of the waist and the hips. In a condition of acute pain, the patient is unable to move and is bedridden. About 90% of backache patients suffer from what is called cervical and lumbar spondylosis. It is a degenerative disorder in which the different vertebrae adhere to each other through bony unions. As a result of this, the spine loses its flexibility (http://www. ome-remedies-for-you. com/remedy/Backache. html). On the other hand, Internet Dependency is also one of the signs or symptoms of being an internet addict. Internet Dependency is a term for excessive use of the Internet to the detriment of one’s physical, psychological, social, or vocational well- being. The majority of Americans and virtually all college students now use the Internet as a source of information and entertainment on at least an occasional basis. Most use it on a regular basis without becoming dependent upon it. However, for some, involvement on the internet begins to have serious, negative consequences.

When such consequences are minimized or ignored while Internet use increases, Internet dependency is occurring. Excessive Internet use may revolve around chat rooms, pornography; database searches; blogging; gambling; gaming; shopping; or any number of other online activities. As of 2005, it is estimated that 6% of users are Internet dependent. Being too dependent on the internet may also lead us to Tolerance, Withdrawal and Compulsive Use of Internet that may harm ourselves (http://www. villanova. edu/studentlife/counselingcenter/infosheets/psych_topics. htm? page=internet_depend. tm). Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and/or alcohol or not in front of the computer. The individual feels very uncomfortable, obnoxious or irritable if not engaged in the behavior after sometime. Compulsive Use or Craving. The individual feels a strong compelling need or urge to engage in the behavior, and thereafter plans for the next opportunity to perform the behavior.

About 25% of the people in the world are active Internet users. More than 100 million Facebook users log on at least once per day. Nine blogs are created each minute. As advancements in Internet technology continue to make the world smaller and smaller, new users are plugging into the Net at an unbelievable pace. But what happens when these users are logging too often? Where do you draw the line between harmless and harmful? Many experts today are asking these questions about Internet usage. The internet can be a valuable tool for accessing information, making connections, and maintaining relationships.

People all over the world use their cell phones, laptops, and home computers to access the Internet and branch out in all directions on the information superhighway. But for some, one wrong turn changes the Internet from a mode of communication to a medium of compulsion. Of course, this process seems a little extreme for the everyday Internet user. But think about it: have you ever felt that nagging urge to check your email or Facebook on your iPhone right after you checked it on your laptop? Does receiving a new e-mail or stumbling upon a new website put a smile on your face? Sometimes simple daily pleasure like hese can slowly lead to serious compulsive behaviors (http://neuroanthropology. net/2009/05/28/caught-in-the-net-the-internet-compulsion/). Along with all the positive influence of the Internet, there will always be some negative effects on it. Carpal Tunnel Syndrome or median neuropathy is a painful progressive condition caused by compression of a key nerve in the wrist. It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm.

As symptoms worsen, people might feel tingling during the day, decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In some cases no direct cause of the syndrome can be identified. Most likely the disorder is due to a congenital predisposition – the carpal tunnel is simply smaller in some people than in others. However, the risk of developing carpal tunnel syndrome especially, common in those performing assembly line work (http://www. ninds. nih. gov/disorders/carpal_tunnel/carpal_tunnel. htm). Dry Eyes Syndrome is a chronic lack of sufficient lubrication and moisture in the eye.

Its consequences range from subtle but constant irritation to ocular inflammation of the anterior (front) tissues of the eye. Dry eyes also are described by the medical term, keratitis sicca, which generally means decreased quality or quantity of tears. Keratoconjunctivitis sicca refers to eye dryness affecting the cornea and conjunctiva (http://www. allaboutvision. com/conditions/dryeye. htm). Migraine Headache is a form of vascular headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes the release of chemicals from nerve fibers that coil around the large arteries of the brain.

Enlargement of these blood vessels stretches the nerves that coil around them and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the arteries magnifies the pain. Migraine attacks commonly activate the sympathetic nervous system in the body. The sympathetic nervous system is often thought of as the part of the nervous system that controls primitive responses to stress and pain, the so-called “fight or flight” response, and this activation causes many of the symptoms

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