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Indian Journal of Community Medicine

HIV and AIDS - Awareness and Attitudes among Males in a Rural Population

Author(s): K. Sobhan, T.S. Kumar, G.S. Kumar, R. Ravi Kanth, S. Adarsha, A.S. Mohammad, R. Washington

Vol. 29, No. 3 (2004-07 - 2004-09)

Abstract

Objective: To determine the awareness and attitudes regarding HIV/AIDS among males in a rural population.

Design: Cross-sectional study.

Setting: Villages in the field practice area of the Mugalur Community Health Training Centre, St. John's Medical College, Bangalore, Karnataka.

Respondents: 118 adult males between the age of 15-45.

Study variables: Age, literacy, marital status.

Outcome variable: Proportion of respondents with knowledge or specific attitudes or preference.

Statistical analysis: Comparison between mean scores obtained.

Results: 90% of the rural males had knowledge about HIV/AIDS. 32% knew what caused AIDS. 20 percent could state the effect of HIV on the body. There is inadequate knowledge about the relationship between STD and HIV/AIDS. 75% of the rural males could endorse at least three methods of prevention of HIV/AIDS. The predominant source of information was TV (78%). Friends are a major source of information among the younger males. 57% feel that a person with HIV must be isolated or even put in prison (22%). There is attribution of the risk of acquiring disease mainly to truck drivers or commercial sex workers. There exists a lack of perception of risk that HIV could also affect rural populations. Small proportion of people still feel that there is a cure for HIV/AIDS (14%).

Key words: HIV/AIDS

Introduction

Six persons in a thousand in Asia are living with HIV/AIDS1. India has emerged as the country with the maximum number of HIV infections in the world. Sentinel surveillance of HIV/AIDS in India has revealed that HIV is prevalent in all parts of the country. It is spreading from urban to rural areas and from high risk behaviour groups to general population since 19902.

A study in Tamil Nadu revealed that the prevalence of HIV was 2.1 in the rural area as compared to 0.7 in the urban area. Though the Tamil Nadu study also revealed that the prevalence of HIV among females was 2.0 as compared to 1.4 among males3, males were selected for the study since decisions related to sexual behaviour are invariably taken by the male. Moreover, the only effective protective device against STD/HIV/AIDS is still the male condom.

The study attempts to highlight lacunae in the knowledge of rural males with respect to cause, effect, modes of transmission and methods of prevention of HIV/AIDS as well as to explore attitudes towards prevention, treatment or care of a person with HIV/AIDS. Perception of risk of the individuals to HIV/AIDS is also studied.

Material and Methods

The study design was cross sectional and was conducted during the residential posting of the medical students. The study was conducted in the field practice area of the Mugalur Community Health Training Centre (CHTC) of St. John's Medical College. This centre caters to a population of about 10,000 people in about 16 villages including Mugalur. Four villages, two from each subcentre under the CHTC were selected by random sampling.

In each subcentre/village one fifth of the houses were selected by systematic random Sampling. One male from each of the selected houses who was within the age group (15-45) was chosen for the interview. If the selected household had more than one male then the person for the interview was selected by random. The total number of interviews conducted were 118.

The interview was conducted using a pre-tested interview schedule containing a set of questions with an in-built scoring system, covering various aspects of the disease. The maximum score obtainable by any individual was 35. The data was analysed on the basis of marital status, literacy status, occupation and age group.

Results

The Table I denotes that the mean scores obtained were significantly higher among unmarried, literate and the younger age group i.e., < than 30.

Table I: Demographic Characteristics of The Sample and Mean Scores Obtained.

Variable Characteristic Number (%) Mean
Score
P value for
mean scores
Marital status Married 78 78 (66%) 14.5 'p'=0.01
  Unmarried 40 (34%) 21  
Literacy status Literate 100 (85%) 18.6 'p' = <0.001
  Illiterate 18 (15%) 6.2  
Age distribution 15-30 yrs 75 (64%) 19.2 p <0.001
  31-45 yrs 43 (36%) 13.5  

Among the occupations though the mean score obtained by the coolies and construction workers (14.2) was less than the mean score obtained by agriculturists (15.6), which was less than the mean score of business men (17). The difference was not statistically significant.

The Table II denotes that literacy status is the important factor determining the level of awareness of HIV/AIDS among the males.

Table II: Comparison of Mean Scores by Literacy and Age

Literacy / Age 15-30 yrs age group 31-45 yrs age group* 'p' value
Literate 20 (61) 17 (39) 'p'=0.08
Illiterate 12 (5) 4 (13) 'p'=0.001
Illiterate 12 (5) 4 (13) 'p'=0.001
Pvalue 'p'=0.02 p<0.001

*( ) indicates number of persons in each category.

Basic Knowledge of HIV/AIDS:

90% had heard of AIDS, 32.2 percent knew that the cause of AIDS was a germ (16.9%) or HIV (15.3%). Only 25 percent could state the effect that HIV has on the body. Only 47 (39.8%) could state some relationship between STD (Sexually Transmitted diseases) and AIDS.

TV friends (71-83%), and newspapers (32-36%) were the main sources of information of HIV/AIDS. The proportion of those who received information from friends was significantly higher in the less than 30 years of age (50%) than among the older respondents (29%). Very few respondents received information from health workers. (6-9%).

Modes of spread:

102(86%) persons knew that sexual transmission was the mode of transmission of HIV, 91 (77%) knew about blood transfusion as a mode, 91 (77%) knew about needles/syringes, 88 (74.5%) knew that an infected pregnant mother could transmit the infection to her child and 68 (58%) knew about breast feeding as a mode of transmission4,5.

In the Table III, Weakness rather than loss of weight was the stated symptom.

Table III: Knowledge of Symptoms of AIDS

Symptom Percentage
Fever 28%
Weakness 38%
Diarrhoea 14%
Skin Diseases 16%
Tuberculosis 7%

*Categories not mutually exclusive.

Specific knowledge of HIV/AIDS:

57 respondents (48%) could state that a blood test or HIV test was necessary to detect HIV/AIDS. No one knew the name of the blood test i.e., ELISA or Western Blot. 41 respondents (35%) knew that a person with HIV infection could be without any symptoms. Only 23 respondents (20%) were aware of the possibility of a person having HIV but without symptoms or a positive blood test.

75% of respondents felt that it was necessary to refrain from sex or use a condom with marital partner. Of this 48% felt that the person must refrain from sex while 27% felt that a condom could be used instead. 77% of respondents felt that it was necessary to refrain from sex or use a condom with extramarital partner. Of this 61% felt that it was better to refrain from extramarital sex, while 16% felt that condoms could be used instead. The difference between the proportion of a response by married and unmarried persons was not significant. 22% of respondents thought that other contraceptives such as Cu-T also prevent spread of HIV.

Susceptibility of HIV:

38% of respondents felt that women were more susceptible to HIV. 19% of respondents felt that men were more susceptible to HIV. 23% of respondents felt that both men and women were equally susceptible. 20% gave no response. 52% of respondents felt that both married and unmarried persons were equally susceptible to HIV as opposed to married only (16%) or unmarried (13%). 19% gave no response. 74% of respondents felt that the disease was more urban than rural. Only 1% thought rural people were more susceptible. 13% felt that both rural and urban were equally susceptible. 12% gave no response. The most commonly mentioned occupations that respondents felt were the most susceptible to HIV/AIDS included truck drivers, female sex workers and businessmen who travel frequently.

Attitudes towards treatment or care:

14% of respondents felt that there was a cure for AIDS while 24% were not sure. 57% of respondents felt that a person with HIV/AIDS must be isolated from others while 22% felt that the HIV/AIDS person must be put in prison. There was no stated specific preference for a private practitioner or for government services if one had HIV/AIDS. However, most respondents (48%) preferred English medicine to the traditional systems for treatment for HIV/AIDS.

Discussion

Though 90% had heard of AIDS only 32.2 percent knew that the cause of AIDS was a germ (16.9%) or HIV (15.3%) and only 20 percent could state the effect that HIV has on the body. Friends appear to be an important source of information on HIV/AIDS especially among the younger age group. Peer educators would therefore be a useful strategy for communication in this group5. The low mean scores obtained by illiterate individuals and married persons especially above the age of 30 indicate that they must be also be paid special attention with respect to HIV/AIDS eduation. In a rural area the occupation of the individual does not appear to influence his knowledge on HIV/AIDS. A substantial percentage of respodents feel that a person with HIV must be isolated (57%) or even put in prison (22%). These attitudes must be addressed. Messages on community based care for HIV positive individuals or people living with AIDS may be delivered6,7,8. There is still a tendency to attribute the risk of acquiring disease mainly to truck drivers or commercial sex workers. The fact that the sero-prevalence of HIV among antenatal women in Karnataka exceeds 1%2 and that the seroprevalence in bordering Tamil Nadu is 1.596 must be emphasised so that people perceive that anybody who is sexually active is at risk of acquiring HIV. There exists a lack of perception of risk that HIV could also affect rural populations. Targeted interventions are therefore perhaps necessary even in the rural areas. There is still inadequate knowledge of the relationship between STD and HIV/AIDS. Small proportions of people still feel that there is a cure for HIV/AIDS (14%). This myth needs to be addressed.

Acknowledgements

The authors would like to thank the department of Community Health, St. John's Medical College for providing an opportunity to conduct the study. A special thanks to the resident medical officer, post graduates and community health worker for their help and guidance. A thank you to the respondents of the study for their enthusiasm and co-operation. Finally a note of acknowledgement to the office staff for their help with computer entry and analysis.

References

  1. Dobson R. "AIDS - dramatic surge in ex-Soviet union, no respite worldwide, new data show. Bulletin of the WHO/International Journal of Public Health, 2001; 79:78
  2. NACO : "Country Scenario of HIV/AIDS" 1997-98
  3. APAC : "Community Prevalence of Sexually Transmitted Diseases in Tamil Nadu - a report 1998; 24.
  4. UNAIDS, UNICEF/WHO : "HIV and Breast Feeding - a review of HIV transmission through breast feeding" WHO/FRH/NUT/CHD/98.3
  5. Baldo M: "Peer Education : a successful strategy with some constraints" Sexual Health Exchange 1998; 4: 1-3.
  6. Improving Access to Care : AIDS Action 2000;46: 1-3.
  7. Piyavorawong S, Suebsaeng L. "Community Based HIV/AIDS Care : a successful model from Thailand". AIDS Watch 2000;1-3.
  8. Gilks C, Floyd K, Haran D et al. Sexual Health and Health Care: Care and support for people with HIV/AIDS in resource poor setting. Health and Population Occasional Paper, DFID, 1998.

Department of Community Medicine,
St. John's Medical College, Bangalore

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