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Indian Journal of Community Medicine

Effectiveness Of Various IEC In Improving Awareness And Reducing Stigma Related To HIV/AIDS Among School Going Teenagers

Author(s): Neeraj Raizada, Chitra Somasundaram, JP Mehta, VP Pandya

Vol. 29, No. 1 (2004-01 - 2004-03)

Deptt. of Community Medicine, M.P. Shah Medical College, Jamnagar

Abstract :

Research question: Is HIV/AIDS related stigma prevalent among adolescents and what is the effectiveness of various IEC in reducing it?

Objective: To find out the effectiveness of various IEC in improving awareness and reducing HIV/AIDS related stigma.

Study design: Interventional study.

Participants: 1000 students from class XI and XII from 7 schools of Jamnagar City, Gujarat.

Interventions: Interpersonal communication, pamphlets and educational video presentation.

Statistical analysis: Simple proportions.

Results:

HIV related stigma was indeed prevalent among adolescents and interpersonal communication emerged as the most effective IEC in reducing it.Remarkable improvement was observed in awareness in all the types of interventions.

Keywords : Stigma, Destigmatization, Interpersonal communication, Adolescents,People living with HIV/AIDS (PLWHA)

Introduction:

Stigma is defined as a "significantly discrediting attribute" possessed by a person with an "undesired difference"2. Stigma is a common human reaction to disease.Throughout history many diseases have carried considerable stigma, including leprosy3, tuberculosis, cancer, mental illness and many STDs. Now HIV/AIDS is the topmost in the list of diseases to be stigmatized1.

In 1987, late Jonathan Mann, the then Director of the WHO Global Programme on AIDS, identified three phases of HIV/AIDS epidemic: the epidemic of HIV, the epidemic of AIDS, and the epidemic of stigma, discrimination and denial.He noted that the third phase is "as central to the global AIDS challenge as the disease itself". Stigma and discrimination relating to HIV/AIDS undermines public health efforts to combat the epidemic. AIDS related stigma negatively affects preventive behaviours such as condom use, HIV test-seeking behaviour, care-seeking behaviour upon diagnosis, quality of care given to HIV-positive patients and perception of PLWHA by communities, families and partners. One of the most surprising elements of AIDS stigma is its ubiquitous nature even where the epidemic is widespread and affecting so many people, such as in sub-Saharan Africa. Therefore, decreasing AIDS stigma is a vital step in stemming the epidemic. Given this situation, it is critical that interventions that effectively reduce AIDS stigma be identified and implemented1.

Despite international efforts to tackle HIV/AIDS, stigma and discrimination remain among the most poorly understood aspects of the epidemic. This poor understanding is due in part to the complexity and diversity of stigma and discrimination, but also in part to limitations in current thinking within the field and inadequacy of available theoretical and methodological tools4,5.

Material and Methods:

The study was carried out in Jamnagar city from Jan-Aug 2003 among the school going teenagers. Adolescents, particularly vulnerable age group of 15-19 years are more prone to misconceptions and it is easy to convince them and guide them in a proper way. It was decided to include class XI students in the study. There are 40 high schools in Jamnagar city. The sample size decided was 1000. By using simple random sampling technique, 7 high schools were selected for the study. Students of both sexes were included in the study. 1000 students were randomly, equally divided into 4 groups according to intervention method. Intervention methods identified for the study were interpersonal communication, distribution of pamphlets, AIDS educational movie and combination of all 3 methods. Interventions were structured in such a way that along with the information of HIV/AIDS, the respondent became aware about the day to day struggle of HIV positive people and the importance of destigmatizing HIV/AIDS.

A questionnaire was developed and tested to assess both knowledge and stigmatizing attitudes of the respondents before intervention (Pre-test), after intervention (Post-test) and after a time period of 3 months (follow up). The groups thus formed were:

Group: 1 = Interpersonal communication: The students were asked to fill the questionnaire independently for which they were given some time and the filled forms were collected.Following this, as decided earlier the students were given a lecture. Lecture comprised of a 15 to 20 minutes of informative speech, relating to various aspects of HIV/AIDS with special emphasis on stigma and other human rights issues. This was followed by an interactive session in which all the students were encouraged to participate. Query if any was responded. The complete session took a total of 45 minutes to one hour, following which fresh questionnaires were distributed and post-test evaluation was conducted.

Group: 2 = Distribution of Pamphlets: Following a pre-interventional evaluation the students were distributed pamphlets. Pamphlets continued information about HIV/AIDS in local language, based on literature obtained from National AIDS Control Organization. The pamphlets were distributed among the students and they were asked to read them carefully.Following this fresh questionnaires were distributed and post-test evaluation was conducted.

Group: 3 = Video presentation ("Sach" source NACO,22 minutes): The Pre-interventional evaluation was conducted.Following this, students were shown the AIDS educational movie after which fresh questionnaires were distributed and post-test evaluation was conducted.

Group: 4 = Combination (all three interventions): All the three interventions were used i.e. first a lecture was given, followed by distribution of pamphlets. After this AIDS educational movie was shown, followed by an interactive session.

The follow-up round was conducted after 3 months on a date convenient to school authorities. The aim of the follow-up was to ascertain how much of the improvement that was seen in the responses of the respondents following various types of stigma reducing interventions could be sustained over the period of 3-4 months.

The follow up study was done in the month of June-July and the class XI students included in the study had got promoted to the next academic session. So the class XII students who had originally participated in the study were approached. All the schools were approached and the students who were given various stigma reducing interventions were again distributed the questionnaires. In addition, they were asked to mention the mode of intervention they were given i.e. interpersonal communication, pamphlets, video presentation or the combination of the three.

Results & Discussion:

A total of 1,000 respondents were included in the study of which 620 were boys and 380 were girls. For the purpose of analysis the questions were divided into the following broad categories:

  1. Coercive attitudes towards PLWHA,
  2. Avoidant behavioural intentions towards PLWHA,
  3. Blaming attitude towards PLWHA,
  4. Sympathetic feelings towards PLWHA,
  5. Knowledge about HIV/AIDS.

Coercive attitudes towards PLWHA:

Table I: Coercive attitude towards HIV positive people.

  Group 1
(Interpersonal Communication)
Group 2
(pamphlet)
Group 3
(Video)
Group 4
(combined)
Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up
Be Legally Seperated 66 35 40 71 51 57 64 47 53 69 32 36
Make Names public so others avoid them 33 33 42 72 52 67 65 49 57 64 35 37
HR group be forced to get tested 73 45 52 69 56 65 77 51 60 66 39 43

Values represent percentages of respondents having coercive attitudes; HR - High risk.

The coercive attitude of the respondents was ascertained time of 3 months follow-up it was observed that: on the basis of three questions; whether, the respondent felt that The reduction in coercive attitude was the seropositive people shown be legally separated from others 21 -26% with Interpersonal Communication, forcefully; whether their names should be made public so that 4-14% in group 2 others could avoid them; and whether they thought that the high 8-17% in group 3 risk group people should be forced to get tested for HIV.

At the time of 3 months follow-up it was observed that:

  • The reduction in coercive attitude was
  • 21 -26% with Interpersonal Communication,
  • 4-14% in group 2
  • 8-17% in group 3
  • Group 4 showed it to be 23-33%

Maximum reduction in coercive attitudes was seen in group 4 where all three methods of intervention were used. As far as individual methods of interventions are concerned interpersonal communication was found to be most effective, while pamphlets were found to be least effective. It was further observed that apart from being most effective mode of intervention, interpersonal communication was found to be most cost effective method.

Avoidant behavioural intentions towards PLWHA:

Table II: Avoidant behavioural intentions.

  Group 1
(Interpersonal Communication)
Group 2
(pamphlet)
Group 3
(Video)
Group 4
(combined)
Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up
Friend/Colleague 58 30 39 65 34 56 59 36 71 73 26 34
Family Member 34 13 18 28 22 25 30 15 19 19 11 13
Beautician/Barber 83 55 68 79 69 75 80 66 71 86 48 62

Values represent percentages of respondents having avoidant behavioural intentions.

This component was evaluated on the basis of response to questions that in case their family member, friends or their beautician or barber was found to be seropositive, how would they react. At the time of 3-month follow-up it was observed that:

The reduction in avoidant behavioural intentions was 15-19% in group 1; It was 4-9% in group 2; 8-12% in group 3 and 6-39% in group 4.

The reduction in avoidant behavioural intention was maximum in group of 4 followed by group 1. Minimum improvement was observed in group 2.

Blaming attitude towards PLWHA:
Table III: Blaming attitude towards HIV positive people.

  Group 1
(Interpersonal Communication)
Group 2
(pamphlet)
Group 3
(Video)
Group 4
(combined)
  Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up
Have got what they deserved 79 52 61 86 71 78 80 56 69 89 46 56
Don't care if they infect others 58 44 49 74 56 67 71 63 67 79 40 51

Values represent percentages of respondents blaming PLWHA.

For this, the respondents were asked whether they felt that seropositive people had rightly got what they deserved as a result of their high risk behaviour; and whether they felt that seropositive people did not care if they infect others with HIV virus. At the time of 3 month follow-up the reduction of this element in group 1 was 9-18%, in group 2 this being 7-8%, 4-11% in group 3 and 28-33% in group 4.

Sympathetic feeling towards PLWHA:
Table IV: Sympathetic feeling towards HIV positive people.

  Group 1
(Interpersonal Communication)
Group 2
(pamphlet)
Group 3
(Video)
Group 4
(combined)
Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up
Friend/Colleague 42 72 63 41 52 48 45 63 56 39 84 71
Family Member 67 88 84 69 75 72 71 81 78 68 91 87
Beautician/Barber 25 52 38 31 45 31 38 53 47 32 70 62

Values represent percentages having sympathetic feelings towards PLWHA.

For this, the respondents were asked whether or not they would have sympathetic feeling if one of their family members, friends or a beautician or barber whom they frequently visited, was found to be seropositive. At the time of 3 month follow-up it was observed:

The increase in respondents having sympathetic feelings was 13-21% in group 1, 0-7% in group 2, 9-11% in group 3 and 21-32% in group 4.

The improvement was maximum in group 4 followed by group 1. Minimum improvement was observed in group 2.

Knowledge regarding HIV/AIDS:
Table V: Knowledge regarding HIV/AIDS.

Can one get HIV infection by: Group 1
(Interpersonal Communication)
Group 2
(pamphlet)
Group 3
(Video)
Group 4
(combined)
Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up Pre test Post Test Follow-up
Cough or Sneeze 38 93 75 35 82 70 41 97 80 43 95 80
Eating in the same plate 34 94 87 40 81 71 37 95 78 39 98 84
MTCT 36 98 70 39 84 60 34 94 62 37 99 72
Kissing 37 99 90 37 83 72 40 96 88 34 100 96
Insect Bite 39 95 90 37 85 76 36 97 87 30 98 91
Breast Feeding 36 95 76 32 86 69 40 96 96 33 95 87
Blood Transfusion 40 99 93 41 84 75 43 98 90 37 99 92
Public Toilets 32 98 89 34 82 71 36 99 88 46 97 91

Values represent percentages of awareness level.

The awareness level regarding HIV/AIDS ranged from 32-40% in group 1,32-41% in group 2,34-43% in group 3 and 30-46% in group 4 before interventions. After interventions, awareness level rose up to 94-99% in group 1,81-86% in group 2,97-99% in group 3 and 95-100% in group 4. The awareness level regarding HIV/AIDS ranged from 70-90% in group 1, 60-76% in group 2, 62-96% in group 3 and 72-96% in group 4 in the follow-up round after 3 months.

It was seen that there was remarkable improvement in knowledge and awareness in all the types of interventions and it sustained till the time of follow-up in all the four groups.

Recommendations:

Frequent Interpersonal communications and sensitization on stigma related issues in HIV is recommended in school going adolescents.

Inclusion of the topic of HIV/AIDS in the curriculum, with frequent updating.

References:

  1. Mann JM. 'AIDS: A Worldwide Pandemic', in Current Topics in AIDS,1989 Volume 2, edited by MS Gottlieb, DJ Jeffries, D. Mildvan, AJ Pinching, TC Quinn.
  2. Erving Goffman, Stigma: Notes on the management of spoilt identity, 1963.
  3. Scambler G, Hopkins A. Being epileptic, coming to terms with stigma, Sociology of Health and Illness, 1986, 8:26-43.
  4. Parker R, Aggleton P, Attawell K, Pulerwits J, Brown. HIV/AIDS -related Stigma and Discrimination: A conceptual framework and an agenda for action. Horizons Report, Horizons Project 2001.
  5. Panos Institute, The Third Epidemic: Repercussions of the fear of AIDS. Panos Publications, London (1990).
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