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Indian Journal of Community Medicine

Impact of Training on Knowlege Regarding Modes of Transmission and Prevention of Sexually Transmitted Infections Including HIV/AIDS of Functionaries of Non-Governmental Organizations

Author(s): Dinesh Paul, Shanta Gopalakrishnan

Vol. 28, No. 4 (2003-10 - 2003-12)

Child Development Division,
National Institute of Public Cooperation and Child Development, New Delhi

Abstract:

Research question: What is the present level of knowledge of functionaries of NGOs dealing with MCH issues regarding STDs/HIV and do they require training?

Objectives: 1. To assess the knowledge of functionaries of NGOs regarding modes of transmission and prevention of STDs and HIV/AIDS. 2. To suggest improvement in training module prepared by National AIDS Control Organization for training of NGOs on HIV/AIDS.

Study design: Cross-sectional.

Participants: Functionaries of NGOs with two years experience in the area of MCH.

Statistical analysis: Percentages, Chi square test.

Results: Almost all representatives of NGOs were aware that HIV infection has emerged as a new disease. Majority of them were aware that use of condom during intercourse could prevent STDs but could not relate this with HIV/AIDS prevention. Majority also were of the view that avoiding sex with multi-partners could prevent HIV/AIDS. The major sources of information on HIV/AIDS were newspaper and TV. Major lacunae in the knowledge which need to be substantiated include use of disposable/sterilized needles for preventing HIV/AIDS, mother-to-child transmission of HIV, complications of STDs, need for partner treatment in STDs and concept of window period for HIV detection.

Key Words: HIV/AIDS, STDs, Knowledge of functionaries of NGOs, Training needs assessment

Introduction:

Globally, WHO1 estimates that reproductive ill health accounts for 36.6% of the total disease burden in women as compared to 12.3% for men of the same age. National Family Health Survey-2 (NFHS-2) 2 has also reported that 39.2% women in India have one or more reproductive health problems.

The National AIDS Control Programme was launched in 1986 in the country3. HIV/AIDS in India is a serious public health challenge, which has certain socio-economic dimensions. The strategy of the National AIDS Control Project (NACP) II launched in 1997 is to formulate a multi-sectoral response that will integrate the concerns of HIV/AIDS into the larger development effort both in the Government and voluntary sector. As a pilot programme NGOs are being supported by NACO to take up activities under the programme. NACO has developed detailed guidelines for selection, capacity building, funding and monitoring of NGOs. In India, about 30,000 NGOs/voluntary agencies4 are working for the welfare and development of children. They are more popular with the community than the Government institutions. The accent of the Government is to increase NGOs participation in health programmes and this is underway even in National AIDS Control Programme. In view of the above, National Institute of Public Cooperation and Child Development has been organising a number of sensitization courses on MCH issues for personnel of voluntary organizations for more than a decade. The topics of the sensitization courses dealt with include health of young women and children, micronutrient malnutrition, child health, adolescent health, family life education and mental health.

In view of the increasing prevalence of HIV/AIDS as also the number of NGOs dealing with the subject of HIV/AIDS, a need to undertake a study was felt to identify concepts requiring clarification in the areas related to STDs and HIV prevention among functionaries of NGOs dealing with MCH.

Material and Methods:

The study was conducted among 150 representatives out of 350 representatives of NGOs attending the sensitization course on MCH issues at NIPCCD from January 1999 to December 2002. The selection criteria was experience of working for MCH programme for more than two years. All participants were oriented about the objectives of the study in a classroom and a pretested semi-structured open-ended schedule was administered to each one of the subjects. The questions were also explained to the subjects in detail to ensure complete comprehension. The investigator clarified the queries wherever necessary with minimum consultation in answering the subjects.

After the pretesting, they were given training on HIV/AIDS using the module prepared for NGOs by NACO 5. It consists of three sections. Section I deals with HIV/AIDS - which covers the need for training programme, objectives and introduction to the training; HIV/AIDS pandemic and its link with developmental issues; modes of transmission; prevention of HIV - critical areas for intervention; care and support in managing HIV/AIDS; and information, education and communication (IEC) in HIV/AIDS and STDs. Section II deals with STDs, which covers introduction of STDs, modes of transmission of STDs; symptoms and complications; prevention and treatment of STDs; and HIV and STDs relationships; and Section III deals with education and counselling in RTIs/STIs and HIV/AIDS. The methodology adopted included lecture-cum- discussions, role plays, field visits, quiz, filling-up of worksheets, PLA technique etc. The same pretest questionnaire was then again administered after training to assess the gain in knowledge.

In the present study, it was found that all representatives of NGOs knew that HIV infection has emerged as a new disease except one.

Table I: Knowledge regarding HIV/AIDS (n=150).

Items Correct Response
Pre-Training Post-Training
No. % No. %
HIV infection is a new Disease 149 99.3 150 100
What does HIV Positive mean? 42 28.0 150 100
HIV is an incurable disease 87 58.0 138 92.0
Window Period 10 6.7 93 62.0
Symptoms of HIV infection 72 48.0 147 98.0
Association of STD's and HIV 119 79.3 150 100
What is AIDS 59 39.3 111 74.0
Why is AIDS a fatal diseease? 15 10.0 126 84.0
Χ2 = 114.18; d.f. = 7; p<0.001

Results and Discussion:

About 80% of the subjects rightly pointed out the association between STDs and HIV/AIDS. Surprisingly 58% of the subjects only reported that HIV is incurable and further only 10% reported that AIDS is a fatal disease. Only 28% of the subjects seemed clear about the meaning of HIV positive and hardly 6.7% were clear about the concept of window period.

Table II: Awareness regarding sexually transmitted infestions (STDs) (n=150).

Items Correct Response
Pre-Training Post-Training
No. % No. %
STD's may be symptomless 84 56.0 123 82.0
Fould Smelling discharge from vagine is a symptom of STD's 97 64.7 141 94.0
STD's could cause sterility 88 58.7 132 88.0
STD's could cause repeated abortions 74 49.3 150 100.0
Most of STD's are curable 115 76.7 150 100.0
Using condom during intercourse could prevent STD's 135 90.0 150 100.0
Sex workers are main sources of STD's in the community 112 74.7 150 100.0
Sex with a virgin female would cure STD's 125 83.3 132 88.0
Availablity of treatment of STD's at health centres 97 64.7 114 76.0
Importance of partner treatment in STD's 32 21.3 135 90.0
Χ2=54.01; d.f. = 9; p<0.001

Majority of them were of the view that condom use during intercourse could prevent sexually transmitted diseases. Two third of the subjects were aware that the treatment of sexually transmitted diseases is available at health centre. Therefore, in the prevention and management of STDs, NGOs could play an important role in building their capacity. The knowledge of subjects was poor regarding the complications of STDs like repeated abortion and sterility and importance of partner treatment in STDs. About l/6th of the subjects still believed that having sex with virgin female could cure sexually transmitted infections (Table II).

Table III: Top five sources of HIV related information.

Source No. %*
Newspaper 98 65.3
TV 88 58.7
Doctor 58 38.7
Health Worker 49 32.7
Radio 39 26.0

*Multiple responses.

About two third of the subjects from the Non- Governmental Organizations reported newspaper as their main source of information about HIV in their day-to-day work and 58.7% reported T.V. as their main source. Only one third of the subjects reported health worker as their main source for HIV related knowledge.

Table IV: Modes of prevention and transmission of HIV/AIDS (n=150).

Items Correct Response
Pre-Training Post-Training
No. % No. %
Using Condom 43 28.7 129 86.0
Avoiding multi partner sex without condom 134 89.3 147 98.0
Using sterilized/disposable properly 43 28.7 132 88.0
Threre ways to protect oneself from HIV 38 25.3 129 86.0
Through blood transfusion 61 40.7 141 94.0
Mother to child transmission 33 22.0 117 78.0
Sexual route 52 34.7 150 100.0
Χ2= 57.28; d.f. = 6;p&lt;0.001.

71.3% of subjects could not relate condom use with HIV/AIDS prevention. Avoiding sex with multi-partners without using condom was reported by majority of them as one of the ways of prevention of HIV/AIDS. Using disposable/sterilized needles was not known to 71.3% subjects as a mode of prevention of HIV/AIDS. Only one fourth of the subjects were able to give the three correct ways to keep oneself free from HIV. Sexual transmission and blood transfusion as the modes of spread of HIV/AIDS were reported by 34.7% and 40.7% subjects respectively (Table IV).

The knowledge regarding mother to child transmission of HIV was poor among the subjects. The knowledge and attitude of NGOs can play important role in changing the views of the community regarding various diseases as people have more faith in NGOs. In most of the studies 6,7 it has been seen that the voluntary agencies have helped in furthering family planning programme; immunization; maternal and child health; promotion and protection of breast feeding and in diarrhoea management programme. Wherever NGOs are working, the rural masses are ready to avail their services. About two third of the subjects were aware that foul smelling discharge from vagina is a symptom of sexually transmitted disease and three fourth were aware that majority of the sexually transmitted diseases are curable.

The present study has revealed some gross lacunae in the knowledge of NGOs like need for partner treatment in STDs, complications of STDs, why AIDS is a fatal disease, window period for HIV detection and mother to child transmission of HIV/AIDS which need some remediation. Since majority of the Non-Governmental Organisations are getting information from newspapers and television regarding HIV/AIDS in their day-to-day work the role of media cannot be undermined and efforts to strengthen it would go a long way in improving the situation.

It is heartening to note that one week's training of NGOs using NACO's module has significantly raised the knowledge level. However, there are some strong misconceptions that exist e.g. belief that sex with virgin female could cure STDs require continuous education through refresher courses and media. The following require emphasis in NACO's module as the knowledge about window period, why AIDS is fatal, mother-to-child transmission of HIV could not be raised to 100% and they were 62%, 84% and 78% respectively.

References:

  1. World Health Organization, Regional Office for South East Asia, New Delhi. Reproductive Health in the South East Asia Region (50 years Commemorative Series -5) New Delhi, 1999.
  2. National Family Health Survey-2, 1998-99. India, International Institute for Population Sciences, Mumbai.
  3. Ministry of Health and Family Welfare, New Delhi. Annual Report 1999-2000. New Delhi, 2000.
  4. Ministry of Human Resource Development, Department of Women and Child Development, New Delhi. Children India's Strength: Universal Children's Day (14 November 1999) New Delhi, 1999 p.18.
  5. Ministry of Health and Family Welfare, National AIDS Control Organization Training Module for Health Workers and Supervisors in RTIs/STDs/HIV/AIDS Prevention and Control, New Delhi.
  6. Family Planning Foundation, New Delhi. People Show the Way: Glimpses of the India NGO Experience (Prepared for the International Conference on Population, Mexico City), New Delhi, 1984.
  7. Mulay, Sanjeevanee, Balasubramanian, K. The performance of Non-governmental Organisations in Family Planning and MCH in Maharashtra State. Artha Vijnana, 1992, Jun. 34(2): 209-331.
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