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Indian Journal of Community Medicine

Knowlege Regarding Modes of Transmission and Prevention of Sexually Transmitted Diseases Including HIV/AIDS

Author(s): Dinesh Paul, Shanta Gopalakrishnan

Vol. 26, No. 3 (2001-07 - 2001-09)

Abstract :

Research question: What is the level of knowledge of Child Development Project Officers (CDPO's), the functionaries of India's largest child development programme regarding STD's and HIV?

Objectives: 1) To assess the knowledge of Child Development Project Officers (CDPO's) regarding modes of transmission and prevention of STD's and HIV/AIDS. 2) To suggest improvement in training of ICDS functionaries regarding STD's including AIDS.

Setting: Training institution.

Study design: Cross-sectional.

Participants: Child Development Project Officers (CDPO's) with two years experience.

Results: All CDPO's were aware that HIV infection has emerged as a new disease. Majority of them were aware that use of condom, disposable needles and avoiding mutli-partner sex could prevent HIV/AIDS. The major source of information on HIV/AIDS has been the health worker. Major lacunae in the knowledge which need to be substantiated include complications of STD's, association of STD's with HIV, concept of window period and misconception that having sex with virgin would cure STD's.

Keywords: HIV/AIDS, STD's, ICDS, Knowledge of CDPO's, Training needs assessment

Introduction:

The first case of HIV in India was reported in 1986 from Madras1. Since then there has been an increase in the number of HIV infections over the years. As per the National AIDS Control Organisation (NACO), it is estimated that about 3.8 million people were living with HIV and AIDS in India in the year 2000. About 20,000 cases of AIDS so far have been reported to NACO by States till 31st March 20012. Studies conducted in various parts of the country have confirmed that HIV infection has shifted from high-risk population to general population in India3. In other words, the present seropositivity rate of 26 per thousand is alarming in India. The predominant mode of spread of HIV is through sexual route and about 83% of the AIDS cases detected so far are on account of transmission through sexual route. The other routes of transmission include blood and blood products, intravenous drug use and mother to child transmission.

The Integrated Child Development Services (ICDS) started on 2nd October 1975 in 33-selected projects has been specially designed to promote holistic development of children under six years of age through the strengthened capacity of care givers and communities and improved access to basic services at the community level4. It is now one of the unique outreach programme to help achieve major national nutrition and health goals. It has reached out to 229 lac children under six years of age, 48 lac pregnant and lactating mothers and 5 lakh adolescent girls through a network consisting of 4200 projects, covering nearly 75% of the country's community development blocks and 273 urban slum pockets5,6.

As the prevalence of HIV infection in India is on the rise, NACO has initiated the HIV/AIDS programme all over the country in 1992 as 100% Centrally Sponsored Scheme (CSS) and it was expected that after eight years of implementation of CSS the grass root level functionaries would have better knowledge of HIV/AIDS prevention as compared to general public. With the above in view, need to undertake this study was felt to identify the areas related to STD's and HIV prevention among ICDS workers who are very close to the community requiring concept clarification.

Material and Methods:

The study was conducted on 188 Child Development Project Officers attending the Job training or refresher courses at NIPCCD. Only those CDPO's who had the experience of working in ICDS programme for more than two years were included in the study. All subjects were oriented about the objectives of the study in a classroom. A pre-tested semi-structured open-ended questionnaire was administered to each one of the subjects. The questions were also explained to the subjects in detail to ensure complete comprehension. The investigators clarified the queries raised by the participants.

Results and Discussion:

The knowledge and attitudes of CDPO's, the main leaders of MCH care team of ICDS can play an important role in changing the views of the mothers regarding various diseases. In most of the studies it has been seen that the ICDS functionaries have played a very important role in promotion of breast feeding, growth monitoring, immunization and family planning programme. Wherever, ICDS is in operation the mortality and morbidity rates are better in these blocks as compared to non-ICDS blocks. If CDPO's are knowledgeable about STD's including HIV/AIDS they can disseminate the information to the community.

Table I: Awareness regarding Sexually Transmitted Diseases (STD's) (n=88).

Statement of questionnaire Responses
Correct No. (%) Incorrect No. (%)
What is STD? 188 (100.0) -  
STD's are spread mainly through sexual contacts 184 (98.0) 4 (2.0)
STD's may be symptomless 102 (54.3) 86 (45.7)
Foul smelling discharge from vagina is a symptom of STD's 123 (65.4) 65 (34.6)
STD's can cause sterility 62 (33.0) 126 (67.0)
STD's can cause repeated abortions 78 (41.5) 110 (58.5)
Most of STD's are curable 128 (68.1) 60 (31.9)
Condom use during intercourse can prevent STD's 176 (93.6) 12 (6.4)
Sex workers are main sources of STD's in the community 149 (79.2) 39 (20.8)
Sex with virgin female would cure STD's 144 (76.6) 44 (23.4)
The treatment of STD's is available at health centers 112 (60.0) 76 (40.0)
Partner treatment in STD's is important for its cure 50 (26.6) 138 (73.4)

In the present study, it was found that CDPO's knew the meaning and mode of spread of STD's. Majority of them could name major STD's such as syphilis, gonorrhoea etc. A sizeable proportion of CDPO's revealed that condom use during intercourse could prevent sexually transmitted infections.

About two third of CDPO's were aware that foul smelling discharge from vagina is a symptom of STD's and that majority of STD's are curable. They were also aware that the treatment of STD's is available at health centers. However, their knowledge was poor regarding the complications of STD's like sterility and repeated abortions and the importance of partner treatment in the management of STD's. About one-fourth of CDPO's still believed that having sex with virgin female could cure sexually transmitted infections.

Table II: Knowledge regarding HIV/AIDS (n=188).

Statement Responses
Correct No. (%) Incorrect No. (%)
HIV infection is a new disease 188 (100.0) 0 (0.0)
What does HIV positive mean? 46 (24.5) 142 (75.5)
HIV is incurable disease 103 (54.8) 85 (45.2)
Window period 9 (4.8) 179 (95.2)
Symptoms of HIV infection 72 (38.3) 116 (61.7)
Association of STD's and HIV 144 (76.6) 44 (23.4)
What is AIDS? 32 (17.0) 156 (83.0)
AIDS is a fatal disease 17 (9.0) 171 (91.0)

All CDPO's were aware that HIV infection has emerged as a new disease. About three-fourth of the CDPO's rightly pointed out the association between sexually transmitted infections and HIV/AIDS. However, about half of them (54.8%) reported that HIV is incurable while only 9% reported that AIDS is fatal. Only 17% of the CDPO's could tell the meaning of AIDS. Hardly about 5% of the CDPO's were clear about the concept of the window period.

Table III: Top five sources of HIV related information.

Source of information No. (%)*
Health worker 93 (49.5)
Radio 47 (25.0)
T.V. 23 (12.2)
Newspaper 21 (11.2)
Doctor 18 (9.6)

*Multiple responses. About half of the CDPO's reported health worker to be the main source of information about HIV. 12.2% CDPO's mentioned TV to be the main source and only about 10% mentioned the source to be a doctor.*

Table IV: Modes of transmission of HIV/AIDS.

Modes of transmission Responses
Correct No. (%) Incorrect No. (%)
Mother to child transmission 30 (16.0) 158 (84.0)
Sexual route 89 (47.3) 99 (52.7)
Through blood transfusion 91 (48.4) 97 (51.6)
Through infected needles 93 (49.5) 95 (50.5)

Sexual transmission, blood transfusion and use of infected needles as modes of spread of HIV/AIDS were mentioned by 47.3%, 48.4% and 49.5% CDPO's respectively. Only 16% of the CDPO's knew that HIV/AIDS could be passed on from the mother to the child.

Table V: Modes of prevention of HIV/AIDS.

Acceptable preventive practices Responses
Correct No. (%) Incorrect No. (%)
Using condom 176 (93.6) 12 (6.4)
Avoiding multi-partner sex without condom 172 (91.5) 16 (8.5)
Using disposable needle 167 (88.8) 21 (11.2)
Three correct ways to keep oneself free from HIV 52 (27.7) 136 (72.3)

Majority of the CDPO's were aware that using condom, disposable needle and avoiding mutli-partner sex could prevent HIV/AIDS. Only 27.7% of the CDPO's were able to enumerate three correct ways of keeping oneself protected from HIV.

The present study revealed some grave lacunae in the knowledge of the CDPO's like need for partner treatment in STD's, complications of sexually transmitted infections, life long HIV positivity, AIDS as a fatal disease, window period for HIV detection and mother-to-child transmission of HIV/AIDS, which need immediate correction. Since majority of the CDPO's are getting information from health functionaries it is possible that the knowledge of ANMs and LHVs may also be deficient in these areas. The above identified deficient areas require emphasis during training courses of CDPO's both during refresher and job training.

Hence, it is suggested that the training module prepared by NACO should be adhered to for imparting HIV/AIDS related information. The ICDS functionaries being non-medicos also need an orientation into the growing up process; reproductive system; human sexuality and behaviour; RTIs/STD's their causes, signs, symptoms and management; counselling in RTIs/HIV; gender issues in RTI/STD's and HIV/AIDS and most importantly strategies for sexual health communication. In addition, trainers' training is of utmost importance in STD/HIV prevention. For a trainer to be effective, he/she has to get rid of all misconceptions about sexuality in general and STD's/HIV in particular. It should, therefore, be imparted by officers from either UNAIDS, NACO, State AIDS Control Society or members of Technical Resource Groups constituted by NACO for providing correct and factual information.

Training strategy could be integration of a set syllabus into the job training courses of various functionaries or separate refresher training. Joint training of health and ICDS functionaries should also to be explored as it has offered high pay-off in performance in health related matters in the past.

Participatory methodology to be adopted during training to build on experience, potentials and inherent talent. It also provides for sequential flow of information, relating to real life situation, wherever possible and also brings about flexibility in the learning process. The various methods to be used in the training should include input sessions in terms of lectures and discussion, body mapping, self-awareness activities, role-plays, case presentations, simulation exercises, group work and observational visits.

Conclusions:

ICDS is a well established programme with a massive infrastructure all over the country. Its coverage of the rural, tribal and urban slums could be utilized for reversing the emerging epidemic of HIV infection. It has played a major complementary role along with the respective health departments in other health related activities; the same could be exploited in prevention and control of HIV infection as well. Moreover, it provides an opportunity for reaching out to the adolescents, an epidemiologically important population group7. Though the study has identified certain glaring shortcomings in the knowledge of CDPO's, it would still be worthwhile to integrate STD/HIV prevention and control in the ongoing ICDS programme. It would indeed prove to be an effective intervention yielding rich dividends.

References:

  1. John TJ, Babu PG, Jayakumari H, Simoes EA. Prevalence of HIV infection in Risk Groups in Tamil Nadu, India (letter). Lancet 1987; 1: 160-1.
  2. Ministry of Health and Family Welfare, National AIDS Control Organisation, New Delhi. Surveillance for HIV infections/AIDS cases in India (www.naco.nic.in/vsnaco/indiascene/update.htm).
  3. Joshi PL, Prasada Rao JVR. Changing Epidemiology of HIV/AIDS in India. AIDS Research and Review, 1999; 1: 7-9.
  4. Ministry of Human Resource Development, Department of Women and Child Development, New Delhi. Scheme of Integrated Child Development Services. New Delhi, 1975.
  5. Ministry of Human Resource Development, Department of Women and Child Development, New Delhi. Integrated Child Development Services (ICDS). New Delhi, 1990.
  6. Ministry of Health and Family Welfare, New Delhi. Annual Report of 1999-2000. New Delhi, 2000.
  7. Paul Dinesh. Role of Integrated Child Development Services in Strengthening HIV prevention and Control. AIDS Research and Review, 1999; 2: 85-8.

Dinesh Paul, Shanta Gopalakrishnan
Deptt. of Child Health,
National Institute of Public Co-operation & Child Development, New Delhi

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