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Indian Journal of Community Medicine

Knowledge and Attitude on HIV/AIDS among Married Women of Reproductive Age Attending a Teaching Hospital

Author(s): S Sarkar, M Danabalan, GA Kumar

Vol. 32, No. 1 (2007-01 - 2007-03)

S Sarkar, M Danabalan, GA Kumar

Acquired immunodeficiency disease syndrome (AIDS) though a disease only about 20 years old now, has evolved into a pandemic affecting millions of people worldwide. By the end of 2001, 25 million people had already died of AIDS. In India, the cumulative number of AIDS cases reported as on June 2002 was 36,160, which is supposed to be only the tip of the iceberg1. The important characteristic of HIV scenario in India is its heterogenicity, the prevelence varying in different states. Pondicherry is among the hardest hit regions. Based on the seroprevalence among antenatal clinic attendees, Pondicherry comes under the high prevelence category (=> 1%), indicative of a generalized epidemic2.

Heterosexual transmission being the commonest route of spread, the only way to check its transmission is by increasing awareness regarding the modes of spread and methods of prevention of this desease among people, particularly those belonging to the sexually active age groups. In this context, this study was conducted to examine the extent of awareness of its determinants as well as the attitude of married women in reproductive age group towards HIV/AIDS in Pondicherry.

Material and Methods

This study was conducted in Mahatma Gandhi Medical College and Research Institute, situated about 18kms from Pondicherry. This hospital draws patients mainly from the nearby rural areas. 250 married women in the 15 to 50 years age group attending various out – patient department were interviewed from July to November 2002 with a preformed an pretested questionnaire. The lady health worker in the Department of Community Medicine was adequately trained to administer the questionnaire appropriately and also give some definite health education about this dreaded disease to women while they were waiting for the doctor’s consultation for their specific illnesses. The questionnaire, a structured and open-ended one was administered without any prompting whatsoever by the interviewer. The responses to the questions on knowledge were appropriately scored. Twenty-eight of the 250 schedules, which were incomplete, were excluded from the study. The remaining 222 schedules were then scored and analyzed. The individual scores on knowledge of these 222 respondents were added to get total and mean scores. The respondents were then categorized as having high or low knowledge depending on whether their individual scores were above or below the mean score respectively.

Results and Discussion

The present study found that majority i.e. 64% women belonged to the younger age group (<30 years). Most of these women (47.7%) were married before 20 years of age and the largest group (40.5%) was married for less than 5 years. Though 18.5% of the study population was illiterate, 52.3% had studied up to SSLC. Only 10% of these women were working and more than half (52.3%) belonged to the lower socio-economic strata.

It was observed that 96% of women had heard about HIV/AIDS. This finding is less than that (99.6%) obtained by NACO. The sources of knowledge were television (81.98%), radio (42.79%), newspaper (15.76%) and health care providers (10.8%). Around 30% were aware of the type of people usually affected by this disease and its signs and symptoms (28.4%). 83% women knew one or more modes of spread of this disease. However, only 44.6% knew about any method of preventing spread, which is quite less than observed in another study. Only 3.2% actually knew that HIV virus is the agent responsible for this disease. Half of the sample population was aware that laboratory investigation could detect HIV status of individuals. Around 62% women knew what condoms were but only 30.2% had the knowledge that its use could prevent STD and HIV/AIDS. The vast difference in the findings of NACO and the present study might be because the population in this study came from rural areas of Pondicherry and thus is not representative of the whole of Pondicherry.

Women aged more than 40 years had proportinately higher knowledge (62.1%) as compared to the other age groups. A greater proportion (59.1%) of those married for more than 15 years had high knowledge. The proportion of women with high knowledge about HIV/AIDS has increased with increase in age at marriage, education, and socio-economic status. Working women though few in number in this study had substantially higher awareness than those who were not employed, which is at par with the finding by APAC3. But the type of family they came from appears to have no infl uence on their knowledge.

Consistent findings were obtained on correlation done between the sample characteristics and knowledge (Table 1). On binomial logistic regression, education and occupation were found to be significantly related to the knowledge regarding HIV/AIDS among the sample population. Those having studied above SSLC had 18 times more and working women 8 times more knowledge than illiterates and housewives respectively.

Table 1 : Logistic Regression Analysis of Knowledge with Variables

Variables B Sig. Exp. (B)
Socio-economic status
  Low   Reference Category  
Medium 0.323 0.336 1.382
High 0.669 0.231 1.952
Education
  Illiterate   Reference Category  
Primary 0.6 0.299 1.823
Up to SSLC 0.917 0.044 2.503
Above SSLC 2.921 0.000 18.565
Age at marriage in (in years)
  Less than 20   Reference Category  
20-25 0.082 0.791 1.091
Above 25 0.513 0.356 1.670
Occupation
  Not working   Reference Category  
Working 2.118 0.003 8.314
Constant -1.596 0.000 0.203


Table 2 : Attitude of the Respondents of HIV/AIDS.

Responses Frequency Percentage
Who should undergo HIV testing
Not Aware 78 35.1
Wife 96 43.2
Husband 45 20.3
Commercial sex workers 1 0.5
STD patients 1 0.5
Pregnant women 1 0.5
Type of reaction if husband develops HIV/AIDS
Not aware 63 28.4
Feel bad 121 54.5
Divorce 18 8.1
Avoid sex 15 6.8
Suicide 4 1.8
Test wife & children 1 0.5
Action to be taken if neighbor develops AIDS
Not aware 88 39.6
Advise to seek treatment 86 38.7
Avoid him/her 38 17.1
Support & Sympathize 4 1.8
Advise to seek treatment/Avoid 1 0.5
Advise to seek treatment/Support 5 2.3

Thirty five percent women were not aware of who should undergo HIV testing (Table 2). Only one woman each had suggested that commercial sex workers, STD patients and pregnant women are the groups that need to undergo the test. Majority of the women (83%) were either not aware (28.4%) or considered feeling bad (54.5%) to be the only reaction a wife can have if husband is found to be HIV positive. Sex should be avoided in such a case. Some (8.1%) suggested divorce and 1.8% even opined that suicide was the only choice available for such women. Most often this is the type of reaction of the individuals having HIV/AIDS4. The study findings show that this disease still continues to be a stigma among these women (Table 2).

Awareness among the women in this sample was better compared to 40% married women all over India having heard of HIV/AIDS5. The greater knowledge among women in Pondicherry may be because of higher prevalence of HIV/ AIDS in this Union Territory. AIDS Prevention and Control Project (APAC) with support from United States Agency for International Development (USAID) has been conducting Behavioural Surveillance Survey in Pondicherry since 2001.

This ongoing project may have contributed to an increase in knowledge regarding HIV/AIDS in the population. But to effectively control the spread of epidemic of this dreaded disease, women’s education seems to be the strongest tool available to health care providers.

References

  1. Zafrullah. Allopathic Private Practitioners Training Module, STI/HIV/AIDS Prevention Education (SHAPE). APAC-VHS; Chennai: 2000.
  2. NACO. National Baseline Behavioral Surveillance Survey, India Datasheet (2001-2002). National Aids Control Organization; New Delhi: 2003.
  3. USAID & APAC. Behavioral Surveillance Survey in Pondicherry wave II, AIDS Prevention and Control Project. USAID; Chennai: 2002.
  4. Jacob K J. Working Together to reduce AIDS damage, Abstracts do most individuals with HIV/AIDS consider suicide. Paper presented in First International Conference on AIDS India – 2002, The Tamil Nadu Dr. MGR Medical University, Chennai; 2002.
  5. International Institute for Population Sciences (IIPS) and ORC Marco 2000. National Family Health Survey, India (NFHS-II), 1998-99, National Summary Report. IIPS; Mumbai: 2000.

Deptt. of Community Medicine, Mahatma Gandhi Medical College
and Research Institute Pillaiyarkuppam, Pondicherry-607 402.
Received: 30.08.03

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