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“Awareness on Prevention and Control of HIV/AIDS Among the Adults." Chapter- 1 Background and Rationale 1.1 Introduction: AIDS, the acquired immuno-deficiency syndrome is a fatal illness caused by a retrovirus known as the Human Immuno-deficiency Virus (HIV) which breaks down the body’s immune system, living the victim vulnerable to a host of life threatening opportunistic infections, neurological disorders or unusual malignancies. The HIV/AIDS pandemic has become a permanent challenge to health, development and humanity. It is one of the leading causes of death in the world. World young’s people have been identified to be at special risks of HIV infection, with majority of infection due to unprotected sex 1. Usually, adolescent age is the time when they begin to take interest in sexual relationship. They may want to experiment with sex without giving much consideration to take implication of their present behavior. It is also at this stage that many of them develop lifelong habits, which could easily be influenced through proper guidance. Several studies can be carried out to evaluate the knowledge of adult, to identify gaps in awareness and perception about HIV/AIDS. A national baseline HIV/AIDS survey among young people aged 15-24 years established that the STI disease burden was high among them. Approximately 25 percent of males and 21 percent of females in the surveyed population reported symptoms of sexually transmitted infections (STIs). Young men and women do not perceive themselves to be at risk of acquiring STI/HIV due to lack of awareness and rampant misconception regarding the transmission and prevention of STIs. Lack of knowledge on STI symptoms and consequent delays in care-seeking behavior increases their risk towards HIV 2. Misperceptions and stigmas surrounding HIV/AIDS are a huge barrier to successful prevention and treatment of the disease in our country. Our society has an extremely conservative attitude toward sexual relations and therefore, issues relating to sexuality such

as HIV/AIDS are not openly discussed. Because of the lack of education and awareness, misperceptions and stigmas at the virus are common. For example, it is generally believed that those infected with HIV at some way ``morally corrupt.â&#x20AC;&#x2122;â&#x20AC;&#x2122; The discrimination faced by infected people is so bad, that (PLWHAs) people living with HIV/AIDS attempt to keep their status a secret and do not seek help or support.

The traditional and conservative social

values about sexuality, combined with a lack of education and awareness about the disease, help to explain why the disease may expand quickly. This situation is particular serious for women. Women and girls face heavier risks of HIV infection than men because their diminished economic, social and cultural status compromises their ability to choose safer and healthier life strategy. Educational initiatives are needed to make people aware of how to protect themselves against the virus3. High levels of illiteracy, religious and cultural modes, gender inequality and political instability contribute to low risk perception and high levels of stigma and discrimination related to HIV. Increasing premarital sex, sex between men and substance is abuse point to the potential for increasing HIV vulnerability and prevalence rates. Recurrent major disasters, such as annual floods and river erosions displace thousands of vulnerable people every year and make them poorer. Many young girls from these families are forced into sex work4.There is little awareness about prevention of vertical transmission interventions among the general population, including health care workers. This is largely due to limited availability of information about vertical transmission and low levels of education among women in rural areas5. Although Bangladesh is a low prevalence country for HIV/AIDS, all the factors that may allow rapid spread of infection leading to an epidemic are present here. These factors include high-risk behavior, lack of awareness, very mobile populations and being surrounded by countries that have a higher prevalence of HIV. More recently, the risk of an impending concentrated HIV epidemic among IDU has been documented in a city of central Bangladesh where HIV prevalence has dramatically risen to 7 percent from 1.7 percent in six years. Sharing of injection equipment is common in most IDUs surveyed and the IDUs are also mobile traveling from one city to another and sharing injection equipment in different cities. Mobility is another major factor that increases the risk of acquiring and spreading HIV

infection. Passive case reporting suggests that another population group vulnerable to HIV may be migrants returning from jobs overseas or through cross-border traffic to regions of high prevalence. The major challenge faced by Bangladesh at present is to keep the prevalence of HIV low. Young people aged between 10 and 24 years account for one third of the total population of Bangladesh or approximately 38 million. Although Bangladesh is a conservative society, studies have revealed that young people irrespective of marital status engage in unprotected sexual encounters that are high risk for exposure to HIV. They are not always aware of the risks and dangers posed by unsafe sexual activity and other risk behaviors like injecting drugs and are ill informed and unprepared to protect themselves. With this as background, young people have been identified as one of the more vulnerable groups in Bangladesh with regard to HIV/AIDS. There are several factors that make Bangladesh vulnerable to an HIV epidemic. The country is geographically situated in close proximity to India and Myanmar, which have a high HIV prevalence, and Nepal which has a concentrated HIV epidemic among IDUs. Open borders, sex industry, links between high risk groups and bridging populations, labour migration, gender inequities, poverty, low literacy levels, gaps in healthcare delivery and low levels of HIV/AIDS awareness have also been identified as important factors in the spread of HIV infection7. Girls and young women are more susceptible to STI/ HIV infection than men due to biological and other factors such as the need to receive blood transfusion more often on account of anemia or complications at child birth. Low social status of women in Bangladesh and other contextual features including widespread poverty, low literacy and educational levels and limited skill training and employment opportunities place girls and young women in particular at a high risk of infection. Women are also more at risk from violence, trafficking and coercive sex or from the economic vulnerability that forces them into sex work. Their economic situation also compromises their ability to negotiate protection or leave risky relationships. Early marriage further deprives women of a chance of acquiring more autonomy, access to information and negotiating power in matters of sexuality. The mean age of marriage of girls in Bangladesh is 16.9 years. While 48% of 15-19 year-old girls are married, about 60 percent of them become mothers before the age of 19 years. Married

women are also at a growing risk of HIV and STIs due to the risky behavior of their spouses who may visit sex workers or engage in IDU practice. In fact, a higher prevalence of STI was observed in married women in comparison with unmarried women. To tackle AIDS, prevention is the most effective and cheapest way out that must be given worldwide public health priority. Prevention of HIV/AIDS is possible through awareness and behavioral changes8.

1.1 Background : The human immunodeficiency virus (HIV) epidemic has emerged as a formidable challenge to public health development and human rights. At the end of 2006, there were an estimated 39.5 million people living with HIV (PLHIV) globally. More than 95 percent of the new infections in 2006 were in low and middle income countries. Among the WHO regions, Sub-Saharan Africa is the most affected followed by South â&#x20AC;&#x201C;East Asia. Although the overall adult HIV prevalence in South-East Asia is still low (0.7 percent) the total number of people affected is huge- an estimated 7.2 million PLHIV by the end of 2006 9. Ever since the first report of acquired immunodeficiency syndrome (AIDS) in 1981 in the United States, human immunodeficiency virus (HIV) infection has reached pandemic proportions, resulting in more than 65 million infections and 25 million deaths worldwide. The global HIV epidemic has emerged as a formidable challenge to public health, development and human rights. In countries most severely affected by HIV, it has eroded improvements in life expectancy. One in every hundred sexually active adults worldwide is infected with HIV. Every day more than 6800 people become infected with HIV and more than 5700 people die from AIDS, mostly because of inadequate HIV prevention and treatment services. If current rates of transmission continue, more than 40 million people would live with HIV in 2010. In spite of advances in the areas of prevention and treatment, the virus continues to spread at an estimated rate of 16,000 new infections a day. Of these, half are women and 40 percent are young people (15-24 years old). Of the estimated 37 million adults living with HIV worldwide, nearly 18 million are women. Sub-Saharan Africa continues to bear the burnt of the global epidemic. Two-thirds (63 percent) of all adults and

children with HIV globally live in sub-Saharan Africa. In southern Africa, HIV epidemics in Swaziland, South Africa and Mozambique continue to grow. In Swaziland, an estimated one in three (33 percent) adults was living with HIV in 2005- the most intense epidemic in the world. South –East Asia with an estimated 7.2 million PLHIV has the second highest of HIV in the world following sub-Saharan Africa. In the Middle East and North Africa Region, Sudan has the largest epidemic. In the Caribbean Region, HIV prevalence has either remained stable or is decreasing with two-thirds of the affected people living in Dominican Republic and Haiti9. At the end of 2006, an estimated 7.2 million (4.7 million -11 million) people were living with HIV in South –East Asia Region which included 0.77 million (0.47 million -2.1 million) new infections in 2006. Approximately, 550000 people died of AIDS during 2006. The majority of the HIV burden in the Region is concentrated in five countries, namely India, Indonesia, Myanmar, Nepal and Thailand. India, the world’s second-most populous country, has multiple and diverse HIV epidemics. In five of the 35 states/ union territories of the country, the median adult HIV prevalence is >1 percent .Thailand is among the few countries in the world to have turned around a rapidly escalating generalized HIV epidemic. The number of estimated new HIV infections decreased from 1, 40,000 per year in 1991 to 17,000 in 2005. Myanmar has the third highest HIV burden in the region with 3, 39,000 adults living with HIV in 2005, i.e. 1.3 percent of the adult population is HIV-infected. As in other Asian countries, HIV is highest among groups practicing high risk behaviors; these include sex workers, IDUs and MSM. Indonesia has the fastest growing epidemics in the Region, although the aggregate national HIV prevalence is still very low, with 48 percent of drug users in Jakarta and up to 23 percent of sex workers in Papua being infected10. Nepal reported its first cases of AIDS in 1988. It is considered to have a concentrated epidemic in populations with high-risk behaviors with IDUs having the highest rates of HIV infection. HIV prevalence among male IDUs in Kathmandu valley increased from 2 percent in 1991 to 68 percent in 2002 and remained high at 51 percent in 2005. In Sri Lanka, the main risk groups are sex workers and their clients and MSM. Maldives already has a massive epidemic of drug users among the youth and could have an explosive HIV epidemic among

IDUs in the future if adequate measures are not taken urgently. In Bhutan, STIs are high among certain population groups and early indications of the spread of HIV among IDUs 10. Bangladesh with a population of about 158 million is one of the most densely populated countries in the world11. In Bangladesh the first case of HIV was detected in 1989. The total number of HIV infected person was 1745 up to the year of 2009. The number of patients suffering from AIDS was 619. The newly AIDS patients were 143 in number and newly infected were 250 in the year 2009. The death from AIDS was 204 in number till 2009 and 39 died in this year. HIV prevalence in general population is still < 0.1 percent. Concentrated epidemic among the IDUs at certain areas of Dhaka city is 7.0 percent. Total number of IDUs and prostitutes are 40,000 and 90,000 at present. It reveals Bangladesh at a crossroad. 12.

1.3 Justification: The first case of HIV/AIDS in Bangladesh was detected in 1989, and since 1994, prevalence has steadily risen with approximately 11,000 people living with HIV/AIDS by 2005

13-14

.The

most at-risk populations include IDUs, CSWs, babus (the regular boyfriends of CSWs), men who have sex with men (MSM), and migrant workers. Prevalence in this vulnerable population has tripled over the last six years. National survey data reveals an increase in HIV infection in IDUs from 1.8 percent in 2001 to more than 4.9 percent in 2005 15. This remains just short of the 5 percent rate necessary to define a â&#x20AC;&#x153;concentrated epidemicâ&#x20AC;? 16. In one hotspot of Dhaka, prevalence has jumped as high as 9 percent17. This data reveals Bangladesh at a crossroad. If epidemic control measures in at-risk populations are not rapidly addressed, it could easily endanger the rest of the country as it becomes a generalized epidemic. Seventy-seven percent of IDUs in Bangladesh generally share needles freely. In addition, the IDU population is growing. Each year for the past five years, 10-20 percent of previously non-injecting drug users began injecting18. The rapid increase in infection rates in this vulnerable and growing population of individuals has important implications for the spread

of the epidemic in the general population. IDUs act as an important bridge population. Not only do they move frequently between regions of Bangladesh, but also frequently interact with other populations in society including male and female sex workers, MSM, and transport and industry workers. Ninety one percent of IDUs in non-intervention sites reported having sex with female sex workers, with 53 percent admitting to never using condoms, and 64 percent having unprotected sex with regular partners. Furthermore, many participate in the illegal sale of blood, thus increasing the risk for the tainting of the national blood supply. With knowledge of HIV transmission lacking, where 34 percent of IDUs do not know that HIV could be spread through needle sharing, and unaware of their own status, the potential for spread to the general population is significant. Further compounding factors of the epidemic include geographic location and open borders. Due to its close proximity and porous borders to parts of India and Myanmar with a generalized epidemic, and Nepal with a concentrated epidemic among IDUs, where both legitimate and informal traffic crosses regularly, Bangladesh remains in a vulnerable situation. Behavioral surveillance in Bangladesh revealed that most people who engage in high-risk behaviors do not know how the virus is transmitted, and are unaware of how their behaviors put them at risk. Furthermore, in the male-dominated society of Bangladesh, the low status of women puts them at greater risk of contracting HIV. Married women who are faithful to their husbands are at a growing risk of HIV and STIs due to the behavior of men in engaging in acts with sex workers and practicing injection drug use. Even equipped with the knowledge of risk involved with their husbandâ&#x20AC;&#x2122;s behavior, they do not have the power to negotiate safer sex with their partners. An increasing number of women and girls are being driven into sex work due to poverty, and are putting them at risk for HIV acquisition. Additionally, in societies where girls and women are not empowered to think critically, make decisions, and solve problems, they lack the self-efficacy needed to protect them against HIV. A set of Millennium Development Goals (MDGS) is an UN declaration on 2000 in New York, represented by 189 countries. MDGs place health at the heart of development. Three of eight goals are directly related with health, of which sixth one is to combat HIV/AIDS,

malaria and other diseases. Goals have to be achieved by 2015 or earlier outlining progress from 1990. To tackle HIV/AIDS, prevention is the most effective and cheapest way. Prevention of HIV/AIDS is possible through awareness and behavioral changes. The present study is therefore conducted to check the level of HIV/AIDS awareness among the adults attending at the outpatient department of Dhaka Mohanagar General Hospital, Naya bazar, Dhaka.

1.4 Research question Does the awareness on Prevention and control of HIV/ AIDS among the adults vary with the socio-demographic or other factors? 1.5 Objectives: 1.5.1 General objective: To assess the level of awareness on prevention and control of HIV/AIDS and to identify the factors influencing awareness among the adults attended at out patient department of Dhaka Mohanagar General Hospital, Naya Bazar, and Dhaka. 1.5.2 Specific objectives: 1.5.2.1 To assess the level of awareness on prevention and control of HIV/AIDS among the adults attended at out patient department of Dhaka Mohanagar General Hospital, Naya Bazar, and Dhaka. 1.5.2.2 To identify factors influencing awareness on HIV/AIDS among the adults attended at outpatient department of Dhaka Mohanagar General Hospital, Naya Bazar, and Dhaka. 1.5.2.3 To relate socio-demographic characteristics of the adults with the level of awareness on prevention and control of HIV/AIDS. 1.6 Operational definition: 1.6.1 HIV/ AIDS HIV stands for Human Immunodeficiency Virus. AIDS means Acquired Immune Deficiency Syndrome.

HIV causes AIDS. AIDS is a disease that slowly destroys the body’s immune system. HIV is spread by (a) Having sex without a condom. Vaginal and anal sex carry a high risk, (b) Sharing needles or syringes to inject drugs or steroids. c) a mother to her infant during pregnancy, delivery or breastfeeding. d) Getting a tattoo or piercing from a dirty needle e) Transfusions of blood or blood products and organ transplants. The average time between HIV infection and the appearance of signs that could lead to an AIDS diagnosis is 8-11 years. This time varies greatly from person to person and can depend on many factors including a person’s health status and behaviors. The only way to determine whether you are infected is to be tested for HIV. Many people who are infected with HIV don’t have any symptoms at all for many years. Many AIDS deaths result from pneumonia, tuberculosis or diarrhea: Death is not caused by HIV itself but by one or more of these infections 22. 1.6.2 Adult The term adult has at least three distinct meanings. It can indicate a biologically grown or mature person. In modern developed countries, puberty and therefore biological adulthood generally begins around 10 years of age for girls and 12 years of age for boys, though this will vary from person to person. Those who have graduated from high school (18 or over) are often recognized as social adults in addition to being biological adults. The legal definition of entering adulthood usually varies between ages 15-21, depending on the region. In most of the world, the legal adult age is 18 for most purposes 23. 1.6.3 Outpatient An outpatient is a patient who is not hospitalized overnight but who visits a hospital, clinic, or associated facility for diagnosis or treatment. Treatment provided in this fashion is called ambulatory care. Outpatient surgery eliminates impatient hospital admission, reduces the amount of medication prescribed, and uses a doctor’s time more efficiently. More procedures are now being performed in a surgeon’s office, termed office-based surgery, rather than in an operating room. Outpatient surgery is suited best for healthy people

undergoing minor or intermediate procedures (limited urologic, ophthalmologic, or ear, nose, and throat procedures and procedures involving the extremities). 1.6.4 Awareness Synonyms are aware, cognizant, conscious, sensible, awake, alert, watchful and vigilant. These adjectives mean mindful or heedful. Aware implies knowledge gained through oneâ&#x20AC;&#x2122;s own perceptions or by means of information. It emphasizes the recognition of something sensed or felt. It also implies knowledge gained through intuition or intellectual perception. To be a awake is to have full consciousness of something i.e., as much as awake to the novelty of attention. It is meant by stresses of quickness to recognize and respond. Finally it can be implied as looking out for what is dangerous or potentially so. 1.6.5 Prevention Prevention means act of preventing. In other wards that it can be explained as ``there was no bar against leavingâ&#x20AC;&#x2122;â&#x20AC;&#x2122;. To prevent literally means to keep something from happenings The term of prevention is reserved for those interventions that occur before the initial onset of disorder. Universal preventive intervention is targeted to the general public or a whole population group that has not been identified on the basis of individual risk. Selective preventive intervention is targeted to individuals or a subgroup of the population whose risk is significantly higher than average. Indicated preventive intervention is targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms but who do not meet diagnostic levels at the present time. 1.6.6 Control: It means power to direct or determine. It is a physiological regulation or maintenance of a function or action or reflex. Control condition is a standard against which other conditions can be compared in a scientific experiment. It can also be defined as restraint, discipline in personal and social activities. It is a relation of constraint of one entity (thing or person or group) by another Dominic. The state of dominance that exists when one person or group has power over another can also be marked as control. 1.7 Key variables

a. Variable related to socio demographic characteristics 1. Sex of the patient 2. Age 3. Education 4. Religion 5. Marital status 6. Monthly family income 7. Number of children 8. Type of family 9. Occupation 10. Educational qualification of spouse b. Variables related with HIV/AIDS awareness 1. Knowledge regarding HIV/AIDS 2. Source of information about AIDS 3. Prevalence 4. Clinical features 5. Methods of transmission of HIV 6. Transmission of HIV between mother and child 7. Diagnosis of AIDS 8. Opportunistic infections associated with AIDS 9. Treatment of AIDS 10. Consequences 11. Vulnerable groups of HIV/AIDS 12. Prevention of HIV/AIDS 13. Protection from HIV/AIDS 14. Role of family planning on prevention and control of HIV/AIDS 15. Situation of HIV/AIDS in Bangladesh 16. Role of media on prevention and control of HIV/AIDS 17. Bangladesh government strategy on prevention and control of HIV/AIDS 18. Role of NGO on prevention and control of HIV/AIDS

19. HIV/AIDS epidemic in other countries 20. Relationship between addiction and HIV/AIDS c. Variables regarding the factors related with HIV/AIDS awareness 1. Factors leading to HIV/AIDS 2. Form of protection for safe sex 3. Risk groups of HIV/AIDS 4. Vaccine of AIDS 5. Free distribution of condom 6. Sex education 7. Level of education system for incorporation of sex education 8. Place for HIV screening 9. Free distribution of disposable syringes 10. Behavior towards a man suffering from AIDS 11. Barriers for HIV/AIDS prevention

Chapter- 2 Literature review The battle against the disease AIDS is undoubtedly getting more and more serious all over the world. Unless the population has an adequate understanding of AIDS and the ability to practice low risk behaviors, the increasing rates of development of HIV/AIDS would be considerable public health threat. This is why; several studies had been carried out in different groups and classes among the communities throughout the world to evaluate the knowledge about the awareness of HIV/AIDS. This will help to identify gaps in awareness about HIV/AIDS, thus recommending the various programmers in the HIV/AIDS awareness campaigns. In a study 185 male drug users who attended a drug addict treatment centre in Dhaka city were investigated and it was found that 99 percent of them had some awareness of AIDS28.In a study from (BDHS) Bangladesh Demographic Health Survey it is found that, the

knowledge on AIDS varied significantly in different parts of the country. Nearly a quarter of adolescents in Dhaka and Chittagong division had heard of AIDS, while only 8 percent of Rajshahi division had heard of AIDS. Education had a linear and positive relationship with having knowledge on AIDS. About 43 percent of the adolescents with secondary or above education had heard of AIDS compared to 12 percent with primary education and 7 percent with no formal education29. Findings in a study done in Rajshahi district of Bangladesh revealed that about 87 percent male were aware about HIV/AIDS and comparatively women were found same aware of AIDS30. A cross sectional study was carried out in 2007 in South Delhi, India to investigate the perception, knowledge and attitude of adolescent urban schoolgirls. In this study 77 percent of the respondents had knowledge that multiple sex partners increase the risk of HIV infection, indicating good awareness about HIV transmission among the adolescent girls 31. To find out the level of awareness a study was done among the students of 13-18 years. It was observed that 82.2 percent of the students knew the virus as the causative agent and 63.2 percent students stated that the virus could transmit both prenatally as well as postnatally. Only 34 percent students were aware of all the precautions to be taken to avoid AIDS8. A study was conducted to know the present knowledge regarding occupational exposure to HIV amongst doctors in non-governmental hospitals and clinics across Delhi. Majority of them had suffered needle stick injuries. Many had also experienced splash over face and eyes. Some participants were still recapping needles most of times. 85.7 percent of participants were fully vaccinated for hepatitis B .Awareness was low (36 percent). The study highlighted the low awareness of post exposure prophylaxis measures amongst health care workers 32. A 1998 study on HIV/AIDS awareness levels among adolescents at St. Xavierâ&#x20AC;&#x2122;s College in Mumbai (Bombay) found that female students were significantly better informed about the disease and its manifestations than their male counterparts. The study also found that students in the Arts stream and those in the younger age group (15 to 20 years) were more

knowledgeable about AIDS than those studying science or commerce who were over 20 years.33 The internet is currently used as a tool to obtain information, make conversation, and find sexual partners. A study included 898 participants. Internet users were in visited to participate from December 2003 to march 2004 through a link on the homepage of the internet health website (www.isnet.com.rt). Two e-mail messages were sent to all internet subscribers, the first one on the first day of the program and the second after a week period, inviting them to participate in the survey. A total of 898 persons participated in the survey with regard to general information about AIDS. Half of the respondents said that it was a viral disease and was transmitted only sexually and 11.4% of them stated that AIDS was curable. This showed that Turkish society did not have adequate awareness of the treatment of HIV/AIDS. 34 A qualitative study using focus group discussions was conducted in both rural and urban areas among the disabled and non-disabled participants. Participants with disability were less well informed about HIV/AIDS than their non-disabled peers 35. A study was conducted in 7 private co-educational English medium schools for classes IX and XI in Cochin, Kerala, India. More than 70 percent of adolescents were aware about AIDS. But adequate knowledge about its spread and prevention was lacking

. To create awareness/

sensitization campaigns on HIV/AIDS in dangers of the HIV/AIDS pandemic in Nigeria, a study was done, from last week of March, 2007 to last week of April, 2007. The senior and junior staffs of Keffi Local Government Area of Nasarawa state of Nigeria took part in this study. Majority (50.7 percent) demonstrated clear knowledge of risky-behavior while 49.3 percent claimed poor knowledge of the same concept. Long distance truck drivers in Pakistan had serious gaps in their knowledge about HIV/AIDS, especially its modes of transmission, signs/ symptoms and prevention. In a study, 75 truck drivers at Badami Bagh Truck Stand, Lahore, Pakistan, were interviewed on non-random basis. Forty to fifty percent of respondents had the misconception that AIDS could be contracted by casual contract and by being in the same room with a person with AIDS. Two third of the truck drivers did think that monogamy and condom use was an effective method for AIDS prevention. They also had a negative attitude towards persons with AIDS 38.

A study about awareness of HIV/AIDS and its oral manifestations among people living with HIV in Dares Salaam, Tanzania was performed. A total of 13.4 percent of the participants were completely unaware of the oral manifestations of HIV/AIDS whereas all participants were fully aware of general symptoms of AIDS. There were no significant associations between awareness of oral manifestations and general awareness of HIV/AIDS on level of education . Impact of Educational intervention on knowledge regarding HIV/AIDS among adults of Kathmandu, Nepal was examined. Finding of the study revealed that most of the respondents had misconception about transmission of HIV/AIDS. Before intervention, mean knowledge for ways to prevent transmission of HIV/AIDS was 2.05 which were increased to 5.65 after intervention

. A nationwide survey, HIV/AIDS knowledge among Malaysian

youths shows that knowledge among the respondents was knowledge score of 20.1 out of 32 points 41. A study was performed at an urban antenatal hospital clinic in Maharastra, India, from April to September 2001. Structured interviews were conducted on 707 randomly selected antenatal clinic patients related to HIV/AIDS knowledge. Nearly 70 percent of women demonstrated knowledge of maternal to child transmission; however, only 8% knew of any methods of prevention. Education of the women was strongly related to HIV/AIDS. In addition, if the husband was reported to have a higher status employment the women were 50 percent more likely to have adequate knowledge of AIDS 42. The US Embassy celebrated World AIDS Day with the US Agency for International Development (USAID) and its partners in the fight against HIV/AIDS in Nepal through a program of informative games and interesting events designed to raise awareness and highlight key issues. The World AIDS Day program represented an important educational initiative in support of USAID/ Nepal. USAID/ Nepal was hopeful that the opportunity that World AIDS Day represented would be used to place the issues of those affected by HIV/AIDS at the forefront and to act as a catalyst for improving efforts to mitigate the impact of HIV/AIDS in Nepal. 43

A recent survey by Assumption University revealed that a third of Thai girls who responded to the poll thought it neat to lose virginity on Valentine’s Day. The World Bank Thailand Youth Club had been focusing on promoting awareness among young people. In Februarythe Month of love for many youths around the youth Club organized two events to encourage youth dialogue on HIV/AIDS. The ``Co Park” on February 10 aimed to raise funds for the HIV/AIDS center at a temple in central. The ``Safe sex or no sex’’ campaign on February 13 aimed to encourage youth to choose and protect themselves from HIV/AIDS 44. A study was carried out in January and February, 2005 among secondary school teachers in Abeokuta, the capital city of Ogun State, and jebu Ode, the second largest town in Ogun State, Nigeria. Twelve schools were randomly selected out of 35 public schools in the towns. The study found that the teachers who participated in the survey had good knowledge of HIV/AIDS. However efforts are still needed on the parts of those concerned to increase the knowledge of these teachers as they had few misperceptions about facts, modes of transmission and the right attitudes towards people with HIV/AIDS. There is need to train teachers for them to be able to deliver information of sufficient quality and intensity that could have positive behavioral impact on the students 4. HIV/AIDS awareness program was conducted in health care workers working in out-patient Health Care facilities in the city of Bangalore in India. The health care workers were doctors, pharmacists, nurses/ nursing assistants, laboratory staffs, health assistants and cleaning staffs. In results, doctors showed 16 percent increase in the correct responses whereas 82 percent of the other participants improved their correct responses by 15 to 70 percent and 14 percent did not show any change. Surprisingly, 4 percent deteriorated by 10 to 15 percent. Conclusion was drawn by stating that HIV/AIDS awareness programs are quite effective in informing & educating health care workers who form the backbone of AIDS control programmes 45. In Kante, situated about 400 miles north of Lome, several hundred young people gathered to view a video entitled ``Sahel Scenario”. After the film, the ARS nouveaux horizons book, ``Sida- Ce Que Les Jeunes Doivent Savoir” (``AIDS- What young people must know”), was presented by the local physician and staff of an AIDS NGO. The focus of the program was `` Girls confronted with AIDS.” The film shown at the HIV/AIDS program in Kante was more effective than speeches to convey to young people the causes and effects to HIV/AIDS 46.

In Karachi-Sindh of Pakistan, HIV/AIDS awareness programs were initiated through quiz and poster competition among youth. Five girlâ&#x20AC;&#x2122;s colleges were selected and the participants were provided informative material, literature about HIV/AIDS for preparation of quiz and making posters. During quiz, questions regarding HIV/AIDS prevention, control and present data were asked. STDs and other public health problems were also covered. Cash prizes and awards were given to the all participants and trophies to the winning teams. General audiences attending the competition were also involved and encouraged by direct questions and prizes. This approach provided an opportunity of creating awareness within locally acceptable atmosphere, norms, language and cultural values. The activity attracted and evolved the youth as a active member to bring about changes in their own attitude and practices 47. A community based cross-sectional study was conducted from August 2003 to January 2004 in 36 villages of Anand district of India. A two page structured questionnaire was prepared both in English and local language i.e., Gujarati. The questions were related to awareness of HIV/AIDS, mode of disease transmission, its prevention & assessment of health service utilization. EPI- INFO package was utilized for statistical analysis. Among all those (76.6 percent) who had heard about HIV/AIDS, 22 percent correctly knew about the sexually transmitted infections. Knowledge of prevention was very good as 76 percent of males and 52 percent of females had the opinion of having sex with single partner was a most important way of life to prevent HIV/AIDS. It was surprised to see the popularity of local so called doctors (Quacks) as 30 percent of the individuals still had the opinion to visit them to get treatment for problem related with their genitalia. Most of them (>90 percent) were uneducated. Among the educated class, 70 percent were interested to visit primary health centers and Skin & VD department of medical college hospital. About two-fifths (40 percent) of them were not interested in doing anything for the infected person 48. The low level of awareness especially on STD, HIV and AIDS is always alarming for rapid diffusion of epidemic in population of higher size. This is because culture of a particular society can restrict partially but not forbid entirely the heterogeneous sexual relation among its inhabitants as because it is solely a spontaneous response to nature. SHAD had been working with under privileged women, children and drug users in Khulna division

located at the Southern region of Bangladesh since last 8 years. From its working experience at this particular region, SHAD found that a mutiny had taken place beyond the sight and was still functioning without any mentionable indication of ending. Random practice of adolescent sex, abundance of multiple marriages for trafficking and sex trade in home and abroad made this individual population of a particular region in Bangladesh was distinguished from general culture and sexual attitude of other areas that might the reason of high vulnerability of STD, HIV/AIDS. SHAD conducted a study to explore their attitude, determine the unsafe sex along with vulnerability to STI, HIV and AIDS 49. The Asian Development Bank had funded an HIV/AIDS awareness project in remote mountains in Chinaâ&#x20AC;&#x2122;s Qinghai and Gansu provinces. Religious festivals around mosques and temples provided opportunities for anti-HIV/AIDS workers to disseminate information and condoms, give lectures, and perform plays related to the fight against the epidemic. Schools were important centers for recruiting teachers and students to become long-term HIV/AIDS prevention volunteers. People between the ages of 18 to 30 were particularly receptive to visual performances as an education tool. It reported that the project was a success with HIV/AIDS prevention awareness rates of up to 90 percent among those targeted 50. Research omnibus survey in April 2002. The survey was carried out in ten cities and ten towns throughout China with 6.777 people completing the interviews. The random sample of adults ranged from ages 18-70 years, with various levels of education (from illiterate to post graduate), and with different occupations and monthly income. Knowledge of HIV/AIDS among men and women was high: over 93 percent of city residents and almost 83 percent of town residents had heard of HIV or AIDS; Disparities in HIV/AIDS awareness existed among people with different socio-cultural backgrounds 51. Hong Kong had a migrant worker population of almost 250, 000 of which nearly 220,000 were foreign domestic workers, 90 percent of them women. Of foreign domestic workers documented in 2004, 54.8 per cent were from the Philippines and 41.2 per cent from Indonesia. To increase awareness of the dangers of HIV/AIDS the centre had, for the last four years, organized a day-long AIDS Festival that brought together migrant workers form various countries. The event not only educated migrant workers about AIDS but promoted other health issues. A study conducted by the centre had shown that migrant workers

interested to self-medicate and were teared of often reluctant to tell their employers if they’re sick because they feared losing their Jobs 52. The male participants, 190 in number from 3 plantations of Penisula, Malaysia participated in a program which was arranged to identify the level of knowledge among the plantation men as well as to initiate future HIV/AIDS programs. An exercise to gauge the level of HIV/AIDS knowledge was carried out followed by basic HIV/AIDS and STD information. In result, the plantation community men had low level of HIV knowledge. Prevention method such as condom use was not well known before this program. At the end of the program there was significant increase in the level of understanding. From the project it was noted that there was a need for more follow up programs on HIV/AIDS for the plantation community53. A cross-sectional study design was undertaken to determine the beliefs and associated highrisk behaviors connected with the transmission of HIV among a group of adult males incarcerated in Rajaei-Shahr prison. This maximum-security prison was located in Karaj city, which was approximately 70 km North West of Tehran, the capital city of Iran. The study sample was 100 adult males, who were incarcerated in March, 2004. The majority of prisoners in this study were knowledgeable about how HIV was transmitted. Their high level of understanding might be due in large part to recent credible HIV training efforts in Iranian prisons. However the vast majority of prisoners still believed that HIV could be transmitted through kissing or hand shaking54. The HIV/AIDS awareness program in the port city of Merauke in West Indonesia increased people’s knowledge and awareness about HIV/AIDS to help to prevent the spread of the disease. The program developed and distributed IEC (Information, Education and Communication) materials such as posters, leaflets, video films, coloured shirts as means of promoting messages on HIV/AIDS so that people in community had access to accurate information about the disease55. Evaluation of a 2-year Acquired Immunodeficiency Syndrome (AIDS) Awareness project in Sri Lanka’s West Coast confirmed the efficacy of interventions based on AIDS related drama productions and brochure distribution. Program evaluation was based on 154 pre- and 97 post-intervention tests and interviews with 30

men and women. Television and newspapers were identified as the major sources of information about AIDS56.

A close ended questionnaire study on knowledge, attitude and practice (KAP) about HIV/AIDS was conducted amongst first year MBBS students immediately on joining the course. One hundred and fourteen students participated in the study. Overall level of knowledge about AIDS was found to be 72 percent. Boys were better informed about possible methods of prevention of AIDS than girls. Misconceptions regarding mode of transmission, clinical presentation and prevention existed amongst large number of them. Seventeen percent of boys and 5 percent of girls approved of pre-marital sex for boys while 14.8 percent of boys approved the same for girls. Thirteen and half percent of boys admitted sexual experience. Awareness programs should be intensified amongst students to improve the overall knowledge of AIDS 57. A study of Nigeria investigated the level of awareness of HIV/AIDS among the rural dwellers in life zone, Osun state. A total of 240 respondents from different age categories were selected through systematic random sampling. It was found that the level of education (p=0.02) and marital status (p=0.02) were significantly related to the awareness of HIV/AIDS by the respondents. A small majority (67 percent) indicated their awareness of the diseases, among which 36.3 percent indicated radio, while 14 percent indicated television, as their sources of awareness. In conclusion, there was an average level of awareness about HIV/AIDS in the studied rural areas, indicating the need for more campaigns against the disease, especially in the rural areas. To examine the awareness of HIV/AIDS amongst students of tertiary institutions in Edo state of Nigeria, a study was performed. The analysis of data showed that the awareness of HIV/AIDS was relatively high accounting 53 percent of respondents. It was revealed that 55 percent of the respondents got their information about HIV/AIDS mostly from the media (television, radio and newspapers), 28 percent got mostly from public lectures, seminars and bills, 17 percent on the other hand got their information from other sources specially, from friends and neighbours.Based on data from 33 states of USA, it was shown that many

older persons were sexually active but might not be practicing safer sex to reduce their risk for HIV infection. Some older person’s injected drugs or smoke crack cocaine, which could put them at risk for HIV infection. HIV transmission through injection drug use accounted for more than 16 percent of AIDS cases among persons aged 50 and older. Some older persons, compared with those who are younger, might be less knowledgeable about HIV/AIDS and therefore less likely to protect themselves. In 2003, China initiated an ambitious program to raise the awareness of the disease, reduce stigma and prevent HIV epidemic in the country. China’s first major television campaign to promote condom use was not launched until 2007.The campaign targeted the young and mobile and comprised of on short public service announcements on public transport, using slogans such as “Life is too good, please protect yourself”. It was shown in the literature that people who had sex in the last six months with someone other than their spouse, 42 percent had not used a condom during their last two acts of sexual intercourse. Nearly 30 percent of all respondents did not know how to correctly use a condom 61.A study was conducted to determine the awareness of AIDS control and sex behavior of youth in Assam state of India. In this study, it was interesting to note that unmarried respondents were better exposed to media than married youth. While 25 percent of the respondents of the high income were “High exposed” to media, only 16.7 and 7.1 percent of the respondents from middle and low income families respectively were “High exposed” to media. Further 40.4 percent of the low income respondents were “Less exposed” to media. Majority of the illiterate respondents were “Less exposed” to media and only one percent was “High exposed”. There was no single case of “Low exposed” among those who studied up to graduation and only 2.2 percent of secondary level educated respondents were low exposed. It was significant to note that students and unemployed youth were “High exposed” than those who are engaged in any occupation. Only “Highly exposed” respondents were “knowledge-able” about AIDS. A study was performed to know the awareness and attitudes about HIV/AIDS among males in a rural population. It was observed that 90 percent of the rural males had knowledge about HIV/AIDS, 32 percent knew what caused AIDS and 20 percent could state the effect of HIV on the body. There was inadequate knowledge about the relationship between STD and

HIV/AIDS. 75 percent of the rural males could endorse at least three methods of prevention of HIV/AIDS. The predominant source of information was TV (78 percent). Friends were a major source of information among the younger males. Majority (57 percent) felt that a person with HIV must be isolated or even put in prison (22 percent). There was attribution of the risk of acquiring disease mainly to truck drivers or commercial sex workers. There existed a lack of perception of risk that HIV could also affect rural populations. Small proportion of people still felt that there was a cure for HIV/AIDS (14 percent). Chapter- 3 Methods and Materials

3.1 Study Design: Cross-sectional descriptive study 3.2 Study Place: Out patient Department of Dhaka Mohanagar General Hospital (DMGH) run by Dhaka city corporation (DCC) under the ministry of local Government and rural development (LGRD) which is situated at Naya bazaar area of old town under Dhaka city. This institution was established in 1988. It was a fifty bedded hospital under the management of chief health officer of Dhaka City Corporation. It is capable of providing curative, preventive, promotive and rehabilitative services to the population.

Services

Preventive

Curative

Promotive

Rehabilitative

1. Emergency

1. Immunization

1. Pathology

1. Social welfare

2. Radiology

2. Physiotherapy

Out

patient

services 3.

services

patient

Family

planning

3. Ultrasonography

3. VCT Program

4. ECG

The outdoor of the hospital provides various types of medical services like medicine, surgery, dental, gynae and obstetrical, eye, otolaryngology and pediatrics. At present daily hospital out door attendance is 350-400 in number. In indoor, bad occupancy rate is over 70 percent. In surgery and gynae departments, all routine operations and laparoscopy operations are performed. In obstetric, normal/ instrumental delivery, caesarian section are done. In pathology, all investigations are done in automatic computerized machine. The childhood vaccination is provided by this hospital according to the international guidelines recommended by the World Health Organization. This institution always takes a positive role in all the NID (National Immunization Day) for immunization coverage. DOTS was introduced in March, 2008 at this hospital under the national TB control program. CARE (Co-operation for American Relief Everywhere), Bangladesh started VCT (Voluntary Counseling and Testing) program in this hospital from 17 th July 2008 for the IDUs (Injecting Drug Users) to detect HIV/AIDS. Rehabilitation program is conducted by Women’s Voluntary Organization in this hospital via physiotherapy department among the children and adults. There was a social welfare center in this hospital for providing help to the poor who were unable to purchase outdoor tickets/ necessary drugs or operation materials not available in the hospital and also to arrange blood/ blood products and for burial of the dead body. 3.3 Study period: From June 2009 – May 2010 3.4 Study Population : All the adult patients at the age of 18 to 35 years, attended at the Out Patient Department of Dhaka Mohanagar General Hospital under Dhaka City Corporation, situated at Naya Bazar area of old town of Dhaka city. 3.5 Study sample: Purposive sampling technique was followed until the desired number of sample met. 3.6 Sample size: Sample size was calculated by applying the following formula with accuracy level at 5% n= z2 pq/d2 here z = 1.96, p= 0.77 (Awareness about HIV/AIDS among the adults about 77 percent) 12 q= 1 – p = 1 - 0.77 = 0.23

d= .05 CL=95% n= Sample size So, the eventual sample size n= 272, But my feasible sample size was 155. 3.7 Eligibility criteria: 3.7.1 Inclusion criteria: •

Adult patients

•

Age between 18 – 35 years

•

Only out door attended patients

•

Who were willing to participate

3.7.2 Exclusion criteria: •

Emergency patients

•

Pregnant patients

•

Severely ill patients

•

Addicted patients

•

Who were not able to understand the nature and purpose of the study.

3.8 Development of research instrument: A semi- structured interview questionnaire was developed according to the variables of the study. Variables were determined depending upon the specific objectives of the present study. In general, all questions would meet the following standards- a) easily understood by the respondent, 2) be simple i.e., would convey only one thought at a time, c) Would be concrete and d) Would conform as much as possible to the respondent’s way of thinking. Size of the questionnaire was tried to keep minimum. Questions usually followed general to the more specific and proceeded in logical sequence moving from easy to more difficult. Personal and intimate questions were kept at the first part of the questionnaire. Technical terms and vague expressions capable of different interpretations were avoided. Concerning the form of questions, two principal forms were used- the open-ended questions and closed-ended questions. In the former the respondent had to supply the answer in his own

words, whereas in the latter the respondent selected one of the alternative possible answers put to him. In open-ended questions, answers were specified by the researcher and comments in the respondentâ&#x20AC;&#x2122;s own words were held to the minimum. The questions were presented with exactly the same wording and in the same order to all respondents. Report was taken to this sort of standardization to ensure that all respondents reply to the same set of questions. Therefore, the questionnaire prepared for this study could be called as a semi-structured questionnaire. Questionnaire was developed in both English and Bengali language (Annexure- 1 and 2). 3.9 Pre testing of questionnaire: the questionnaire was pre tested among the adult population (fifteen percent of the sample size) in out patient department of Mitford hospital, Dhaka with due permission from the administration. Some changes like inclusion and exclusion of some variables and correction in the pattern of questions were made to finalize the interview questionnaire. 3.10 Data Collection: Information was collected by researcher him-self from the study population by face to face interview with the help of pre-tested semi-structured interview questionnaire. The researcher explained the aims and objects of the study and also tried to remove the difficulties which any respondent might feel free in understanding the meaning of a particular question or the concept of difficult terms. Data collection was done in every working days from Saturday to Wednesday except government holidays. Everyday data collection was started from 8-00 am to 01-00 pm during the period of out patient department. The duration was average 45 to 50 minutes for each interview. Each day 3/4 respondents were interviewed. Data was collected until the desired number of sample met. 3.11 Data analysis: Data analysis was done by SPSS software program. Using suitable test statistics, the significance of the findings were tested. Following measuring scale and test statistics were used for data analysis.

Name of the variable Socio-demographic: Age Education occupation Religion Monthly family income Family type

Measuring scale

Statistical test used

Continuous Mean, SD, percentage, frequencies, ranges. Percentage, frequencies Percentage, frequencies Percentage, frequencies Percentage, frequencies Chi-square

Ordinal Qualitative Qualitative Qualitative Qualitative Relationship between dependent Dichotomous and independent variables To assess the level of patient’s awareness about HIV/ AIDS, 20 factual information were collected. Then information’s were categorized in a five point scale, as very good -5, good 4, neither good nor bad =3, average-2, Poor= 1. Each of the respondent’s answer was marked as graded in the questionnaire. The total marks of each individual from twenty factual information i.e.,, awareness related variables regarding HIV/AIDS was divided by twenty and the average mark was calculated for each individual regarding his knowledge. Afterwards, recoding was made about the value of five point scale measuring the awareness related variables regarding HIV/AIDS to indicate knowledge of HIV/AIDS for each individual in the following manner:1-1.9 indicates poor knowledge 2-5 indicates good knowledge. Again, recoding was done in regarding each of the socio-demographic variables. The adult against each of the variables was divided into two groups. Sex Male

Age Higher age group

Education Literate

Religion Muslims

Marital status Married

Female

28-35 years Lower age group

Illiterate

Non Muslims

Unmarried

of Type

of Occupation

18-27 years Monthly

family Number

income High income group

children family Group having Nuclear

Employed

Education of spouse Literate

>10,000 taka Low income group

no children group Group having Joint/

group Unemployed

group Illiterate

<10,000 taka

children

group

Extended group

3.12 VARIABLES AND OBJECTIVES WITH QUESTION NO. Name of the variable Socio-demographic

objectives

Question no.

Age Education

assess

the

socio- 1 to 9

Religion

demographic

Marital status

with the level of awareness on

Monthly family income

prevention and control of

Number of children

HIV/AIDS.

characteristics

Type of family Occupation Educational qualification of spouse Awareness related variables

assess

the

level

awareness on prevention and 10-29 Factors

with

control of HIV/AIDS. HIV/AIDS To identify factors influencing

awareness.

HIV/AIDS awareness.

30-40

3.13 Presentation of findings: The findings of the study will be presented by frequency, average, mean, median, standard deviation, percentage, Chi-square, tables, graphs, charts and descriptions.

3.14 Ethical considerations:

To make a dissertation, permission from the university authority was taken. Proposal on a particular topic was made ready with discussion, consultation and kind permission from my guide Dr. Md. Nuzrul Islam-MBBS, Ph D. Finally, the proposal on that particular topic for making dissertation was approved by the university authority. For the study, participation of the adult patients was voluntary. Informed consent was obtained after a brief over view of the study in Bengali to all respondents and it was clarified to them that they were free to leave or refuse to take part in any portion of the study. All assurance was given that information received from the respondents would be kept confidential. The interviews were conducted when the respondent would attend at the outpatient department of the hospital. Every attempt was made to conduct the interview privately (Annexure- 3). 3.15 Limitation of the study: 1. The study was done on a purposively selected hospital. Thus the conclusion derived from this study was not representation of the country as a whole, where population was largely mixed- educated/ uneducated or rural/ urban. 2. There was limitation of time, for which an extensive survey could not be done. So, the sample size was small and the findings might not be reflective of the actual situation of the whole population. 3. The study was a cross sectional survey in which the information was collected retrospectively i.e., without any campaign about prevention and control of HIV/ AIDS, the assessment of awareness was performed. 3.16 Data Quality Management: First, activity schedule/chart in months was prepared (Annexure- 4). A semi-structured questionnaire was made ready that was pre-tested among the adult outdoor patients of other hospital. Interview questionnaire was finalized. A purposive sampling technique was followed to make a sample. A conceptual frame-work was prepared.

During data collection a portion of data would be periodically reviewed by the supervisor for accuracy and completeness. If a data accuracy problem was observed by the supervisor, special direction was given to researcher to improve data quality. Finally, data was processed with the help of personal computer by registration schedule, editing and coding. Statistical analysis was done by SPSS program. After that data was tested for validity and reliability. Then the data was presented.

3.17 Conceptual Frame Work:

Adult Patients

Purposive Sampling

Out -patient department Of

Socio-

Out come Awareness

Demographic Dhaka Mahanagar General Hospital

prevention

Characteristics

control HIV/AIDS

Open ended questionnaire *HIV/AIDS awareness related variables

Close ended questionnaire *Factors related with HIV/AIDS awareness

on and of

*Selection of adult patients attended at out-patient department having different sociodemographic characteristics. *Purposive sampling. *Open and close ended questionnaire applied. *Awareness among the respondents established as outcome of findings of questionnaire.

CHAPTER-4 Results and Findings This cross sectional descriptive study was done in Dhaka Mohanagar General Hospital, under Dhaka City Corporation among 155 adult patients. They were interviewed to assess the objectives of the study and findings were interpreted by tables, graphs and description and statistical inferences. There were no missing data and all respondents answered all the questions.

Socio-demographic Characteristics Variables:

Figure -1: Distribution of the adults by their sex

The figure-1 shows that among the adults 67.7 percent were female and 32.30 percent were male . Table-1: Distribution of the adults by their different age groups.

Age Group

Male No. (% )

Female No. ( % )

Total No ( % )

18 - 20 years

(7.7)

(17.4)

(25.2)

21 â&#x20AC;&#x201C; 25 years

(9.7)

(21.9)

(31.6)

26 – 30 years

(14.2)

31 – 35 years

(0.6)

Total

(32.3)

105

(27.7)

(0.6)

65 2

(67.7)

(41.9)

(1.3) 155

(100.0)

* Mean: 24.8 (SD± 4.3) years. Table-1 shows the age distributions of the adult’s population. The youngest adult was of 18 years while the eldest one was of 35 years. The mean age was 24.8 (SD± 4.3) years. Majority of the adults belonged to 26- 30 years age group (41.9 percent).The adults belonging to 2125 years were 31.6 percent and those belonging to 18-20 years were 25.2 percent. The adults belonging to 31-35 years were 1.3 percent only. Table-2: Distribution of the adults by their education. Male Female Educational Status No. (%) No. (%)

Total No.

(%)

Illiterate

(1.93)

(16.77)

(18.70)

Non formal education

(0.64)

(1.29)

Primary level

(5.80)

(15.48)

(21.29)

Secondary level

(25.80)

(45.16)

HSC level

(2.58)

(4.51)

(7.09)

Graduation & above

(0.64)

(3.87)

(4.51)

Others

(1.29)

(0.64)

(1.93)

Total

(19.35)

(32.25)

105

(67.74 )

155

(100.0)

The table-2 shows that majority (45.2 percent) of the adults were of secondary level, 21.3 percent at primary level, 7.1 percent at HSC level & 4.5 percent at graduate or above level. The percentage of illiteracy was 18.7 percent. Therefore, the percentages of literate and illiterate population were 81.3 percent and 18.7 percent respectively. Figure-2: Distribution of the adults by their Religion.

Figure-2 reveals that most of the adults (96.8 percent) were Muslims, 2.6 percent were Hindus and 0.6 percent were Christians. Table-3: Distribution of the adults by their marital status.

Marital status

Frequency

Percentage

Unmarried

23.9

Married Divorced

113 2

72.9 1.3

Widow

1.9

Total

155

100.0

The above table shows that among the adults,72.9 percent were married, 23.9 percent were unmarried, 1.9 percent widow and 1.3 percent divorced. Majority of the respondents were married. Table-4: Distribution of the adults by their monthly family income. Monthly Family Income Tk < 2500

Frequency

Percentage

(4.5)

Tk 2501 – 5000

(27.7)

Tk 5001 – 7500

(27.7)

Tk 7501 – 10000

(22.6)

Tk 10001 – 20000

(10.3)

Tk > 20000

(7.1)

Total * Mean Tk. 10216 (SD ± 12502)

155

(100.0)

The total monthly family income of majority of the adults (50.3 percent) was within 5001 – 10,000 taka only. The monthly family income more than 20,000/- taka was of 7.1 percent of the adults, within 10,001-20,000/-taka was of 10.3 percent and 4.5 percent had less than 2500/- taka. The mean total monthly family income was taka 10,216 (SD ± 12502). Table-5: Distribution of the adults by their number of children.

Number Children

Frequency

(16.1)

(32.2)

(28.0)

(18.6)

(5.1)

118

(100.0)

Total

Mean ± SD (Range)

Percentage

1.7 ± 1.1

* Mean 1.7 (SD ± 1.1) Children The above table-5 shows that among the adults, majority (60.2 percent) had only 1-2 children. 23.7 percent had 3-5 children and only 16.1 percent had no child. The mean number of children was 1.7 (SD+ 1.1).

Figure-3: Distribution of the adults by their family type.

Above figure shows that majority of the adults i.e. 65.8 percent were from nuclear family, 33.5 percent were from joint family and 0.6 percent were from extended family.

Table-6: Distribution of the adults by their main occupation

Occupation

Frequency

Percentage

Unemployed

3.2

Day labor

6.5

Agriculture

0.6

Business

11.0

Government service

16.8

Private service

18.7

NGO worker

0.6

House wife

42.6

Total

155

(100.0)

In this table, majority (42.6 percent) of the adults were housewife, the service holders were 36.1 percent, the businessmen were 11 percent, the day labors were 6.5 percent and the farmer was 0.6 percent. The unemployed adults were 3.2 percent only.

Table-7: Distribution of the adults by the educational qualification of their spouse:

Educational Status

Frequency

Percentage

Illiterate

(13.5)

Non formal education

(0.6)

Primary level

(20.0)

Secondary level

(34.2)

HSC level

(6.5)

Others

(1.3)

Missing

(23.9)

Total

155

(100.0)

The above table shows that educational status of the majority (34.2 percent) of the spouse was of secondary level, 20 percent was at primary level, 6.5 percent was at HSC level and 0.6 percent at non- formal level of education. The number of illiterate was 13.5 percent. HIV/AIDS knowledge related variables. Table-8: Distribution of the adults by their knowledge regarding HIV/AIDS.

Knowledge Regarding HIV/AIDS

Frequency

Percentage

Poor

(16.1)

Average

(46.5)

Neither Good nor bad

(27.1)

Good

(10.3)

Total

155

(100.0)

The above table shows that 46.5 percent of the adults had average knowledge about HIV/AIDS. Knowledge regarding HIV/AIDS was good in 10.3 percent cases, neither good nor bad in 27.1 percent cases and poor in 16.1 percent respondents. Table-9: Distribution of the adults by the source of information about HIV/AIDS.

Source of Information about HIV/AIDS Poor

Frequency 7

Percentage (4.5)

Average

(36.1)

Neither Good nor bad

(31.0)

Good

(28.4)

Total

155

(100.0)

The above table-9 shows that among the adults, the knowledge about source of information about HIV/AIDS was average in 36.1 percent, neither good nor bad in 31 percent and good in 28.4 percent adults. Only 4.5 percent had poor knowledge regarding source of information. Table-10: Distribution of the respondents by knowledge regarding prevalence period of HIV/AIDS.

Knowledge regarding Prevalence Period of HIV/AIDS

Frequency

Percentage

Poor

144

(92.9)

Average

(6.5)

Neither Good nor bad

(0.6)

Total

155

(100.0)

This table reveals that most of respondents (92.9 percent) had poor knowledge regarding prevalence period of HIV/AIDS. Only 6.5 percent had average knowledge. Table-11: Distribution of the adults by their knowledge regarding Signs & Symptoms of HIV/AIDS. Knowledge regarding Sign & Symptoms of HIV/AIDS

Frequency

Percentage

Poor

113

(72.9)

Average

(21.3)

Neither Good nor bad

(3.9)

Good

(1.9)

Total

155

(100.0)

The above table shows that 72.9 percent of the adults had poor knowledge regarding signs & symptoms of HIV/AIDS. Average knowledge was 21.3 percent and good knowledge was 1.9 percent. Table-12: Distribution of the adults by their knowledge regarding Spreading of HIV/AIDS. Knowledge HIV/AIDS

regarding

Spreading

Frequency

Percentage

Poor

(9.0)

Average

(29.0)

Neither Good nor bad

(36.8)

Good

(25.2)

Total

155

(100.0)

The above table shows that 36.8 percent of the adults had knowledge neither good nor bad about spreading of HIV/AIDS. Only 9 percent had poor knowledge. Adults bearing good knowledge regarding spread were 25.2 percent and those bearing average knowledge were 29 percent. Table.-13: Distribution of the adults by their knowledge regarding mother to child transmission of HIV/AIDS.

Knowledge Regarding Mother to Child Transmission of HIV/AIDS

Frequency

Percentage

Poor

(34.8)

Average

(47.1)

Neither Good nor bad

(16.1)

Good

(1.9)

Total

155

(100.0)

Among the adults, 47.1 percent had average knowledge regarding mother to child transmission of HIV/AIDS and the knowledge was neither poor in 34.8 percent cases and neither good nor bad in 16.1 percent cases. Only 1.9 percent of the adults had good knowledge. Table-14: Distribution of the adults by their Knowledge Regarding Diagnosis of HIV/AIDS. Knowledge HIV/AIDS

Regarding

Diagnosis

Frequency

Percentage

Poor

(57.4)

Average

(21.9)

Neither Good nor bad

(19.4)

Good

(1.3)

Total

155

(100.0)

The table-14 shows that the knowledge regarding diagnosis of HIV/AIDS majority (57.4 percent) of the adults had poor knowledge, 21.9 percent had average knowledge, 19.4 percent had neither good nor bad knowledge and only 1.3 percent adults had good knowledge. Table 15: Distribution of the adults by their Knowledge Regarding Opportunistic Infection associated with HIV/AIDS.

Knowledge Regarding Opportunistic Frequency Infection Associated with HIV/AIDS

Percentage

Poor

136

(87.7)

Average

(11.0)

Neither Good nor bad

(1.3)

Total

155

(100.0)

The above table shows that most (87.7 percent) of the adults had poor knowledge regarding opportunistic infection associated with HIV/AIDS, 11.0 percent had average knowledge and only 1.3 percent had neither good nor bad knowledge. Table-16: Distribution of the adults by their Knowledge Regarding Treatment of HIV/AIDS.

Knowledge HIV/AIDS

Regarding

Treatment

Frequency

Percentage

Poor

108

(69.7)

Average

(24.5)

Neither Good nor bad

(4.5)

Good

(1.3)

Total

155

(100.0)

Among the adults, 69.7 percent had poor knowledge regarding treatment of HIV/AIDS. The knowledge regarding treatment is neither average in 24.5 percent cases and neither good nor bad in 4.5 percent cases. Only 1.3 percent had good knowledge. Table-17: Distribution of the adults by their Knowledge regarding Consequence of HIV/AIDS.

Knowledge HIV/AIDS

regarding

Consequence

Frequency

Percentage

Poor

(34.2)

Average

(18.1)

Neither Good nor bad

(40.6)

Good

(7.1)

Total

155

(100.0)

Table-17 shows that 40.6 percent of the adults had neither good nor bad knowledge regarding consequence of HIV/AIDS. The knowledge was poor in 34.2 percent cases and average in 18.1 percent adults. Only 7.1 percent had good knowledge. Table-18: Distribution of the adults by their Knowledge Regarding Vulnerable Group of HIV/AIDS. Knowledge Regarding Vulnerable Group of HIV/AIDS

Frequency

Percentage

Poor

(25.8)

Average

(39.4)

Neither Good nor bad

(31.6)

Good

(3.2)

Total

155

(100.0)

This table-18 shows that 39.4 percent had average knowledge regarding vulnerable group of HIV/AIDS, 31.6 percent had neither good nor bad knowledge, 25.8 percent had poor knowledge and only 3.2 percent had good knowledge. Table-19: Distribution of the adults by their Knowledge Regarding Prevention of HIV/AIDS. Knowledge HIV/AIDS

Regarding

Prevention

Frequency

Percentage

Poor

(11.6)

Average

(40.6)

Neither Good nor bad

(38.1)

Good

(9.7)

Total

155

(100.0)

Knowledge regarding prevention of HIV/AIDS among the adults was average in 40.6 percent cases, 38.1 percent had neither good nor bad knowledge, 11.6 percent had poor knowledge and 9.7 percent of the respondents had good knowledge. Table-20: Distribution of the adults by their Knowledge Regarding Protective methods of HIV/AIDS.

Knowledge Regarding Protective methods of HIV/AIDS

Frequency

Percentage

Poor

(29.7)

Average

(30.3)

Neither Good nor bad

(32.3)

Good

(7.7)

Total

155

(100.0)

The above table-20 shows that 32.3 percent of the adults had knowledge regarding protective methods of HIV/AIDS- neither good nor bad, 30.3 percent adults had average knowledge and 29.7 percent adults had poor knowledge. The knowledge was good in 7.7 percent of the adults. Table-21: Distribution of the adults by their Knowledge Regarding Role of Family Planning on HIV/AIDS Prevention. Knowledge Regarding Role of Planning on HIV/AIDS Prevention

Family

Frequency

Percentage

Poor

(45.2)

Average

(38.7)

Neither Good nor bad

(15.5)

Good

(0.6)

Total

155

(100.0)

In this table, it is shown that 45.2 percent of adults had poor knowledge regarding role of family planning on HIV/AIDS prevention, 38.7 percent had average knowledge and 15.5 percent had neither good nor bad knowledge. Only 0.6 percent had good knowledge regarding it.

Table-22: Distribution of the adults by their Knowledge Regarding Situation of HIV/AIDS in Bangladesh.

Knowledge Regarding Situation of HIV/AIDS in Bangladesh

Frequency

Percentage

Poor

(37.4)

Average

(35.5)

Neither Good nor bad

(26.5)

Good

(0.6)

Total

155

(100.0)

The table shows that knowledge regarding situation of HIV/AIDS in Bangladesh among the adults was poor (37.4 percent), 35.5 percent had average knowledge and 26.5 percent had neither good nor bad knowledge. Only 0.6 percent had good knowledge. Table-23: Distribution of the adults by their Knowledge Regarding Role of Media in HIV/AIDS Prevention.

Knowledge Regarding Role of Media in Frequency HIV/AIDS Prevention

Percentage

Poor

(19.4)

Average

(29.7)

Neither Good nor bad

(41.9)

Good

(9.0)

Total

155

(100.0)

Above table reveals that 41.9 percent of adults had neither good nor bad knowledge regarding role of media in HIV/AIDS prevention, 29.7 percent had average knowledge and 19.4 percent had poor knowledge. Only 9 percent had good knowledge. Table-24: Distribution of the respondents by Knowledge Regarding Role of Bangladesh Government Strategy for Prevention & Control of HIV/AIDS.

Knowledge Regarding Role of Bangladesh Government Strategy for Prevention & Control of HIV/AIDS

Frequency

Percentage

Poor

(18.1)

Average

(47.1)

Neither Good nor bad

(29.7)

Good

(5.2)

Total

155

(100.0)

Here it is shown that knowledge regarding role of Bangladesh Government strategy for prevention & control of HIV/AIDS was average i.e., 47.1 percent of the respondents, 29.7 percent had neither good nor bad knowledge and 18.1 percent had poor knowledge. Only 5.2 percent had good knowledge regarding the strategy. Table-25: Distribution of the adults by their Knowledge Regarding Role of NGO for Prevention & Control of HIV/AIDS.

Knowledge Regarding Role of Prevention & Control of HIV/AIDS

NGO for

Frequency

Percentage

Poor

(42.6)

Average

(36.1)

Neither Good nor bad

(20.0)

Good

(1.3)

Total

155

(100.0)

Among the adults, this table reveals that 42.6 percent had poor knowledge regarding role of NGO for prevention & control of HIV/AIDS, 36.1 percent adults had average knowledge and

20 percent had neither good nor bad knowledge. Only 1.3 percent of adults had good knowledge.

Table-26: Distribution of the adults by their Knowledge Regarding Magnitude of Problems of HIV/AIDS Epidemics in Other Countries.

Knowledge Regarding Magnitude of Problems of HIV/AIDS Epidemics in Other Countries

Frequency

Percentage

Poor

(50.3)

Average

(29.7)

Neither Good nor bad

(18.1)

Good

(1.9)

Total

155

(100.0)

The above table shows that 50.3 percent of the adults had poor knowledge regarding magnitude of problems of HIV/AIDS epidemics in other countries, 29.7 percent had average knowledge and 18.1 percent had neither good nor bad knowledge. The knowledge regarding above was good in only 1.9 percent of cases..

Table-27: Distribution of the adults by their Knowledge Regarding Association between Drug Addiction and HIV/AIDS.

Knowledge Regarding Association Between Drug Addiction and HIV/AIDS

Frequency

Percentage

Poor

(23.9)

Average

(45.8)

Neither Good nor bad

(27.7)

Good

(2.6)

Total

155

(100.0)

The table-27 shows that 45.8 percent had average knowledge regarding association between drug addiction and HIV/AIDS among the adults, 27.7 percent had neither good nor bad knowledge nor 23.9 percent had poor knowledge. Only 2.6 percent of the adults had good knowledge.

Factors related with HIV/AIDS awareness Figure- 04: Distribution of the adults by the factors leading to HIV/AIDS.

This figure reveals that majority (60.6 percent) of the adults thought that the peer pressure was responsible for leading to the HIV/AIDS, 26.5 percent supported illiteracy, 25.8 percent supported familial stress, 16.8 percent supported poverty, 15.7 percent supported unemployment and 23.2 percent for the other factors like financial solvency, inability to arrange marriage for the young adults by their parents in time.

Figure-05: Distribution of the adults by their preference for safe sex.

This figure shows that 76.8 percent of the adults preferred condom as a form of protection for safe sex 0.6 percent preferred injection, 1.9 percent preferred pill and 20.6 percent preferred other methods like abstinence.

Figure- 06: Distribution of the adults regarding the risk groups of HIV/AIDS in our society.

This figure reveals that most (79.4 percent) of the adults recognized prostitutes as the risk groups of HIV/AIDS in our society, 68.4 percent recognized drugs addicts and others (truck and buss drivers, rickshaw puller). 47.1 percent recognized foreign migrants, 14.8 percent recognized local migrants and 8.4 percent recognized commercial sex workers.

Figure- 07: Distribution of the adults regarding availability for vaccine against HIV/AIDS.

Among the adults, 51.6 percent informed their negative response about the availability of vaccine against HIV/AIDS in the market, 27.7 percent gave positive responses and 20.6 percent were not sure about that.

Figure- 08: Distribution of the adults about the role of the free distribution of condom on HIV/AIDS spreading

This above figure shows that most of the adults (81.9 percent) gave their positive responses about the role of the free distribution of condom on HIV/AIDS spreading, 3.2 percent gave negative response and 14.8 percent gave no opinion.

Figure- 9: Distribution of the adults about the necessity of sex education incorporating in our educational curriculum.

This above figure shows that most of the adults (96.8 percent) gave their positive responses about the necessity of sex education incorporating in our educational curriculum, 1.9 percent gave negative response and 1.3 percent gave no opinion.

Figure- 10: Distribution of the adults by their choice at which level, sex education should be incorporated.

About the level of education at which sex education should be incorporated, 36.2 percent supported secondary level, 27 percent supported primary level, 21.7 percent supported college level and only 5.3 percent university level.

Figure- 11: Distribution of the adults by their choice of places to get services/ for screening of HIV/AIDS.

For screening of HIV/AIDS, majority (60.6 percent) of the adults mentioned that private clinic/ hospital was the place of choice and then 53.5 percent suggested to go to a physicianâ&#x20AC;&#x2122;s chamber, 36.1 percent suggested primary health center, 31 percent suggested district hospital, 29.7 percent suggested medical college hospital and 13.8 percent suggested other places like chamber of skin and venereal disease specialist and health care workers. Figure- 12: Distribution of the adults by their knowledge about the role of the free distribution of disposable syringes on HIV/AIDS spreading.

This above figure shows that most (77.4 percent) of the adults gave their positive responses about the role of the free distribution of disposable syringes on HIV/AIDS spreading, 17.4 percent gave negative response and 5.2 percent gave no opinion.

Figure- 13: Distribution of the adults by their attitude towards a man suffering from AIDS.

Regarding the attitude towards a man suffering from AIDS, 78.7 percent of the adults supported friendly behavior, 30.3 percent supported helping attitude, 5.2 percent suggested creating opportunity for work, 3.2 percent suggested living together and 24.5 percent told otherwise i, e, isolation of the patients. Figure- 14: Distribution of the adults according to the barriers of preventing HIV/AIDS.

Among the adults, majority (63.2 percent) of them thought that lack of awareness was the barrier of preventing HIV/AIDS, 15.5 percent told about parentâ&#x20AC;&#x2122;s opposition, 11 percent suggested loss of self respect, 5.8 percent for cultural inhibition, 4.5 percent for religious constraints and the rest (12.9 percent) for other reasons like easy availability of narcotics and free border of our country.

The relationship of knowledge about HIV/AIDS with socio-demographic characteristics: Table- 28: Relationship between sex and knowledge of the adult patients regarding HIV/AIDS. Knowledge about HIV/AIDS Sex

Total N o.

( %)

Male

(32.25)

Female

105 (67.74)

Poor Knowledge No. ( % )

Good Knowledge No ( % )

23 (46.0)

27 (54.0)

52 (49.52)

53 (50.48)

ď Ł2

0.168*

0.682.

Total

155

75 (48.39)

80 (51.61)

* Pearson Chi-Square with two tail significance. The above table-28 shows that 54.0 percent of the male population and 50.48 percent female population had good knowledge about HIV/AIDS, The male adults had more knowledge than female. Table-29: Relationship between age and knowledge of the adult patients regarding HIV/AIDS.

Knowledge about HIV/AIDS Age Group

Total No.

( %)

Poor Knowledge N o. ( % )

Good Knowledge No. ( % )

Lower age

100 (64.51)

(47.0)

53 (53.0)

Higher age

28 (50.91)

27 (49.9)

Total

155

75 (48.39)

80 (51.61)

(35.48)

ď Ł2

0.089*

0.766

* Pearson Chi-Square with two tail significance. The above table-29 shows that 53.0 percent of lower age group and 49.9 percent of higher age group had good knowledge. The adults of lower age group had more knowledge than the adults of higher age group. Table-30: Relationship between literacy and knowledge of the adult patients regarding HIV/AIDS.

Knowledge about HIV/AIDS Literacy

Total No.

( %)

Poor Knowledge No. ( % )

Good Knowledge No. ( % )

Illiterate

29 (18.71)

17 (58.62)

12 (41.38)

Literate

126 (81.29)

(46.3)

68 (53.97)

Total

155

75 (48.39)

80 (51.61)

* Pearson Chi-Square with two tail significance.

ď Ł2

1.496*

0.221

This table reveals that 46.3 percent of literate group and 58.62 percent of illiterate group had poor knowledge regarding HIV/AIDS. On the other hand, 53.97 percent of literate group and 41.38 percent of illiterate group had good knowledge. The adults of literate group had more knowledge than the adults of illiterate group. Table-31: Relationship between religion and knowledge of the adult patients regarding HIV/AIDS.

Knowledge about HIV/AIDS Religion Group

Total No.

( %)

Poor Knowledge No. ( % )

Good Knowledge No. ( % ) 78

Islam

150 (96.77)

(48)

Others

5 (3.23)

Total

155

75 (48.39)

(60)

2

(52.0)

0.674

(40.0)

80 (51.61)

* Fisher’s Exact Test with two tail significance. This table reveals that 52.0 percent of Muslims and 40.0 percent of non Muslims had good knowledge. The Muslims adults had more knowledge than the adults of other religions.

Table-32: Relationship between marital status and knowledge of the adult patients regarding HIV/AIDS. Knowledge about HIV/AIDS Marital Status Group

Total N o. ( %)

Poor Knowledge No. ( % )

Good Knowledge No. ( % )

Unmarrie d

(23.87)

17 (45.94)

20 (54.05)

Married

118 (76.13)

58 (49.15)

60 (50.85)

Total

155

75 (48.39)

80 (51.61)

* Pearson Chi-Square with two tail significance.

2

0.116*

0.733

This table-32 reveals that 54.05 percent of unmarried group and 50.85 percent of married group had good knowledge. The adults of unmarried group had more knowledge than the adults of married group. Table-33: Relationship between monthly family income and knowledge of the adult patients regarding HIV/AIDS. Knowledge about HIV/AIDS Monthly Income Group

Total

Low Income

Poor Knowledge No. ( % )

Good Knowledge No. ( % )

128(82.58)

63 (49.22)

65 (50.78)

High Income

27 (17.42)

12 (44.44)

15 (55.55)

Total

155

75 (48.39)

80 (51.61)

No.

( %)

ď Ł2

0.204*

0.652

* Pearson Chi-Square with two tail significance. The above table-33 shows that 50.78 percent of low income group and 55.55 percent of high income group had good knowledge. The adults of high income group had more knowledge than the adults of low income group.

Table-34: Relationship of the adults by their Knowledge Regarding HIV/AIDS in respect of having children in the family.

Knowledge about HIV/AIDS Children in the Family Total Group No. ( %)

Poor Knowledge No. ( % )

Good Knowledge No. ( % )

Yes

99 (63.87)

47 (47.47)

52 (52.52)

19 (12.26)

11 (57.89)

8 (42.10)

Total

118

58 (49.15)

60 (50.85)

* Pearson Chi-Square with two tail significance.

ď Ł2

0.693*

0.405

This table-34 shows that 52.52 percent of the adult having children and 42.1 percent of adults having no children had good knowledge. The adults having children had more knowledge than the adults having no children.

Table-35: Relationship between type of family and knowledge of the adult patients regarding HIV/AIDS. Knowledge about HIV/AIDS Type Family

Nuclear

Total No. ( %) 102 (65.81)

Poor Knowledge No. ( % ) 46 (45.10)

Good Knowledge No. ( % ) 56 (54.90)

Join/Extended 53(34.19)

29 (54.72)

24 (45.28)

Total

75 (48.39)

80 (51.61)

155

ď Ł2

1.292*

0.256

* Pearson Chi-Square with two tail significance. The above table-35 reveals that 54.90 percent of the nuclear group and 45.28 percent of other groups had good knowledge. The adults of nuclear family had more knowledge than the adults of others families.

Table-36: Relationship between employment and knowledge of the adult patients regarding HIV/AIDS. Knowledge about HIV/AIDS Employment

Total

Unemployed

No. ( %) 68 (43.87)

Poor Knowledge No. ( % ) 36 (52.94)

Good Knowledge No. ( % )

Employed

87(56.13)

39 (44.83)

48 (55.17)

Total

155

75 (48.39)

80 (51.61)

(47.06)

ď Ł2

1.006*

0.316

* Pearson Chi-Square with two tail significance. The above table-36 reveals that 47.06 percent of unemployed group and 55.17 percent employed group had good knowledge. The adults of employed group had more knowledge than the adults of unemployed group.

Table-37: Relationship between educational status of spouse and knowledge of the adult patients regarding HIV/AIDS.

Knowledge about HIV/AIDS Education spouse Illiterate

Total No. ( %) 21(13.55)

Poor Knowledge No. ( % ) 11 (52.38)

Good Knowledge No. ( % )

ď Ł2

10 (47.62) 0.107*

Literate

97(62.58)

47 (48.45)

50 (51.55)

Total

118

58 (49.15)

60 (50.85)

0.744

* Pearson Chi-Square with two tail significance. This table 37 reveals that 47.62 percent of the adults having illiterate spouse and 51.55 percent of the adults having literate spouse had good knowledge. The adults having literate spouse had more knowledge than the adults having illiterate spouse.

Chapter- 5 Discussion, Conclusion and Recommendations 5.1 Discussion: The general objectives of this study were to assess the level of awareness on prevention and control of HIV/AIDS and to identify the factors influencing HIV/AIDS awareness among the adults attending at out patient department of Dhaka Mohanagar General Hospital, Naya Bazar, and Dhaka. The study populations were adult patients at the age of 18-35 years and

155 adults were interviewed for this purpose. Purposive sampling technique was followed until the desired number of sample met. Among the adults, majority of the adults were female, 67.7 percent. In consideration of knowledge about HIV/AIDS, 54 percent of the male adults and 50.48 percent of female adults had good knowledge. In a study

with awareness of AIDS control and sexual

behavior of youth in India showed that the knowledgeable respondents of male and female were 12 percent and 8.3 percent of total respondents and the proportion of not knowledgeable was 37.5 percent in male and 39.6 percent in female. In comparison to other study59 in Nigeria, the male student scored highest with 189 or 50.5 percent and female scored 185 percent or 49.5 percent and therefore making male students to be more aware of the diseases. In another study 48 done in Anand district of India, it was shown that 85.8 of male and 67.5 percent of female had heard about HIV/AIDS. A national survey 2 among the youth conducted in 2005 showed that 93 percent of males and 85.5 percent of females were aware of HIV/AIDS. So therefore our result is consistent with national and international studies. The age of the adults ranged from minimum of 18 years to maximum of 35 years. In consideration of age group we divided the adults in two age group â&#x20AC;&#x201C; (low age 18-27 years and high age group 28-35 years). Low age group adults had good knowledge about HIV/AIDS in 53 percent and poor knowledge in 47.0 percent. On the other hand, the knowledge about HIV/AIDS in high age group was good in 49.09 percent and poor in 50.91% cases. In a study 62 about the awareness and attitude regarding HIV/AIDS, the lower age group (15-30 years) scored 19.2 and the high age group (31-45 years) scored 13.5.

In comparison to other

study60, some older persons, compared with those who were younger, might be less knowledgeable about HIV/AIDS and therefore less likely to protect themselves. Another study33 found that students in the Arts stream and those in the younger age group (15 to 20 years) were more knowledgeable about AIDS than those studying science or commerce who were over 20. Our study is comparable with international level. Among the adults, majority (45.16 percent) had education at secondary level, 21.29 percent at primary level. 11.59 percent were at HSC and graduation or above level. The illiterate was 18.70 percent and the literate was 81.30 percent. The knowledge about HIV/AIDS was good

in 53.97 percent of literate group and poor in 46.03 percent. In illiterate group, good knowledge was in 41.38 percent and poor knowledge in 58.62 percent. A study

regarding

HIV/AIDS awareness and attitude showed that literate group scored 18.6 and illiterate scored 6.2. In comparison of other study 57, the knowledge about HIV/AIDS among literate i.e., among medical entrance â&#x20AC;&#x201C; 1 st year MBBS students, 98.5 percent were acquainted with HIV/AIDS. Another study

done in Rajshahi district in Bangladesh showed that about 96.4

percent of the respondents who were completed primary education had heard of AIDS compared to 100.00 percent who were completed secondary and higher education. Therefore the study done is consistent both nationally and internationally. Out of 155 adults, most (96.8 percent) were Muslims, 2.6 percent were Hindu, 0.6 percent were Christian. In respect of religion, 52 percent Muslims had good and 48 percent had poor knowledge about HIV/AIDS and in case of other religion groups, 40 percent had good knowledge and 60 percent had poor knowledge. So Muslims had more knowledge than adults of other religions. Among the adults 76.1 percent were married of whom 1.9 percent were widow, 1.3 percent were divorced and 23.9 percent adults were unmarried. Regarding knowledge about HIV/AIDS, the married adults had good knowledge in 50.85 percent cases. In comparison to married group, unmarried group had good knowledge in 54.0 percent cases. In comparison to other study

unmarried ranks top most among knowledgeable respondents. In

unmarried, the proportion of knowledgeable respondents was 12.1 percent and in married, that was 7.5 percent. The proportion of not knowledgeable in unmarried group and married group was 30.8 percent and 53.1 percent respectively. In another study

unmarried scored

21 and married scored 14.5 regarding the knowledge of HIV/AIDS. So our study is relevant with international studies. The adults were divided in two groups in respect of monthly income- high income group (>10,000 taka) and low income group <10,000 taka). The overall knowledge about HIV/AIDS was good in 55.55 percent cases in high income group and 50.78 percent in low income group. In a study

the respondents who belong to higher income group (>15,000 taka per

month) are knowledgeable about HIV/ AIDS of 25.0 percent and in lower income group

(<5,000 taka per month) knowledgeable is of 9.7 percent and not knowledgeable in 49.4 percent. No body was found as not knowledgeable in high income group. A study 51 in china showed that higher average monthly income indicated increased awareness of HIV/AIDS. Our study is pertinent with study of other country like China. Majority (60.2 percent) of the adults had only 1-2 children. Only 16.1 percent had no children. The adults were classified in respect of having children or not â&#x20AC;&#x201C; yes group (having children) and no group (having no children). Majority (52.53 percent) of the adults having children had good knowledge about HIV/AIDS and 47.47 percent had poor knowledge. On the other hand, the adults having no children had good knowledge in 42.10 percent cases and poor in 57.90 percent cases. Therefore, the adults having children had good knowledge about HIV/AIDS in comparison to those having no children. In the distribution of the adults by their family type 65.8 percent were from nuclear family. In the adults of nuclear family 54.90 percent had good knowledge regarding HIV/AIDS and 45.10 percent had poor knowledge. But the adults of other family types had good knowledge in 45.28 percent cases and poor knowledge in 54.72 percent cases. Therefore the adults of nuclear family had more knowledge than the adults of other families. The distribution of adults by their knowledge in respect of employment in service showed that in the employed group, 55.17 percent had good knowledge about HIV/AIDS and 54.83 percent had poor knowledge. In the other respect, in unemployed group 47.06 percent had good knowledge and 52.94 percent had poor knowledge. In comparison to other study

the respondents whose profession are non-manual (service, business etc) have more knowledge about HIV/AIDS as compare to those respondents whose profession are manual (agriculture, day labour etc). Our study result is partially relevant with international study. By the educational status of the spouse, majority of the study population showed of secondary level i.e., 34 percent. In respect of education of spouse of the adults, two groups were made- 1st group having literate spouse and 2nd group having illiterate spouse. In the 1st and 2nd groups, 51.55 percent and 47.62 percent had good knowledge about HIV/AIDS respectively. In comparison to other study 30, it was also observed that about 95.1 percent of

the respondentâ&#x20AC;&#x2122;s wife who were primary education completed, had heard of AIDS compared to 100.00 percent who were completed secondary and higher education. Another study 42 showed that, if the husband was reported to have a higher status employment the women were 50 percent more likely to have adequate knowledge of AIDS. Therefore this result is relevant to the national and international study findings. HIV/AIDS awareness related variables: Majority (46.5 percent) of the person had average knowledge about HIV/AIDS, 10.3 percent had good knowledge and 16.1 percent respondents had poor knowledge. Regarding source of information about HIV/AIDS 36.1 percent had average knowledge, 28.4 percent had good knowledge and only 4.5 percent had poor knowledge . A study1 done in Nigeria identified television, newspaper and radio as the foremost channel by which the respondents obtained their knowledge and also showed that 81.3 percent had reported television was the most important source of HIV/AIDS. In another study 8 95.2 percent of the respondents mentioned television as an important and best source of information to increase awareness among population. Therefore this result is consistent with international studies. Regarding signs and symptoms of AIDS majority (72.9 percent) had poor knowledge and only 1.9 percent had good knowledge. A study 30 showed that awareness about signs and symptoms of AIDS was very low among the respondents. In another study 57, it is found that 48.2 percent of the respondents knew that infected patients need not show signs and symptoms of AIDS. These studies are consistent with the study performed. Regarding treatment of HIV/AIDS majority (69.7 percent) of the adults had poor knowledge and only 1.3 percent had good knowledge. A study 57 showed that 31.6 percent of respondents believe that AIDS patients could be cured. Regarding consequences of HIV/AIDS majority (40.6 percent) of the adults had neither good nor bad knowledge, 18.1 percent had average knowledge and 34.2 percent had poor knowledge. In a study 8, 84.4 percent of the respondents were aware of the fact that till today there is no effective cure for AIDS. About spreading of HIV/AIDS 36.8 percent of the adults had neither good nor bad knowledge, 29.0 percent had average knowledge and only 9.0 percent had poor knowledge. A study8 showed that 25.2 percent of the respondents were aware of all the possible routes of transmission. Therefore the study results regarding treatment, consequences and spreading of HIV/AIDS are consistent with international studies.

Majority (47.1 percent) of the adults had average knowledge regarding mother to child transmission of HIV/AIDS, 34.8 percent had poor knowledge and only 1.9 percent had good knowledge. A study1 showed that most of the respondents i.e., 80.4 percent mentioned correct answer about mother to child transmission during birth and 75.5 percent mentioned about the process of breast feeding. So the study result is consistent with the international study. Regarding vulnerable groups of HIV/AIDS, majority (39.4 percent) of the adults had average knowledge. Only 3.2 percent had good knowledge. In a study8 above 80 percent of the respondents were aware that the children of the affected parents and female sex workers are at a higher risks. Regarding prevention of HIV/AIDS, majority (40.6 percent) of the adults had average knowledge and 11.6 has poor knowledge. A cross-sectional study 48 showed that knowledge of prevention was very good as 76 percent of males and 52 percent of the females had the opinion of having sex with single partner as a most important way of life to prevent HIV/AIDS. Therefore the study results regarding vulnerable groups of HIV/AIDS and prevention of HIV/AIDS are consistent with international studies. Regarding the role of family planning, role of media, role of Bangladesh government strategy and role of NGO in HIV/AIDS prevention majority of the adults had average knowledge. In a study34 majority (63.8 percent) of the respondents mentioned that all sections of the society had the primary responsibility in the fight against the AIDS. Therefore this study is pertinent with the international study.

Factors related with HIV/AIDS awareness Majority (60.6 percent) of the adults mentioned that the peer pressure was responsible for leading to the HIV/AIDS. In comparison to other study

in Kerala of India , Showed that 19

percent of boys succumbed to peer pressure into reading/ viewing pornography and 6.5 percent boys had consumed alcohol with peers. This result is very much consistent internationally. As a form of protection for safe sex, majority (76.8 percent) of the adults preferred condom in this study. In comparison to a cross sectional study 48 of awareness on HIV/AIDS among young adults population (15-24 years) of villages of Anand district of India showed that use

of condom to prevent transmission from high risk sex was identified by 76 percent of male and 52 percent female. A study

done in Pakistan showed that it was interesting to note

that two third of the truck drivers did think that condom use is an effective method for AIDS prevention. Therefore our study is comparable with international studies. Most (79.4 percent) of the adults recognized prostitutes first, 68.4 percent recognized drugs addicts and others and 47.1 percent recognized foreign migrants as the risk groups of HIV/AIDS in our society. In comparison to other study

in China, migrants are at greater

risk of contracting and transmitting HIV due to low rates of condom use and facing barriers to accessing education and healthcare. Here it is found that our study is relevant with other studies done internationally. Among the adults, 51.6 percent thought that there was no vaccine against HIV/AIDS in the market, 27.7 percent responded positively and 20.6 percent were not sure about that. In a study1 in Nigeria, 81.5 percent thought that there was no vaccine against HIV/AIDS and 15.2 percent gave positive response and 3.3 percent expressed ignorance. This result is very much consistent with international study. In this study most of the adults (81.9 percent) gave their positive responses about the role of the free distribution of condom on HIV/AIDS spreading, in a study

in china, it has been

shown that many Chinese people continue to associate condoms with promiscuity and considerable education is required for an effective safer sex campaign. Annually, 25 billion condoms are manufactured in China, of which 0.5 billion are distributed nationally (this is roughly one condom per man, per year). Therefore our study is relevant internationally. Most of the adults (96.8 percent) gave their positive responses about the necessity of sex education incorporating in our educational curriculum. Last base line survey 12 2008 showed that about 80 percent guardians, more than 77 percent school teachers and 83 percent of religious leaders supported necessity of sex education for their children. About the level of education at which sex education should be incorporated. 36.2 percent supported secondary level. A study1 done in Nigeria by identifying gaps in awareness of HIV/.AIDS recommended the involvement of school based programmers in the HIV awareness

campaign particularly in secondary school to increase and upgrade the knowledge among secondary school teachers. A study12 from Bangladesh Demographic Health Survey (BDHS) showed that information about HIV/AIDS had been enclosed in the text books of class VI. Therefore, the study done is consistent both nationally and internationally. For screening of HIV/AIDS, majority (60.6 percent) of the adults mentioned that private clinic/ hospital is the place of choice and then 53.5 percent suggested for physicianâ&#x20AC;&#x2122;s chamber, 31 percent suggested district hospital and 29.7 percent medical college hospital. Others (8.4 percent) gave opinion for the chamber of Skin and Venereal disease specialist and health workers. A study

showed that among the educated class 70 percent were

interested to visit primary health centers and Skin & VD department of medical college hospital for screening of HIV/AIDS. So the study done is pertinent with the international study. Most (77.4 percent) of the adults gave their positive responses about the role of the free distribution of disposable syringes on HIV/AIDS spreading and 17.4 percent gave negative response i.e., according to them, the injecting drugs users would use the provision as a chance so that HIV contamination would increase further. In a study

done in Pakistan 49.3

percent of the respondents did not think that spread of HIV infection could be prevented by using a new disposable syringe for injection when needed. Our result is relevant internationally. Regarding the attitude towards a man suffering from AIDS, 78.7 percent of the adults supported friendly behavior, and 30.3 percent supported helping attitude. Only 24.5 percent behaved otherwise i.e., according to them, they would not co-operate an AIDS patients, they liked to keep him isolate and would never behave friendly. In a comparative study

in Pakistan the attitude of more than 50 percent the respondents towards AIDS

sufferer was negative. Therefore, our study is relevant with international study. Among the adults, majority (63.2 percent) of them thought that lack of awareness was the barrier of preventing HIV/AIDS, 15.5 percent for parentâ&#x20AC;&#x2122;s opposition, 11 percent for loss of self respect, 5.8 percent for cultural inhibition, 4.5 percent for religious constraints and the rest for other reasons. In a study

in China 66.1 percent respondents were more likely to

maintain HIV status of a family member secret. (loss of self respect). In another study 31 half of the adolescent girls considered that it was not possible to talk with their parents about sex (parent’s opposition). A study1 done in Nigeria showed that barriers to the teaching of HIV/AIDS by respondents were inadequate knowledge (28.2 percent) cultural inhibitions (20.6 percent) and religious constraints (12.6 percent). Therefore the study done is consistent with the studies done internationally. 5.2 CONCLUSION: This cross sectional study was conducted among the adult patients attended at the out patient department of Dhaka Mohanagar General Hospital under Dhaka City Corporation at Nayabazar area of old town of Dhaka. Among them majority were female. The age range was from eighteen years to thirty-five years. Most of them were Muslims and of nuclear family. Majority of them were married having children from one to two. Among them, majority had educational status of secondary level and was housewives in occupation. In consideration of knowledge regarding awareness on prevention and control HIV/AIDS, the male adults were more aware of the disease than the female. The lower age group was more knowledgeable about HIV/AIDS than the higher age group. In comparison to illiterate adults, literate adults had good knowledge about HIV/AIDS. The higher average monthly income indicates increased awareness of HIV/AIDS. The employed portion of the adults had more knowledge about HIV/AIDS than the unemployed group. The unmarried group of the adults ranks top most among the knowledgeable respondents in comparison to the married group. The adults having literate spouse had good knowledge about HIV/AIDS than the adults having illiterate spouse. Men’s communication with their spouse can help in preventing AIDS. Majority of the adults mentioned about the responsibility of peer pressure for leading the youths towards HIV/AIDS. Regarding the form of protection of safe sex, most of the adult preferred `condom’ as a method of choice. According to the adults, the vulnerable group for spreading HIV/AIDS in our society is mostly prostitute, then injecting drug users, foreign migrants and man with multiple sex partners. Most of the adults gave their positive

response about the effective role of free distribution of condoms and disposable syringes on prevention of HIV/AIDS. Incorporation of sex education in our educational curriculum is supported by more than ninety percent of adult respondents. According to their opinion, sex education should be incorporated from the secondary level of our educational system. Regarding the attitude towards a man suffering from AIDS, majority of the adults supported friendly behavior and social co-operation. About one fourth of the adult respondents had negative attitude towards them i.e. they liked to keep them isolated and would hate them. As a barrier against prevention of HIV/AIDS, lack of awareness was supposed to be most important factor according to the adult respondents. The other factors acting as barrier were parentâ&#x20AC;&#x2122;s opposition, loss of self respect, cultural inhibition and religious constraints. Reviewing the overall findings, it was concluded that majority of the adults had more or less considerable knowledge on prevention and control of HIV/AIDS irrespective of gender, age, literacy,

family

status,

employment,

educational

qualification

and

financial

condition. Besides, the adults were also more or less aware about the factors related with prevention and control of HIV/AIDS like vaccination, role of condom and free distribution of syringes, protective method of safe sex, incorporation of sex education in educational curriculum and barriers for prevention of HIV/AIDS. Therefore, prevention of HIV/AIDS is possible through awareness and behavioral changes irrespective of socio-demographic variables or other factors. 5.3 Recommendation: This study found that education is positively associated with the knowledge about HIV/AIDS. The following actions may be taken: Literacy rate should have to be increased to reach the target. It may be said that despite all oppositions, there is an immense need for implementation of appropriate genderbased, culturally sensitive sex education curriculum in secondary school to cope up with the increasing vulnerability of young adults towards HIV/AIDS in Bangladesh. A program can be taken for providing adult education to out of school youth and adults in order to create a well-informed human resources. Literacy is not functional unless it is relevant

to social reality. Therefore functionality of literacy will be the first line of defense against the prevention and control of HIV/AIDS and prevention with condom and other precautions will become the second line of defense. The mass media should be used more frequently and more effectively. Radio and TV should be used for broadcasting and telecasting special awareness programs taking into consideration the peak listening hours, viewing hours and day of the week. Newspapers can also play a major role by putting only one common advertisement daily on the importance of prevention of AIDS. HIV/ AIDS public awareness campaign can be designed as follows: We should target the married couples especially at the family level by family planning workers during their door to door visit in the community. Group discussions & community training about safe sex should be conducted on the World AIDS Day. By distributing IEC (Information, Education and Communication) materials such as posters, leaflets, video films, calendar shirts as means of promoting messages on HIV/AIDS and by arranging national debate among the college and university students on safe sex on the Valentines day, we may proceed further. Based on the problems and challenges of HIV/AIDS in the country, the opportunities available and the relative strengths of our government, we should come forward to combat HIV/AIDS according to the Millennium Development Goal with the following priorities: To monitor the HIV/AIDS epidemics and the risk factors, which enhance HIV transmission? To conduct research to identify factors that makes adolescents and youth vulnerable to HIV/AIDS. To coordinate our research findings with other groups active in HIV/AIDS and assist them in advocacy and strategy development. To make voluntary counseling and testing (VCT) program accessible at grass-root level. To develop strategies for care and support of HIV infected people in Bangladesh. To mobilize political commitment, allocate adequate resources and initiate multispectral response in all aspects of program implementation regarding prevention and control of HIV/AIDS. Informed Consent Form (ICF)

I am Dr. Md. Azmal Hossain, a student of Master of Public health (MPH) of American International University of Bangladesh (AIUB) going to conduct research entitled, ``Awareness on prevention and control of HIV/AIDS among the Adults- an Outpatient Study’. I would like to ask you some questions regarding this topic. Would you please provide me answer of the following questions? You have freedom to take part in an interview, even you may refrain form answering any question. I will assure you privacy, confidentiality and anonymity will be strictly maintained. I am …………………………………….. Willingly agreed to take part in the above mentioned study.

Signature or Thumb impression Of the respondent

Work Plan Activity Schedule/Chart (in months) Activities

2009-2010 Ju n

Phase-1 Finalization of the research proposal Take permission from authority Selection of

Jul

Aug

Sep

Oc t

Nov

De c

Jan Fe b

Mar

Ap r

May

hospital Take permission from hospital authority Preparation of questionnaire Questionnaire review and field test Phase-2 Finalization of questionnaire Phase-3 Data collection Code data Enter data on computer Edit data Phase-4 Conduct analysis Prepare draft report Phase-5 Submission of final report

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