Knowledge and Attitudes on HIV/AIDS among residents of Kandy, Sri Lanka
Samidi Navaratna, Samath. D. Dharmaratne, Ananda Jayasinghe, Niroshan Jayasekara, Katsutoshi Nagano,Yoshihide Obayashi Asuna Arai, Koji Kanda, Hiko Tamashiro
Introduction • Human immunodeficiency virus infection / Acquired Immunodeficiency Syndrome(HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV) • HIV is transmitted primarily via unprotected sexual intercourse (including anal and even oral sex), contaminated blood transfusions, hypodermic needles, and from mother to her baby during pregnancy, delivery, or breastfeeding.
Justification • Most of the HIV/AIDS related interventions in Sri Lanka are targeted towards most at risk populations. • There were no published studies on the knowledge of the general public on HIV/ AIDS in Sri Lanka at the time this study was designed • Personal interest • Local/ Global burden of HIV/AIDS
Background (Global Situation) • Was first recognized in 1981 • As of 2011, approximately 34 million people have HIV worldwide • Of these, approximately 17.2 million are men, 16.8 million are women and 3.4 million are less than 15 years old • Sub-Saharan Africa is the region most affected • South & South East Asia (a region with about 2 billion people as of 2010, over 30% of the global population) has an estimated 4 million cases (12% of all people living with HIV)
Background (Global Situation) • According to the UNAIDS global report 2010, the number of new HIV infections has been steadily declining globally since 1990 and thus it is believed to be stabilised
Background (Local Situation) • First HIV case was reported in 1986 • The prevalence of HIV infection in Sri Lanka is less than 0.1% even among the most at risk populations (MARP) • By the end of the 4thquarter, 2011, National STD/AIDS Control Programme (NSACP) indicate that there are 1,463 cumulative HIV cases and seven reported AIDS deaths • Male to female ratio of reported HIV cases was 1.4:1 at the end of 2010 • In Sri Lanka, most HIV cases are acquired through heterosexual contact
METHODS
Methods (1) • Study
Design
and
setting:
A
cross-sectional,
descriptive survey was conducted among the residents of Kandy, Sri Lanka, in September 2010
• Study Population: All the residents between 18-64 years of age, living within the Kandy Municipality area were considered eligible for the study.
Methods (2) • Sample size and sampling technique. A sample of 869 was selected using a two stage sampling technique. In the first stage, six ‘public health midwife areas’ were selected in the municipality. Then rows of households were selected randomly and household residents in every other household were asked to join the survey.
Methods (3) • Questionnaire: A structured questionnaire developed after a thorough literature review
was
• The questionnaire included various questions on • socio-demographic variables • 20 questions to assess the knowledge of the participant on HIV/AIDS • 16 questions to determine the attitudes related to stigma and discrimination • five questions were included to determine the practices related to HIV/AIDS
Methods (4) • Pretested • Self administered
• Ethical considerations: • Informed consent was obtained from all participants • Ethical clearance obtained from Faculty of Medicine, University of Peradeniya
Methods (5) • Data Analysis: SPSS Ver. 14.0 • After cleaning the data, 713 out of 869 in the original sample were used as the valid sample for analysis • Besides descriptive statistics, chi-square test was used to ascertain statistical significance. • All the responses on attitudes towards HIV/AIDS were evaluated through a 5-point Likert scale, and in the analysis, the scale was subsequently summarized into 3 groups as ‘agree’, ‘disagree’ and ‘don’t know’.
Methods (6) • ‘Attitudes’ were sub-grouped under four headings (fear, shame
and
blame,
discrimination
and
exposure
resistance)
• Multivariate logistic regression analysis was performed to identify possible associations between attitudes of the participants
towards
those
PLHIV
and
socio
demographic factors by controlling confounding effects of third variables
RESULTS
Results (1) • Response rate was 82.0% • Sample characteristics: • Out of 713, more than a quarter (28.1%) was in the 30-39 years age-group and there were more females (55.5%) than males • Majority of the participants were Buddhists (66.2%) while 16.2% were Hindu, 13.4% were Islamic and 4.1% were Christians • Education level: 11.6%-up to O/L; 43.7%-O/L; 35.1%A/L; 9.6%-University or above
Results (2) • Knowledge: • 93.5% of the participants have heard of HIV/AIDS • The knowledge on HIV/AIDS was low with an average score of 51.7%. • There was no statistically significant difference in the knowledge level between males and females (p=0.352) • Only 58.1% were aware that a condom was an effective tool for prevention of HIV/AIDS
Results (3) • Misconceptions: • 58.4% of respondents thought that HIV/AIDS is transmissible by mosquits or tick bites while 34.6% believed that it can be contacted by sharing kitchen utensils. • Similarly, 40.1% were in the belief that the disease can spread through coughing/sneezing and 40.7% thought staying with people who have HIV/AIDS at school or workplace can lead to cross infection.
Results (4) Figure 1: HIV/AIDS related knowledge by topics 100
Percentage %
80
60
62.7
60.5
59.9
62.3 55 48
Male Female
40 36.6 30.4 20
0 Epidemiology
Pathogenesis
Clinical manifestations
Knowledge Category
Prevention
Results (5) â&#x20AC;˘ There were statistically significant relationships among males and females between participantsâ&#x20AC;&#x2122; levels of knowledge and education(p<0.001; p<0.001), religion (p=0.001; p=0.006), and the ethnicity (p=0.002; p=0.001) but not with age (p=0.292; p=1.000), respectively.
Results (6)
Results (7) • Attitudes: • The participants showed more positive attitudes towards HIV/AIDS and people living with HIV/AIDS (PLHIV) for all questionnaire items except for those listed under shame and blame • More than a half of the respondents (58.2%) claimed that they would like to support PLHIV. • There was hardly any significant difference between the attitudes of males and females towards PLHIV where many attitudinal questions were considered
Results (8) • There was no statistically significant association between the participants’ attitudes towards PLHIV and sociodemographic characteristics such as age, level of education, ethnicity and religion. • statistically significant more positive attitudes were observed among those who scored high for HIV/AIDS related knowledge questions when logistic regression was performed by adding knowledge score as an independent variable (adjusted odds ratio (AOR)=1.174; 95% confidence interval (CI): 1.124-1.229).
Conclusions • There is a greater need of making attempts towards educating the general public regarding HIV/AIDS in order to reduce misconceptions that are prevalent in the society • Stigma related attitudes are mainly due to shame and blame associated with the disease • As the attitudes towards PLHIV were more positive among those with a better HIV/AIDS related knowledge score, targeted HIV/AIDS related health advocacy interventions maybe recommended
References • 1) UNAIDS. UNAIDS Report on the Global AIDS Epidemic 2010. Geneva: UNAIDS; 2010. • 2) WorldBank. HIV/ AIDS in Sri Lanka August 2008. Washington DC: WorldBank; 2008. • 3) National STD/AIDS Control Programme. HIV/AIDS Surveillance Data in Sri Lanka: Update 4thQuarter 2011. Colombo: National STD/AIDS Control Programme; 2011. • 4) WorldBank. HIV/AIDS in Sri Lanka August 2010. Washington DC: WorldBank: 2010. • Behavioral Surveillance Survey. Sri Lanka Behavioural Surveillance Survey: First Round Survey Results 20062007. Colombo: National STD/AIDS Control Programme, Ministry of Healthcare and Nutrition; 2007.
Thank you
Full text article â&#x20AC;˘ http://www.tandfonline.com/doi/full/10.1080/09540121.20 14.963496.