The contribution of India to the global burden of HIV/AIDS is significant. A major barrier that the country has faced in its battle against this disease is the inadequate and inaccurate information about it among the population. The present analysis explores the knowledge about HIV/AIDS among clients attending a voluntary counselling and testing (VCT) facility in India. Two hundred clients attending the VCT facility were assessed in this regard using a structured predesigned questionnaire. Sixty-three (31.5%) of the respondents had never heard of HIV/AIDS. In comparison to males, a significantly higher number of females had not heard about the disease (
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a major and one of the most serious public health challenges in today’s world. An estimated 35.3 million people across the world are infected with HIV [
The contribution of India to the global burden of HIV/AIDS is significant with nearly 2.39 million people currently affected with the disease in the country [
Among these a major barrier in the battle against HIV/AIDS has been inadequate and inaccurate information that further perpetuates various forms of social stigmas and discriminations against the HIV infected. The synonymous interpretation of HIV/AIDS to immorality would result in hesitation on part of the people to get themselves tested for HIV infection leaving a large number of HIV infected individuals unaware of their status. This could be potentially devastating as it would accelerate the unknowing, unchecked, and silent transmission of HIV infection from the infected to the naive population. Low levels of education would also leave the population unaware of the HIV risk reduction strategies. Another matter of concern is the changing face of HIV epidemic in India. The epidemic has crossed the conventional boundaries of the traditional high risk groups where it initially started and has now percolated into the general population [
A bipronged approach has been employed to limit the disastrous consequences of this epidemic. The first strategy is promoting HIV awareness and knowledge among the population through media as well as through voluntary counselling and testing (VCT) facilities so as to empower the individuals to protect themselves by adopting safe sexual practices and other necessary precautionary measures. The second approach is increased and easy accessibility to antiretroviral therapy to reduce the mortality due to HIV/AIDS. Though antiretroviral drugs can slow down the progression of this disease, they are not curative. Moreover, an effective HIV vaccine is also far from reality. Therefore the only feasible and cost-effective approach in the current situation, especially in the developing world, would be to disseminate among the general population correct, accurate, and complete knowledge about HIV/AIDS transmission modes, risk factors, preventive measures, and available therapeutic options. In this context, education has often been described as a “social vaccine” with information, education, and communication (IEC) being considered the key tools of HIV prevention.
A number of studies have attempted to explore the peoples’ perceptions about HIV/AIDS. The present analysis was undertaken as an attempt to assess the extent of knowledge about HIV/AIDS among clients attending a VCT facility in India and to correlate their levels of awareness with various sociodemographic determinants.
The present cross-sectional analysis was conducted at the VCT facility of a tertiary care health centre situated in Delhi, India. The VCT caters to nearly 1100 clients per month. The study population is comprised of clients attending the VCT facility in November-December 2013. Two hundred consecutive clients who were 18 years of age and above and who verbally consented to participate in the interviews after the primary purpose of the study was explained to them were enrolled in the analysis. The interviews were conducted by the investigators before the clients underwent the HIV counselling sessions. All the interviews were voluntary and confidential.
A standardised, structured predesigned questionnaire was employed and was translated into Hindi, which is the commonly used and fully understood language of this region. The same procedure was followed by the interviewers for all the participants whether literate or nonliterate and the responses were recorded. The interviews were conducted independently by two senior resident doctors and the quality of the questionnaire and of the personal interviews was assessed by the faculty in charge of the VCT. The questionnaire is comprised of two broad sections. The first section dealt with the sociodemographic characteristics of the participants (age, sex, education, marital status, type of family, occupation, and place of residence). While “nuclear family” was defined as a household consisting of a father, a mother, and their children all in one household dwelling, the term “joint family” was used to describe a family composed of parents, their children, and the children's spouses and offspring all in one household. The names of the participants were not entered so as to maintain anonymity and confidentiality.
The second section of the questionnaire sought to explore the participants’ awareness regarding various aspects of HIV/AIDS. This section comprised only close-ended questions, the answers to which were recorded as yes/no/I do not know. The participants were initially questioned if they had ever heard of HIV/AIDS. Only those respondents who claimed to have heard of HIV/AIDS were questioned further. These participants were asked about the source of their information about HIV/AIDS. Their level of awareness regarding modes of HIV transmission was judged by their ability to correctly identify the four principal ways by which this infection can spread. By incorporating misleading questions in the panel, we attempted to simultaneously explore and identify some common misconceptions that prevail among Indian population pertaining to modes of HIV transmission. In the subsequent questions the participants’ perception regarding availability of possible treatment options and their knowledge about preventive measures/practices of HIV/AIDS were assessed.
For data analysis of responses to the questions concerning modes of transmission, treatment, and prevention of HIV/AIDS, participants with an “I do not know” response were also considered unaware about the concerned aspect as were the participants with a “No” response. For analyzing the responses to the panel of questions dealing with misconceptions, respondents with “No” response to all the questions were categorized as having “no misconception” while those with a “Yes” response to even one of the questions were categorized as having “at least one misconception.”
Data entry was performed using Microsoft Excel sheet. All the entries were doubly checked for any possible keyboard errors. Data was analyzed using the Epi Info software, and Chi-square and Fischer’s exact test were applied to determine the difference of proportion between qualitative variables. A
Of the 200 study subjects included in this analysis, 46 (23%) were 18–24 years, 75 (37.5%) were 25–31 years, 43 (21.5%) were 32–38 years, 25 (12.5%) were 39–45 years, 3 (1.5%) were 46–50 years, and 8 (4%) were more than 50 years of age. The mean age of the study participants was
Sociodemographic profile of study population.
Sociodemographic variable | Number ( |
Percentage (%) |
---|---|---|
Age group (years) | ||
18–24 years | 46 | 23% |
25–31 years | 75 | 37.5% |
32–38 years | 43 | 21.5% |
39–45 years | 25 | 12.5% |
46–50 years | 3 | 1.5% |
>50 years | 8 | 4% |
Gender | ||
Male | 80 | 40% |
Female | 120 | 60% |
Marital status | ||
Single | 40 | 20% |
Married | 160 | 80% |
Education | ||
Nonliterate | 58 | 29% |
Primary | 68 | 34% |
Secondary | 50 | 25% |
College and above | 24 | 12% |
Occupation | ||
Unemployed/housewives | 117 | 58.5% |
Daily wages | 25 | 12.5% |
Salaried | 39 | 19.5% |
Business | 19 | 9.5% |
Type of residence | ||
Rural | 88 | 44% |
Urban | 112 | 56% |
Type of family | ||
Nuclear | 108 | 54% |
Joint | 92 | 46% |
Sixty-three (31.5%) of the respondents admitted that they had never heard of HIV/AIDS. The percentage of females (42.5%) who had never heard of HIV/AIDS was significantly higher than the corresponding percentage of males (15%) (
Distribution of participants depending on whether they have “heard of HIV/AIDS” or “not” (
Sociodemographic determinants | Not heard about HIV/AIDS ( |
Heard about HIV/AIDS ( |
|
---|---|---|---|
Age group (years) | |||
18–24 years | 15 (32.6%) | 31 (67.4%) | 0.027; S |
25–31 years | 17 (22.7%) | 58 (77.3%) | |
32–38 years | 13 (30.2%) | 30 (69.8%) | |
39–45 years | 13 (52%) | 12 (48%) | |
46–50 years | 0 (0%) | 3 (100%) | |
>50 years | 5 (62.5%) | 3 (37.5%) | |
Gender | |||
Male | 12 (15%) | 68 (85%) | <0.01; S |
Female | 51 (42.5%) | 69 (57.5%) | |
Marital status | |||
Single | 9 (22.5%) | 31 (77.5%) | 0.238; NS |
Married | 54 (33.8%) | 106 (66.2%) | |
Education | |||
Nonliterate | 37 (63.8%) | 21 (36.2%) | <0.01; S |
Primary | 21 (30.9%) | 47 (69.1%) | |
Secondary | 5 (10%) | 45 (90%) | |
College and above | 0 (0%) | 24 (100%) | |
Occupation | |||
Unemployed/ housewives | 47 (40.2%) | 70 (59.8%) | 0.002; S |
Daily wages | 8 (32%) | 17 (68%) | 0.862; NS |
Salaried | 5 (12.8%) | 34 (87.2%) | 0.009; S |
Business | 3 (15.8%) | 16 (84.2%) | 0.197; NS |
Type of residence | |||
Rural | 32 (36.4%) | 56 (63.6%) | 0.246; NS |
Urban | 31 (27.7%) | 81 (72.3%) | |
Type of family | |||
Nuclear | 37 (34.3%) | 71 (65.7%) | 0.448; NS |
Joint | 26 (28.3%) | 66 (71.7%) |
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; S: significant; NS: nonsignificant.
Among the 137 (68.5%) respondents who had heard about HIV/AIDS, television was the main source of information for 130 (94.9%), posters for 93 (67.9%), and newspapers for 88 (64.2%). A conversation or discussion with friends, health professionals, and teachers was a possible source of information about HIV/AIDS in 45 (32.8%), 34 (24.8%), and 26 (19%) respondents, respectively. A conversation or discussion within family was the least reported source of information (8%) (Table
Sources of information regarding HIV/AIDS (
Source of information | Number | Percentage |
---|---|---|
Television | 130 | 94.9% |
Newspapers | 88 | 64.2% |
Family | 11 | 8% |
Friends | 45 | 32.8% |
Teachers | 26 | 19% |
Doctors | 34 | 24.8% |
Posters | 93 | 67.9% |
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome.
Of the 137 study participants who were further interviewed, 135 (98.5%) could identify unprotected sex as the mode of HIV transmission. One hundred thirty-two (96.4%) were aware of blood transfusion and use of unsterile needles and syringes as other modes of HIV transmission. Only 122 (89.1%) knew about HIV transmission from infected mother to her child (Table
Knowledge of participants regarding various aspects of HIV/AIDS.
Question | Response | ||
---|---|---|---|
Yes | No | Do not know | |
Have you ever heard about HIV/AIDS? ( |
137 (68.5%) | 63 (31.5%) | — |
|
|||
Knowledge regarding modes of HIV transmission: ( |
|||
(a) Unprotected sexual intercourse with HIV infected | 135 (98.5%) | 2 (1.5%) | — |
(b) Transfusion of infected blood | 132 (96.4%) | 1 (0.7%) | 4 (2.9%) |
(c) Use of unsterile needles/syringes | 132 (96.4%) | 2 (1.4%) | 3 (2.2%) |
(d) From an HIV infected mother to her baby | 122 (89.1%) | 4 (2.9%) | 11 (8%) |
|
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Myths and misconceptions regarding HIV transmission: ( |
|||
Do you think HIV/AIDS can be transmitted by | |||
(a) Coughing/sneezing? | 45 (32.9%) | 75 (54.7%) | 17 (12.4%) |
(b) Mosquito bite? | 47 (34.3%) | 73 (53.3%) | 17 (12.4%) |
(c) Touching a person with HIV/AIDS? | 20 (14.6%) | 110 (80.3%) | 7 (5.1%) |
(d) Working with a person with HIV/AIDS? | 26 (19%) | 107 (78.1%) | 4 (2.9%) |
(e) Taking food with a person with HIV/AIDS? | 32 (23.3%) | 99 (72.3%) | 6 (4.4%) |
(f) Sharing towels/clothes/handkerchief of a person with HIV/AIDS? | 41 (29.9%) | 82 (59.9%) | 14 (10.2%) |
|
|||
Knowledge regarding availability of antiretroviral treatment ( |
68 (49.6%) | 19 (13.9%) | 50 (36.5%) |
|
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Knowledge regarding preventive interventions for HIV/AIDS: ( |
|||
(a) Use of condom during sexual intercourse | 136 (99.3%) | — | 1 (0.7%) |
(b) Loyalty to a single partner | 137 (100%) | — | — |
(c) Use of sterile disposable needles and syringes | 137 (100%) | — | — |
(d) Transfusion of screened and tested blood units | 136 (99.3%) | 1 (0.7%) | — |
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome.
Distribution of participants according to their knowledge regarding modes of HIVAIDS transmission (
Sociodemographic variable |
Unprotected sexual
intercourse with HIV
infected ( |
Transfusion of infected
blood ( |
Use of unsterile
needles/syringes ( |
From an HIV infected
mother to her baby ( | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Aware ( |
Unaware ( |
|
Aware ( |
Unaware ( |
|
Aware ( |
Unaware ( |
|
Aware ( |
Unaware ( |
|
|
Age group (years) | ||||||||||||
18–24 years | 29 (93.5%) | 2 (6.5%) | 0.225; NS | 29 (93.5%) | 2 (6.5%) | 0.808; NS | 30 (96.8%) | 1 (3.2%) | 0.962; NS | 25 (80.6%) | 6 (19.4%) | 0.301; NS |
25–31 years | 58 (100%) | 0 (0%) | 57 (98.3%) | 1 (1.7%) | 56 (96.6%) | 2 (3.4%) | 52 (89.7%) | 6 (10.3%) | ||||
32–38 years | 30 (100%) | 0 (0%) | 29 (96.7%) | 1 (3.3%) | 29 (96.7%) | 1 (3.3%) | 29 (96.7%) | 1 (3.3%) | ||||
39–45 years | 12 (100%) | 0 (0%) | 11 (91.7%) | 1 (8.3%) | 11 (91.7%) | 1 (8.3%) | 11 (91.7%) | 1 (8.3%) | ||||
46–50 years | 3 (100%) | 0 (0%) | 3 (100%) | 0 (0%) | 3 (100%) | 0 (0%) | 2 (66.7%) | 1 (33.3%) | ||||
>50 years | 3 (100%) | 0 (0%) | 3 (100%) | 0 (0%) | 3 (100%) | 0 (0%) | 3 (100%) | 0 (0%) | ||||
Gender | ||||||||||||
Male | 68 (100%) | 0 (0%) | 0.496; NS | 68 (100%) | 0 (0%) | 0.057; NS | 66 (97.1%) | 2 (2.9%) | 1; NS | 63 (92.6%) | 5 (7.4%) | 0.287; NS |
Female | 67 (97.2%) | 2 (2.8%) | 64 (92.8%) | 5 (7.2%) | 66 (95.7%) | 3 (4.3%) | 59 (85.5%) | 10 (14.5%) | ||||
Marital status | ||||||||||||
Single | 29 (93.6%) | 2 (6.4%) | 0.049; S | 30 (96.8%) | 1 (3.2%) | 1; NS | 29 (93.6%) | 2 (6.4%) | 0.316; NS | 24 (77.4%) | 7 (22.6%) | 0.043; S |
Married | 106 (100%) | 0 (0%) | 102 (96.2%) | 4 (3.8%) | 103 (97.2%) | 3 (2.8%) | 98 (92.5%) | 8 (7.5%) | ||||
Education | ||||||||||||
Nonliterate | 20 (95.3%) | 1 (4.7%) | 0.419; NS | 19 (90.5%) | 2 (9.5%) | 0.339; NS | 18 (85.7%) | 3 (14.3%) | 0.024; S | 16 (76.2%) | 5 (23.8%) | 0.081; NS |
Primary | 47 (100%) | 0 (0%) | 46 (97.9%) | 1 (2.1%) | 45 (95.7%) | 2 (4.3%) | 45 (95.7%) | 2 (4.3%) | ||||
Secondary | 44 (97.7%) | 1 (2.3%) | 43 (95.5%) | 2 (4.5%) | 45 (100%) | 0 (0%) | 41 (91.1%) | 4 (8.9%) | ||||
College and above | 24 (100%) | 0 (0%) | 24 (100%) | 0 (0%) | 24 (100%) | 0 (0%) | 20 (83.3%) | 4 (16.7%) | ||||
Occupation | ||||||||||||
Unemployed/housewives | 69 (98.6%) | 1 (1.4%) | 1; NS | 66 (94.3%) | 4 (5.7%) | 0.366; NS | 68 (97.1) | 2 (2.9) | 0.676; NS | 60 (85.7%) | 10 (14.3%) | 0.314; NS |
Daily wages | 16 (94.2%) | 1 (5.8%) | 0.233; NS | 16 (94.1%) | 1 (5.9%) | 0.489; NS | 15 (88.2%) | 2 (11.8%) | 0.116; NS | 15 (88.2%) | 2 (11.8%) | 1; NS |
Salaried | 34 (100%) | 0 (0%) | 1; NS | 34 (100%) | 0 (0%) | 0.332; NS | 33 (97.1%) | 1(2.9%) | 1; NS | 32 (94.1%) | 2 (5.9%) | 0.356; NS |
Business | 16 (100%) | 0 (0%) | 1; NS | 16 (100%) | 0 (0%) | 1; NS | 16 (100%) | 0 (0%) | 1; NS | 15 (93.8%) | 1 (6.2%) | 1; NS |
Type of residence | ||||||||||||
Rural | 54 (96.5%) | 2 (3.5%) | 0.165; NS | 53 (94.6%) | 3 (5.4%) | 0.398; NS | 51 (91.1%) | 5 (8.9%) | 0.010; S | 47 (83.9%) | 9 (16.1%) | 0.187; NS |
Urban | 81 (100%) | 0 (0%) | 79 (97.5%) | 2 (2.5%) | 81 (100%) | 0 (0%) | 75 (92.6%) | 6 (7.4%) | ||||
Type of family | ||||||||||||
Nuclear | 70 (98.6%) | 1 (1.4%) | 1; NS | 67 (94.4%) | 4 (5.6%) | 0.367; NS | 67 (94.4%) | 4 (5.6%) | 0.367; NS | 62 (87.3%) | 9 (12.7%) | 0.690; NS |
Joint | 65 (98.5%) | 1 (1.5%) | 65 (98.5%) | 1 (1.5%) | 65 (98.5%) | 1 (1.5%) | 60 (90.9%) | 6 (9.1%) |
HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; S: significant; NS: nonsignificant.
On exploring the extent of misconceptions about HIV transmission, we observed that 45 (32.9%) had a false perception that HIV can be transmitted by coughing/sneezing; 47 (34.3%) thought that it can be transmitted by mosquito bite; 20 (14.6%) thought that it can be transmitted by touching an HIV infected person; 26 (19%) thought that it can be transmitted by working with an HIV infected person, while 32 (23.3%) and 41 (29.9%) incorrectly stated that it can be transmitted by eating with and by sharing towels/clothes/handkerchief of a person with HIV/AIDS, respectively (Table
Of the 137 participants who had heard about HIV/AIDS, only 68 (49.6%) were aware of the availability of antiretroviral treatment (Table
Use of condom as a preventive intervention was known to 136 (99.3%) respondents. All (100%) participants understood the role of loyalty to a single sexual partner and use of sterile disposable needles and syringes as precautionary measures to protect themselves from contracting HIV/AIDS. One hundred thirty-six (99.3%) knew the importance of screening of blood before transfusion. No statistically significant correlation could be established between sociodemographic profile of the study participants and their awareness regarding HIV prevention strategies.
In the present study, 68.5% of the participants had heard about HIV/AIDS. Similar findings were observed in a community based cross-sectional study conducted among rural youth of Saurashtra where nearly two-thirds of the respondents had ever heard about this infection [
While majority of the respondents who had heard about HIV/AIDS had a good knowledge about HIV transmission modes, nearly 11% were still unaware of risk of HIV transmission from infected mother to her baby. Our findings are consistent with another study conducted among rural youth of Saurashtra, Gujarat, where the participants were less aware of mother to child transmission of HIV in comparison to other modes [
As with other studies conducted in Indian population, we observed that compared to males, a lower percentage of females have heard about HIV/AIDS. This finding highlights that members of the biologically more susceptible gender are largely unaware of the disease to which they are highly vulnerable, a phenomenon driven by the male dominated Indian society that denies the females education and access to information [
Education was found to have a direct relation to the awareness levels of the respondents. Not only were the nonliterate subjects less likely to have heard about HIV/AIDS, but also the awareness of some aspects of HIV transmission such as spread by sharing of needles and syringes was significantly lower in the nonliterate subjects. A study conducted in rural district of Raigad also found the level of awareness to be significantly lower in illiterates as compared to literates [
With regard to occupation, we observed that a significantly lower number of unemployed men and housewives had heard of HIV/AIDS while the proportion of respondents from the salaried class who had heard about it was significantly higher. Differences in knowledge between different occupational groups have also been highlighted in another study conducted in Hyderabad where students and people in service and business were found to have high awareness levels while lowest awareness levels were seen in housewives, cultivators, agriculture labourers, and industrial workers [
While we could not establish a correlation between age of respondents and HIV awareness, lower awareness levels among younger populations have been reported in other studies [
Married respondents seemed to be more aware of certain aspects of HIV transmission such as unsafe sex and mother to child HIV transmission as well as antiretroviral treatment. Higher awareness levels in married as compared to unmarried respondents have also been documented in other studies [
While the knowledge of HIV transmission modes and preventive strategies was good among the respondents who were interviewed, the prevalence of misconceptions regarding HIV transmission was high. Our findings are consistent with other studies where casual contact, mosquito bite, bed bugs, public toilets, pools, and sharing meals have been considered as modes of HIV transmission by the participants [
A summary of various studies undertaken to explore HIV/AIDS awareness among Indian population.
Authors | Demographic region | Sample size | Sex distribution | Education level of respondents | Occupation/economic status of respondents | Extent of misconceptions about HIV transmission |
---|---|---|---|---|---|---|
Srivastava et al. [ |
Bareilly district, Uttar Pradesh | 341 | Males: 68% |
Studying in secondary school at the time of enrolling to study | Students | Mosquito bite (20.5%) |
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Malleshappa et al. [ |
Kuppam Mandal, Andhra Pradesh | 850 | Males: 53.6% |
Illiterate: 12.3% |
Student: 38% |
Kissing on cheeks (20%) |
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Yadav et al. [ |
Saurashtra region, Gujarat | 1,237 | Males: 49.9% |
Illiterate: 13.42%, |
Percentage distribution not mentioned | Living with an HIV infected person: 20.78% |
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Shrotri et al. [ |
Pune, Maharashtra | 707 | All females | Illiterate/primary: 33% |
Housewife: 83% |
By mosquito bite: 62% |
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Andersson and |
Solapur district, |
260 |
|
Studying in higher secondary at the time of enrolling to study | Students |
HIV spreads by kissing: 36.9% in village versus 31.9% in city |
HIV: Human immunodeficiency virus; AIDS: Acquired immunodeficiency syndrome.
Our study highlights that a significant proportion of Indian population is unaware of HIV/AIDS to the extent that they have not even heard of it. There is a strong need to raise the levels of HIV awareness among the population especially among women and nonliterate members of the community. The prevalence of misconceptions regarding HIV transmission is also high in the Indian population. While media has played a crucial role in attaining the present level of knowledge about HIV/AIDS in the community, much efforts are still needed in this direction including education in conjunction with evolution of novel creative strategies to reach out to more and more people, make them aware about HIV/AIDS, improve their existing knowledge about this disease, and demystify their myths and misconceptions.
The authors declare that there is no conflict of interests regarding the publication of this paper