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African Journal of Reproductive Health, Vol. 6, No. 2, August, 2002 pp. 30-38 Assessment of Awareness of HIV/AIDS among Selected Target Groups in and around Addis Ababa, Ethiopia Mehret Yerdaw1, Teshome Nedi1 and Fikre Enquoselassie2 1Department of Pharmacology,
School of Pharmacy, Addis Ababa University, P.O. Box 1176, Addis Ababa. 2Department
of Community Health, Addis Ababa University,
P.O. Box 1176, Addis Ababa. Code Number: rh02019 ABSTRACT A total of 2278 individuals were interviewed using a pre-tested questionnaire with key indicators such as mode of transmission, attitude towards HIV/AIDS patients, information sources, sex, educational and marital status. Findings indicate that most of the respondents (93.2%) were aware of the reality of HIV/AIDS and considered it as a killer disease (89.2%). A significant number of them had negative attitude towards HIV/AIDS patients. Some 30.4% believed HIV/AIDS patients can be identified through symptoms rather than clinical diagnosis. There is significant association between knowledge of HIV/AIDS and target group (p < 0.001), age (p < 0.05), sex (p < 0.05), marital status (p < 0.05) and educational level (p < 0.001). There is also a remarkable knowledge difference among respondents on means of prolonging life of individuals with HIV/AIDS. Some have never heard about how to prolong the life of such patients (10.2%). Farmers (42.5%) indicated that there is no means of prolonging the life of such patients. Respondents' knowledge on combating HIV/AIDS related diseases as a means of prolonging the life of succumbed individuals was rather low (5.5%). Low level awareness, therefore, may deter HIV/AIDS patients from seeking necessary medical attention. (Afr J Reprod Health 2002; 6[2]: 30–38) RÉSUMÉ Evaluation de la prise de conscience du VIH/SIDA parmi des groupes cible selectionnés à Addis Abeba, Ethiopie, et ses alentours. 2278 individus au total ont été sondés à l'aide des questionnaires qui ont été préalablement vérifiés avec telles indices clé que le mode de transmission, l'attitude envers les patients séropositifs, les sources d'information, le sexe, l'état civil et le niveau scolaire. Nous avons découvert que la plupart des répondants interrogés (93,2%) étaient conscients de la réalité du VIH/SIDA et le considéraient comme une maladie mortelle (89,2%). Bon nombre parmi eux avaient une attitude négative envers les malades séropositifs. Certains autres (30,4%) ont cru que les malades séropositifs peuvent être identifiés à partir des symptômes plutôt qu'à partir du diagnostic clinique. Il y a un rapport important entre la connaissance du VIH/SIDA et le groupe cible (p < 0,001), l'âge (p < 0,05), le sexe (p < 0,05), l'état civil (p < 0,05) et le niveau scolaire (p < 0,001). Il y a également une différence remarquable au niveau de la connaissance chez les répondants par rapport à la manière de prolonger la vie des individus atteints du VIH/SIDA. Certains parmi eux n'ont jamais entendu parler de la manière de prolonger la vie de tels malades (10,2%). Les fermiers (42,5%) ont indiqué qu'il n'y a pas de moyens de prolonger la vie de tels malades. La connaissance des répondants sur le combat des maladies liées au VIH/SIDA comme moyen de prolonger la vie des individus qui sont morts était plutôt limitée (5,5%). Un niveau inférieur de conscience pourrait donc décourager les malades séropositifs de rechercher le soin médical nécessaire. (Rev Afr Santé Reprod 2002; 6[2]: 30–38) KEY WORDS: Awareness, HIV/AIDS, transmision, attitude, knowledge Introduction Although HIV prevalence was very low in Ethiopia during the early 1980s, it has been increasing rapidly in the past few years.1-4 It is estimated that there are 2.6 million HIV infected individuals of whom 250,000 are children below the age of five years. In terms of absolute number of people infected with the virus, the country stands next to South Africa and Nigeria, which have 4.2 and 2.7 million infected people respectively.2 The prevalence is expected to reach 7.7% by the year 2006.2 An ever-growing AIDS epidemic is inevitable. Experience shows that HIV/AIDS can devastate whole regions and threaten the social and economic well-being of the country. Unless action against the epidemic is scaled up drastically, the damage already done will seem minor compared with what lies ahead. Lack of awareness and misconceptions by the public about HIV/AIDS might have contributed to the spread of the disease. In addition, lack of access to information, education and counselling about the disease also contribute to continued high-risk behaviours. To date, the only protection against infection with the disease is to modify behaviour pattern in order to minimise risk. Hence, information dissemination, education and communication continue to play a major role in the prevention of HIV/AIDS. Studies conducted in Ethiopia on knowledge, attitude and practice (KAP) on various target groups provided a baseline data on sexual behaviour, knowledge and attitude towards HIV/AIDS and the urgency of comprehensive health education as an intervention method.6-10 Based on this, a few studies conducted on behavioural interventions for reduction of sexually transmitted diseases (STDs) and HIV/AIDS transmission among female commercial sex workers and clients indicated that knowledge on both AIDS and STDs increased using trained outreach workers.5 Such systematic awakening campaign can help curb the rate of transmission of HIV and STDs. However, there are no KAP studies so far conducted on stratified cross-sectional bases encompassing the different target groups in Ethiopia. In the light of this, the present study was conducted to assess and compare the knowledge of various target groups on HIV/AIDS. STUDY AREAS AND METHODS Study Areas Two areas, namely; Addis Ababa, the capital city of Ethiopia, and Nazareth, the city of Regional State of Oromia, Ethiopia, were selected for this study as part of larger studies. The two cities are close to each other and have emerged recently as the growing metropolitan cities. The number of hotels/bars, nightclubs and restaurants in these cities have increased with time. With an increased number of hotels/bars, the number of prostitutes and visitors have also increased. Available data show that in 1998 alone 73.4% of sex workers in Addis Ababa were infected with HIV/AIDS, whereas sex workers with HIV/AIDS cases in Nazareth were reported to be 65% in 1991.2 In addition, a cumulative report (1986 to April 30, 2001) submitted to the Ministry of Health (MOH), Ethiopia, shows that HIV/AIDS infection is highest in Addis Ababa (27,412), followed by Oromia (20,287). Out of this 30.56% is reported in Eastern Oromia where Nazareth is located. Due to high prevalence of the disease in these two areas they were selected for the study. METHODS A stratified cross-sectional survey on public awareness of the modes of transmission of HIV/AIDS, identification of patients with HIV/AIDS, and attitude towards HIV/AIDS patients was conducted in and around Addis Ababa and Nazareth from February 2000 to January 2001. Subjects The representative sample consisting of four target groups, namely, students, residents, farmers and sex workers were randomly selected from the target areas. Addis Ababa's target groups consisted of university students (from all faculties except Pharmacy and Medicine), high school students (from Menelik II and Menene), residents (from Woreda 13, Kebele 2) and sex workers (from Kazanchis & Pizza). Nazareth's target groups consisted of Nazareth Technical College students and high school students (from Hawas and Adama), residents (from Kebele 18 and 19), and sex workers (from Kebele 15, 18 & 19). Farmers target groups were mainly from Akaki and Legetafoo, which are located in the vicinity of Addis Ababa. Questionnaires Pre-tested questionnaires with key indicators such as age, sex, marital status, occupation, knowledge about HIV/AIDS transmission, individuals' attitude towards HIV/AIDS patients, and source of information were distributed to each study group. Both open-ended and close-ended questions were included, such as “How do you know a person with HIV/AIDS infection? What are HIV/AIDS modes of transmission? How do you prevent HIV/AIDS? Have you participated in the HIV/AIDS campaign before? What are your sources of information on HIV/AIDS? Do you believe that HIV/AIDS exists?” A minimum sample size of 250 was chosen from each study group. Data from residents and farmers were collected through house to house interview. The students were allowed to fill the questionnaires after they had been given orientation about the aim and purpose of the study. Interview for sex workers took place in pubs/bars or at home, for those who use their houses for commercial sexual activities. To encourage participation of sex workers, interview and data collection were conducted before noon, since daily activities of sex workers usually start at noon. In certain circumstances permission was sought from the owners of bars to interview them during working hours. Data Analysis Data obtained from respondents were entered using EPI INFO Version 6 and analysed. Results were generated in the form of frequencies, median and standard deviations. To study the association of sex, age, martial status and educational level on respondents' knowledge of the modes of transmission of HIV/AIDS, 15 questions were used. In order to calculate the total average scores of correctly answered questions, two markings were used. For wrong answers including “I don't know” a zero was given while one was given for a correct answer. Scoring above 12 out of 15 knowledge questions was considered “high level of awareness”. Based on these scores, a multivariate analysis using SPSS Version 6.1 was carried out to compare and find whether there is any correlation between knowledge about HIV/AIDS and the different parameters. The p values were determined using a non-parametric equivalent for analysis of variance. RESULTS A total of 2300 questionnaires were collected, of which only 2278 (99%) were valid. The remaining 22 (1%) were invalid because of incomplete information. The sample size of Nazareth's sex workers was less because nearly 50% (out of 250 targeted) refused to take part in the study. Table 1 indicates the socio-demographic distribution of the study group. The mean age of the study group was 23.07 ± 2.8 years. Majority of the respondents were aged between 14 and 35 years, which is considered to be the most high-risk group. Out of the 381 sex workers interviewed, only 130 (34.1%) were from Nazareth while the remaining were from Addis Ababa. Exactly 96.3% of the commercial sex workers interviewed in Addis Ababa and Nazareth belonged to the age group 15–30 years. Some of them were illiterates (12.9%) or (elementary) school dropouts (24.7%), junior high school students (39.4 %) and high school students (23.1%). On the contrary, the majority of farmers interviewed were illiterates (59.8%) while some have had elementary school education (24.6%). Table 2 summarises respondents' knowledge of the presence of HIV/AIDS and their opinion on whether it is curable or not. The findings indicate that most of the respondents (93.2%) are aware of the presence of HIV/AIDS and considered it as untreatable killer disease (89.2%). However, comparison between target groups revealed that sex workers have the highest level of awareness (97.9%) of HIV/AIDS and recognised it as a killer disease, while the students had the lowest level of awareness (88.7%). Further comparison of the target groups based on their geographical location revealed that those who resided in Addis Ababa knew that HIV/AIDS exists (93.8%) and recognised it as a killer disease (87.2%), while corresponding results for Nazareth target groups were 92.7% and 90.8% respectively. In both Addis Ababa (8.8 %) and Nazareth (6.2%), some minor groups said HIV/AIDS can be cured. Further analysis of students' responses in the two areas revealed that Nazareth high school students had slightly higher knowledge of the existence of HIV/AIDS (85.7%) and recognised it as a killer disease (78.5%) than those high school students in Addis Ababa (79.5% and 60.1% respectively). In addition, substantial number of high school students in Addis Ababa (28.8%) and Nazareth (14.5%) considered HIV/AIDS as a disease that can be cured. Table 3 shows the study groups' knowledge of the mode of HIV/AIDS transmission. There were misconceptions on modes of transmission of the disease. In particular, farmers had higher level misconceptions, followed by sex workers. They considered mosquito and other insect bites, getting close to someone with HIV, sharing property and toilets as various means of HIV/AIDS transmission. Table 4 shows that there is statistically significant association on average scores of the 15 knowledge questions on mode of HIV/AIDS transmission. It shows that farmers (9.6), older aged (10.8), females (11.5), the married (10.8), divorced (10.9) and those with elementary or no education (9.6) had relatively lower knowledge of the mode of HIV/AIDS transmission than their respective group members. The same table also uncovers that people with more years of formal education have higher knowledge of HIV/ AIDS transmission. Assessment of respondents' knowledge about means of prolonging life of HIV/AIDS patients is presented in Table 5. Twenty seven per cent of respondents said combination of three methods (use of antiretroviral drugs, combating HIV/AIDS related opportunistic disease and self care) would yield good results. However, there is a remarkable knowledge difference among the respondents on means of prolonging life of individuals who are already infected with the disease. As shown in Table 5, a significant number of respondents (10.2%) were unaware of how to prolong the life of HIV/AIDS patients. Specially, a substantial number of farmers (42.5%) indicated that there is no means of prolonging the life of individuals with HIV/AIDS. According to the respondents, the most common source of information on HIV/AIDS is the mass media (86.5%), followed by information from community members (49.2%) and health professionals (46.7%). In fact, the majority of farmers indicated that they hear more about HIV/AIDS over the radio in the form of drama, songs and chats. Other respondents also indicated that in addition to radio they get information about the disease from television, newspapers and magazines. Respondents' knowledge of how to identify individuals with HIV/AIDS is summarised in Table 6. They indicated that one can easily identify individuals with HIV/AIDS using symptoms (30.4%) such as severe diarrhoea, TB and losing hair or skin rashes. Particularly, sex workers who were supposed to be the highest risk group used these symptoms (17.7%) and avoid sexual contact with customers having such symptoms. Similarly, a substantial proportion of students (41.4%) responded the same way. As shown in Table 7, the overall respondents' attitude towards HIV/AIDS patients was negative. Most of the respondents (particularly the farmers) had negative attitudes towards HIV/AIDS patients despite their good knowledge of the main mode of transmission of the disease. DISCUSSION Within the surveyed area, the study has attempted to target the most HIV/AIDS vulnerable age group. In order to compare differences in knowledge within target groups and minimise the effect of geographical location on information dissemination, two nearby cities were selected. The sample representatives were randomly selected around the same area with assumption that there is equal information access. Students from the Faculty of Medicine and School of Pharmacy were excluded from the survey because they have had formal education on modes of HIV/AIDS transmission. As shown in the results, the proportion of single respondents was higher (77.7%). Although there are reports of high prevalence of the disease among married individuals, the investigators' assumption was based on the fact that the singles target groups are more at risk for high risk behaviour. The overall knowledge of respondents about mode of transmission of HIV/AIDS seems encouraging. There was statistical association between knowledge of HIV/AIDS transmission based on background characteristics such as sex, marital status and educational status. This finding agrees with findings from a similar study conducted among out-of-school youths in Bahir Dar, Ethiopia.10 The level of awareness also increased when compared with earlier findings.8,9 This survey also reveals that respondents aged between 14 and 30 years have relative higher knowledge (median 12) of mode of HIV/ AIDS transmission. This is encouraging in the light of their high vulnerability to the disease. A similar survey conducted by other investigators on college students in Addis Ababa reported that 93% of students indicated sexual intercourse to be the major mode of AIDS transmission, followed by blood transfusion (86.7%) and sharing tooth brush (56.5%).7 In contrast, the relatively low level awareness of the existence of HIV/AIDS as a killer disease among the students rather seems paradoxical. This low awareness might have influenced school dropouts to join commercial sex work as a means of livelihood, which will definitely increase the prevalence of HIV/AIDS. Such findings have also been reported in another study on STDs/HIV related attitudes, beliefs and behaviours of sexually experienced racially diverse urban high school teenagers.11 Thus, timely and effective measures should be taken to curb this outflow. The proportion of farmers who were aware of the different modes of transmission other than sexual intercourse was low. This suggests that inadequate information dissemination might be responsible for the difference. The finding from this study is in agreement with other published reports on knowledge of HIV among urban, rural and minority residents in Viet Nam.12 However, in this study farmers were relatively adequately informed about the risk of sharing needles and harmful traditional practices (such as circumcision, tattooing and ear piercing) as modes of transmiting HIV/AIDS. This finding is encouraging since these practices are more frequently practiced in the countryside than in urban areas. A significant number of the respondents considered individuals with severe diarrhoea and TB as having the disease. Thus, carriers (sero-positive individuals) who do not show any symptom at the early stage are likely to be accepted as HIV negative. Few respondents (1.2%) also believed that whites are less vulnerable to HIV than blacks. This has to be taken with precaution as it may give wrong clue to those street girls who run after foreign white tourists. Finally, despite the high knowledge of the main mode of transmission of HIV/AIDS, the majority of respondents (particularly farmers) had negative attitudes towards the patients. In fact, farmers had the least interest in having contact or having a meal with such patients. The result may not be surprising because even a study conducted in Kampala, Uganda, on attitude towards AIDS patients by health workers revealed that 35% of the respondents agreed with the statement, “I am frightened of taking care of AIDS patients”, despite their overall positive attitude towards HIV/AIDS patients.13 Therefore, a lot has to be done in changing the attitudes of the community towards HIV/AIDS patients. LIMITATIONS OF THE STUDY As this study was conducted in pocket areas of the two cities, assumptions employed may not apply to target groups elsewhere in the country. Attempts should be made to extend the same study to school dropouts, shoe polishers, street girls and drivers. It should also extend to other parts of the country. The study also assumed that target groups localised in the two cities have equal access to information despite differences in their educational background. In the house to house interview of residents and farmers when both the husband and wife were at home, it was very difficult for either of them to give genuine answers to some very sensitive sex related questions. In conclusion, the findings indicate that most of the respondents are aware of the existence of HIV/AIDS and consider it as a killer disease. Despite their knowledge of the main mode of transmission, i.e., sexual intercourse and blood transfusion, the survey revealed that a significant number of the respondents have negative attitude towards HIV/AIDS patients. A strategy must be evolved to reduce this stigma and encourage patients with the disease to disclose their status and contribute positively in the campaign against HIV/AIDS. Factors such as age, occupation, marital and educational status should be considered in the information dissemination. Easily comprehensible radio programmes in the form of dramas, talks and chats might help low-income target groups and illiterates. Finally, proper dissemination of information through the mass media, especially radio, seems very important to the community in order to bring about behavioural and attitudinal changes. ACKNOWLEDGEMENTS The authors of this article are deeply indebted to the Research and Publication Office, Addis Ababa University, for financial assistance. Our thanks also go to Dr Berhanu Demeke and Ato Teferi Gedif for their constructive suggestions during questionnaire designing. We thank Professor Tsige G/Mariam for his valuable suggestions and for reading the final version of this manuscript. Lastly, we appreciate the assistance and facilities given to us by the School of Pharmacy. REFERENCES
Copyright 2002 - Women's Health and Action Research Centre The following images related to this document are available:Photo images[rh02019t4.jpg] [rh02019t2.jpg] [rh02019t7.jpg] [rh02019t6.jpg] [rh02019t5.jpg] [rh02019t3.jpg] [rh02019t1.jpg] |
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