|Year : 2020 | Volume
| Issue : 3 | Page : 126-132
A study of knowledge and attitude about HIV/AIDS among college-going rural youths in Vasai in Palghar District of Maharashtra
Quincy Vaz, Prasad Waingankar
Department of Community Medicine, MGM Medical College, Navi Mumbai, Maharashtra, India
|Date of Submission||18-May-2020|
|Date of Acceptance||18-May-2020|
|Date of Web Publication||18-Aug-2020|
Dr. Prasad Waingankar
Department of Community Medicine, MGM Medical College, Navi Mumbai, Maharashtra.
Source of Support: None, Conflict of Interest: None
Background: Knowledge and a positive attitude are necessary for the successful reduction in the prevalence of and stigma surrounding human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The rural youth is a vulnerable group because of a lack of knowledge and maturity, misconceptions, cultural beliefs, and taboos about HIV/AIDS. Objective: The study aimed to assess knowledge and attitude about HIV/AIDS among college-going rural youths in Vasai in Palghar district of Maharashtra. Materials and Methods: The proportionate allocation approach was used with the stratified random sampling technique to select a 10% sample from 5000 rural students from two colleges in Vasai. A total of 512 students from various academic streams consented to participate. A pretested, semi-structured questionnaire comprising 50 questions (in English only) was administered. It included details about their sociodemographic status, economic background, knowledge, and attitude about HIV/AIDS with a scoring system. Data were analyzed using Excel and Epi Info. Results: Of the total of 512 students, 89.78% of males and 85.37% of females were aware of HIV/AIDS. The science students obtained a mean score of 8.49, whereas the nonscience students obtained a mean score of 6.93. Only 57 students could write a few correct symptoms of HIV/AIDS. About 65.82% of students feel that testing is important, but only 33.01% were willing to get tested. When asked about shaking hands with or touching people living with HIV/AIDS (PLHAs), 79.69% said that merely touching does not transmit HIV/AIDS, but only about half of the students (51.95%) would actually shake hands with or hug a PLHA. Interpretation and Conclusion: Unlike many other studies, where knowledge was poor and therefore attitude also reflected poorly, rural youth in Vasai has fair knowledge, but their attitude toward HIV/AIDS/PLHA is unfavorable. Although Vasai is rapidly developing, and literacy levels are increasing, the misconceptions and social stigma persist. Therefore, having adequate knowledge is not sufficient; the attitude has to change as well.
Keywords: Acquired immunodeficiency syndrome, attitude, human immunodeficiency syndrome, knowledge, rural youth
|How to cite this article:|
Vaz Q, Waingankar P. A study of knowledge and attitude about HIV/AIDS among college-going rural youths in Vasai in Palghar District of Maharashtra. MGM J Med Sci 2020;7:126-32
|How to cite this URL:|
Vaz Q, Waingankar P. A study of knowledge and attitude about HIV/AIDS among college-going rural youths in Vasai in Palghar District of Maharashtra. MGM J Med Sci [serial online] 2020 [cited 2021 Oct 21];7:126-32. Available from: http://www.mgmjms.com/text.asp?2020/7/3/126/292372
| Introduction|| |
Acquired immunodeficiency syndrome (AIDS) is an illness caused by a retrovirus known as human immunodeficiency virus (HIV). As the disease progresses, the body’s immune system continues to weaken, and susceptibility to infections increases until the last stage of the disease is reached which is fatal. The first known cases of AIDS were diagnosed in 1986. During the year 2005, the number of HIV infections rose to 5.2 million. Of the estimated people living with HIV, 60% reside in rural areas.
Though the prevalence of HIV is low, with a population of more than 1.2 billion, India has the world’s third largest number of people living with HIV/AIDS (PLHA). Thus, India bears the significant global burden of HIV/AIDS with nearly 2.39 million people presently infected with the disease. Despite the low prevalence of HIV in India, a high population with a low level of knowledge makes the country more fertile ground for HIV to spread. These rising numbers were no doubt due to the impoverished state of the majority of India, but more importantly, lack of awareness about this disease. There is also a stigma surrounding this disease, as it is sexually transmitted, which has led to a number of misconceptions in the rural areas of the country where illiteracy and ignorance increase the prevalence of this disease.
Youths are a vulnerable group because of a lack of knowledge and maturity, misconceptions, cultural beliefs, and taboos about HIV/AIDS and their tendency to become sexually active, oblivious to the precautionary measures to be taken while making their sexual debut. Several other factors are also responsible for this dearth of knowledge: the influence of media, modernization of culture and loss of traditional Indian values, lack of sex education in school and at home, inability to obtain contraceptives, and incorrect use of contraceptives. Studies conducted in Gujarat, Kerala, and Punjab have also shown several misconceptions about HIV/AIDS among the youth, making this a subject of national interest. India’s epidemic is marked by heterogeneity—a number of distinct epidemics in some places within the same state. 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. This epidemiological shift calls for a well-organized process of awareness creation. Therefore, this study assessed the preconceived ideas and understanding of HIV/AIDS among subjects of this study being among the rural youths of the Palghar District of Maharashtra.
The objective of the study was to assess the level of knowledge and the presence of misconceptions and attitude toward HIV/AIDS/PLHA among college-going rural youths in Vasai in Palghar District of Maharashtra.
| Materials and methods|| |
The two colleges in Vasai taluka in the Palghar District of Maharashtra, India, Vartak College and St. Gonsalo Garcia College, include totally around 5000 students from the peri-urban and rural areas.
This is a cross-sectional study comprising a knowledge attitude survey. Any male or female college-going youth older than 16 years who was a resident of Vasai Taluka and willing to participate in the study was eligible for participation in the study and was included in the study by the random selection process. The research conducted was both descriptive and analytical. The data obtained from the questionnaires were entered into Microsoft Excel and further analysis was done using Epi Info.
Confidentiality and ethical considerations
Approval was obtained from the Institutional Scientific and Ethics Committee before conducting the study. Written letters of consent were obtained from the principal of the college to include their students in the study. All the students participated voluntarily and anonymously, after individual written consent, and their recorded responses were used only for research purpose and kept confidential.
Sample size determination and sampling technique
Both the colleges together has around 5000 students, enrolled for various courses. Using the random number table, and applying it to the roll numbers of students, as a 10% sample, around 512 students stratified academic year-wise across different academic streams fulfilling the eligibility criteria mentioned above were included in this study.
Data collection instrument
A pretested, semi-structured questionnaire (in English only) was administered in the presence of principal researcher. The questionnaire is organized as follows:
- Section A: Details about their sociodemographic status and economic background. Questions about their field of study, the extent of education also come under this category. The updated Kuppuswamy Socioeconomic Scale was used to determine the socio-economic status of the participant. The income scoring was updated using a web tool for Kuppuswamy Scale update applying latest all India Consumer Price Index of Industrial Workers (CPI-IW) value of July 2016, a month before data collection.
- Section B: Questions on awareness, sources of information about HIV/AIDS. Questions on what they believed to be the modes of transmission (contaminated needles or syringes, sexual contact, breastfeeding, from mother to fetus, through body fluids, through a mosquito bite, or by making physical contact with a person infected with HIV/AIDS). Questions on preventive measures and treatment for HIV/AIDS. The students were asked to name HIV/AIDS diagnostic tests, whether they have taken the test before or not if they would like to get tested, and where their nearest test center is located. Questions on attitude towards a person suffering from HIV/AIDS. These qualitative questions evaluated whether they were willing to come in contact with an HIV/AIDS patient and how would they react if a close friend or relative was diagnosed with HIV/AIDS. Personal questions related to the student’s sexual activity such as their relationship status, number of sexual partners, knowledge about condoms, and communication about sex. There was also a comments section. The data collection was carried out in August 2016.
| Results|| |
A total of 512 students participated in the study. The minimum age of participants was 16.2 years and the maximum age was 24.4 years. The median age was 18.1 years (mean 18.3, SD 1.0, Q3 18.9). Of the total, 287 participants (56.1%) were females and 225 were males (43.9%). Of the total, 320 participants (62.5%) were from the nonscience streams and 192 participants (37.5%) were from the science stream [Table 1].
|Table 1: Academic year (AY) and faculty-wise distribution of participants|
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All the students were unmarried. The majority of students were of Hindu religion (355, 69.3%), followed by Christians (73, 14.3%) and Muslims (55, 10.7%), whereas 10 (2.0%) belonged to other religions and 19 (3.7%) did not declare their religion. In 60.9% cases, students belonged to nuclear families, whereas 33.8% of students belonged to joint families and around 5% belonged to three-generation families. The average family size was 5, ranging from 2 to 17. The mean per capita income per month was Rs. 10,349 (minimum—Rs. 285, median—Rs. 6,000, Q3—Rs. 12,500, n = 466).
Benchmarking for academic performance was done using the percentage of marks obtained at HSC State Board Examination. In below-average category (<50%), there were 12 (2.4%) students, whereas majority, 298 (60.1%), were in average category (≥50% and <70%) and 186 (37.5%) had above-average (≥70%) performance (n = 496).
As per the updated Kuppuswamy SE Scale, 53 (12.0%) participants belonged to upper class (I), 227 (51.5%) belonged to upper middle class (II), 106 (24.0%) belonged to lower middle class (III), 55 (12.5%) belonged to upper lower class (IV), and nobody belonged to lower class (V) (n = 441). The remaining 71 participants did not declare about father’s education, father’s occupation, or total family income.
The 447 participants (87.30%) had heard of HIV/AIDS; however, the full form of these terms was known only to 30.27% (AIDS) and 23.24% (HIV) of participants and only 34 students knew that HIV was the causative agent of this disease. The most common source of information turned out to be school textbooks (62.9%) followed by TV and media (22.4%). Other sources of information include friends and parents [Table 2].
When tested for awareness about HIV/AIDS faculty wise, 95.3% of science faculty students were aware of it while among the nonscience faculty students, this proportion was 82.5%. This difference was statistically significant (χ2 16.6, P < 0.001). When tested for awareness of HIV/AIDS SE Scale wise (n = 441), 98.1% of participants in Class I, 88.9% in Class II, 91.5% in Class III, and 78.1% in Class IV gave a positive response. The low awareness in Class IV in comparison with upper classes was statistically significant (χ2 12.02, P < 0.05). The knowledge score was calculated by assigning one point for each correct answer and zero points for each wrong answer to the selected 15 knowledge-based questions with equal weightage to all questions. When tested for knowledge score faculty wise, the mean score for science faculty was 8.48, whereas the mean score for nonscience faculty was 6.92. This difference was statistically significant. The mean knowledge score for Class I was 9.4 (SD 2.74), 7.40 (SD 3.10) for Class II, 7.22 (SD 3.17) for Class III, and 6.94 (SD 3.07) for Class IV. This difference was statistically significant [Table 3].
|Table 3: Association of knowledge scores with socioeconomic scale and faculty|
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Of the total, 68.95% of participants said that HIV/AIDS can be transmitted through contaminated needles and syringes, whereas 24.22% did not know this answer. 79.49% knew that HIV/AIDS can be transmitted by unprotected sexual relations. 64.84% believed that HIV/AIDS can be transmitted from mother to fetus during pregnancy, whereas 44.53% did not know that HIV/AIDS can be transmitted through breastfeeding. Of total students, 79.69% said that handshake is not a mode of transmission, 39.84% said it cannot be transmitted by kissing, 35.94% said it cannot be transmitted by using the same toothbrush, and 58.98% of students correctly said that it cannot be transmitted through sharing of utensils, whereas 29.30% of students incorrectly stated that mosquito bite spreads HIV/AIDS.
The 84.77% of students did not know whether there were any high-risk groups for HIV/AIDS; however, 16 students listed homosexuals, prostitutes, and drug abusers as high-risk groups. Of total students, 54.30% did not know whether HIV/AIDS has a cure, whereas only 25.39% of students correctly answered that HIV/AIDS has no cure. Of total students, 99.22% did not know the treatment of HIV/AIDS, only 4 students correctly stated that antiretroviral therapy is used.
About 53.71% of students correctly believed that HIV/AIDS is preventable, yet 12.30% of students wrongly stated that HIV/AIDS cannot be prevented by abstinence from unprotected sexual activities, whereas 57.03% of students said it can be prevented by disposing of contaminated needles and syringes. Most of them, that is, 97.85%, did not know what laboratory test diagnoses HIV/AIDS, only 11 students correctly answered this question. There was confusion about the symptoms of HIV/AIDS, only 57 students correctly listed some symptoms such as fatigue, loss of weight, lethargy, and recurrent infections. Only 65.82% believed that getting tested for HIV/AIDS is important. Though 98.83% of students have never taken the test before, only 33.01% were willing to get tested. Only 2.34% of students knew someone who has taken the test, whereas only 20 students knew the nearest test center in Vasai. Of total students, 19.14% claimed to know someone with HIV/AIDS, whereas only 16.02% of students know someone who has died due to HIV/AIDS [Table 4].
Most students did not want to play or eat with or hug a PLHA. Although 86.13% of students would not avoid their friend if he/she was diagnosed with HIV/AIDS, 13.87% of students would still avoid their HIV/AIDS-positive friends.
The 89.65% of students have reported their relationship status as single, 4 students are engaged, and 9.57% of students are in heterosexual relationships. Only 4.49% of students claim to have had sexual partners. The age of first sexual contact ranges from 15 to 20 years, and 1.17% of students mentioned 18 years as their age of first sexual contact. The number of sexual partners ranges from 1 to 4. Of total students, 1.95% have had one sexual partner, and two students claim to have had four sexual partners. Of total students, 63.87% have seen a condom, whereas 4.30% have used condoms as a barrier contraceptive; 28.24% of students believed that the male has the bigger responsibility to make sure a condom is being used during sexual intercourse, 4.12% hold the female responsible, whereas a majority of 67.65% feel that both the male and female are equally responsible [Graph 1].
When asked about where they talk about sex, 56.25% of students said that they do not talk about it anywhere, 42.19% talk among their friends, and 1.56% talk about it at home. Of total students, 21.68% do not feel that HIV/AIDS is an important disease that they should be aware of, whereas 35.74% of students do not want to know more about it and 64.26% of students want to understand more about this disease to bridge their knowledge gap.
In regression analysis, the knowledge score was found to be influenced by statistically significant independent effect of Kuppuswamy SE Scale score, along with HSC performance and faculty [Table 5].
| Discussion|| |
In this study, 89.78% of males and 85.37% of females said that they were aware of HIV/AIDS. In a study conducted in Vadodara, on being asked the same question, 81% of the boys and 77% of the girls gave an affirmative response. Note that in both cases, the males had the upper hand and there is a similar difference of roughly about 4%–5% in both cases. It is also fascinating to note that this study finds that the knowledge score has a significant association with SE class.
In another study in Srinagar, from those who were aware, 49.12% of students had no idea of the causative agent. In this study, only 6.64% (34 students) could write the causative agent as HIV, indicating a very poor knowledge of the etiology of HIV/AIDS. The most common source of information about HIV/AIDS was found to be school textbooks (54.88%). In a study conducted in Haryana, the majority of the students (91.2%) said that the source of information about HIV/AIDS was television; mass media was found to be the main source in a study in Rajasthan. Thus, we see that due to a lack of dialogue about this stigmatized topic, only one-way means of communication such as mass media and books contribute to knowledge and awareness.
Most students knew the main modes of transmission: contaminated needles and syringes, unprotected sexual relations, and transplacental (vertical). There was confusion about transmission through breastfeeding, only 32.23% of students answered this correctly. Only 39.84% of students knew that kissing does not transmit HIV/AIDS. 35.94% of students rightly said that HIV/AIDS cannot be spread by using the same toothbrush as an HIV/AIDS positive individual, but almost the same number of students (35.16%) said that it is a mode of transmission. There seems to be a wrong preconceived notion that HIV/AIDS can be transmitted through saliva. Of total students, 42.38% do not think that mosquito bite transmits HIV/AIDS, but the majority either answered in the affirmative or did not know. Similarly, in a study conducted in Karnataka, 46% of students thought that mosquito bite is also responsible for HIV/AIDS.
About HIV/AIDS test taking, 65.82% of students feel that testing is important, but only 33.01% are willing to get tested. Stigmatization would make people hesitant to get the test done; therefore, more PLHAs are unaware that they are having HIV/AIDS. This reflects the negative attitude of the students toward being aware of one’s HIV/AIDS status as they would then become social outcasts.
It is interesting to note that only the males answered affirmatively about being sexually active, none of the females confessed to being sexually active, which is probably out of embarrassment to discuss their sexual activities. In India, a lot of importance is placed on a young woman’s virginity and premarital sex is a complete no-no for young women, although it is acceptable for men. This partiality again traces back to the male-dominated society we live in today. Vasai, like many other smaller rural areas in India, has a very value-oriented culture; therefore, the children inherently absorb these values from their parents, and any deviation from these values is despised by the society.
Though 78.32% of students feel that HIV/AIDS is an important disease to be aware of, only 64.26% want to know more about it. On the whole, the students have a fair knowledge of HIV/AIDS because they have mostly learned about it in school, but due to their traditional mindset they harbor a negative attitude.
| Conclusion|| |
Unlike many other studies, where knowledge was poor and therefore attitude also reflected poorly, the rural youths in Vasai have fair knowledge, but their attitude toward HIV/AIDS/PLHA is unfavorable. Although Vasai is rapidly developing, and literacy levels are increasing, the misconceptions and social stigma persist. Therefore, having adequate knowledge is not sufficient; the attitude has to change as well.
This study shows that having adequate knowledge alone is not enough, the mindsets and behavior have to evolve as well to bring about a positive impact in the lives of PLHAs. The rural youths of Vasai have access to educational resources, but they have yet to undergo essential attitude change. This objective can be achieved through, planning, implementation of a Behavior Change Communication, the program addressing misconceptions and clarifying major aspects of HIV/AIDS followed by reinforcement focused on positive attitude change and the advantages it brings with it, along with periodic monitoring and evaluation of such activities.
We acknowledge the Indian Council of Medical Research (ICMR) in funding STS Project Management of Vartak College, Vasai and St. Gonsalo Garcia College, Vasai for their administrative support.
Financial support and sponsorship
This study was supported by ICMR.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]