Abstract
Background:
Adequate knowledge about HIV/AIDS among people living with HIV (PLHIV) is essential for the prevention of HIV transmission.
Methods:
A cross-sectional study consisting of 409 PLHIV aged ≥18 years were interviewed regarding their HIV-related knowledge, from April 2014 to April 2015. HIV-related knowledge was assessed using the HIV knowledge questionnaire 18 . Univariate and multivariate analyses were done to determine the factors associated with high HIV-related knowledge. Odds ratios with its corresponding 95% confidence intervals were reported. A value of P < .05 was considered to be statistically significant.
Results:
Among 409 PLHIV, 46.2% had high HIV-related knowledge. Univariate analysis yields factors like upper socioeconomic status, those who are literates, unemployed, and adherent to antiretroviral therapy (ART) were associated with higher HIV-related knowledge. On multivariate analysis, upper socioeconomic status and adherence to ART were the factors that remained significantly associated with higher HIV-related knowledge.
Conclusion:
HIV-related knowledge among PLHIV can be improved through HIV educational programs.
Introduction
Despite HIV/AIDS being a major public health problem and both international and national health agencies making information pertaining to HIV prevention available to all, there is still a rise in the number of new HIV cases globally. Also, some people living with HIV (PLHIV) still indulge in high-risk behavior, 1 –3 which is a setback for ongoing preventive programs on HIV/AIDS.
Knowledge regarding HIV and its transmission is essential to reduce the risk of superinfection and also prevention of HIV transmission. Studies have shown that, PLHIV with sound knowledge of HIV had improved adherence to antiretroviral therapy (ART). 4,5
In the recently published National Integrated Biological and Behavioural Surveillance survey findings, it was reported that comprehensive knowledge among the high-risk groups such as female sex workers, men who have sex with men, and injecting drug users were 43%, 46%, and 43%, respectively. 6
Heterosexual route of HIV transmission is most common in India and this transmission usually occurs from someone who is unaware of their HIV status. If the same person is aware of their serostatus, they are more likely to use protective measures like condoms to reduce the risk of transmission. 7 –9 Increasing awareness and early initiation of ART among PLHIV have shown to reduce the HIV burden. 10 These are essential component of comprehensive preventive strategies of HIV. 11,12
Most of the studies assessing knowledge regarding HIV have been conducted on people who are not infected with HIV; there is a lack of literature focusing on knowledge regarding HIV among PLHIV. Also, as perception and attitude of PLHIV regarding HIV is directly related with the social, cultural, and regional setting of PLHIV, the present study was conducted to assess the level of HIV-related knowledge and factors associated with HIV-related knowledge among PLHIV in coastal South India.
Methodology
In this facility-based cross-sectional study, PLHIV were interviewed to assess their HIV-related knowledge during the period of April 2014 to April 2015 at the Infectious Disease Department of the tertiary care hospitals, in Mangalore, Karnataka.
The protocol of the study was approved by the Institutional Ethics Committee of Kasturba Medical College (Manipal University), Mangalore, India, prior to the commencement of the study.
The sample size of 409 PLHIV was calculated considering the proportion of HIV-related knowledge among PLHIV from a previous study as 80%, 13 with 95% confidence interval (CI) and a relative precision of 5%.
All PLHIV aged 18 years and above and those receiving ART were included in the study. Study participants were clearly explained about the study objectives in their vernacular language. A written informed consent was obtained from those who were willing to participate in the study.
People living with HIV were interviewed in a separate consultation room to maintain confidentiality. A pretested semi-structured questionnaire was used to collect data regarding PLHIV characteristics (sociodemographic and clinical characteristics). Modified Kuppuswamy scale 14 was used to assess the socioeconomic status of PLHIV.
HIV-related knowledge among PLHIV was assessed using the “HIV Knowledge Questionnaire 18” (HIV-KQ-18). 15 HIV-KQ-18 is a validated self-administered questionnaire, which has been shown to be reliable and internally consistent, used to assess HIV knowledge mainly regarding transmission, diagnosis, and prevention of HIV. It consisted of 18 items and PLHIV responded for each item as “true,” “false,” or “don’t know.” People living with HIV responded as don’t know to an item were considered as false. Each correct answer was scored as 1 and incorrect answer as 0. A single summary score was yielded by summing the number of items correctly answered. The possible HIV knowledge scores ranged from 0 to 18. The responses were dichotomized into high and low HIV-related knowledge by taking a cutoff point as 9. Participants who had scored above 9 were considered as having high HIV-related knowledge and those scored 9 and below were considered as having low HIV-related knowledge among PLHIV.
Data Analysis
Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 (SPSS Inc, Chicago, Illinois). The results were expressed as proportions. Univariate logistic regression was done to assess various factors favoring high HIV-related knowledge. Multivariate logistic regression was done to rule out the effect of potential confounding factors. A value of P < .05 was considered to be statistically significant. Odds ratios and corresponding 95% CIs were also reported.
Results
Out of 409 PLHIV, 46.2% had high HIV-related knowledge. The mean age of the participants was 43 ± 8.7 years, with higher proportion of the participants (42.1%, n = 172) in the age group of 41 to 50 years. Majority (62.6%, n = 256) were male and 64.8% (n = 265) were married. About half of the participants belonged to middle socioeconomic status (49.6%; n = 203). Baseline characteristics of the study participants are shown in Table 1.
Baseline Characteristics of the Study Participants.a
Abbreviation: ART, antiretroviral therapy.
aN = 409.
Factors Influencing HIV-Related Knowledge among PLHIV
On univariate analysis, participants who were literate, those belonging to upper socioeconomic status, who were unemployed, and who were adherent to ART were found to have higher HIV-related knowledge (P < .05). However, on multivariate analysis, higher socioeconomic status (OR = 2.0, 95% CI = 1.3-3.1; P = .002) and adherence to ART (OR = 3.4, 95% CI = 2.1-5.5; P < .001) were found to be independently associated with high HIV-related knowledge (Table 2).
Factors Influencing HIV-Related Knowledge among the Study Participants.a
Abbreviations: ART, antiretroviral therapy; CI, confidence interval; OR, odds ratio.
aN = 409.
b P value significance at .05 level.
Discussion
The present study was conducted to assess the level of HIV-related knowledge among PLHIV and to study the various factors influencing it. Only 46.2% of the PLHIV had a high HIV-related knowledge in our study despite the regular counseling regarding HIV given before ART initiation and also during the course of treatment. Also considering majority of the study participants belong to our study district, which has a literacy rate of 83%, higher than the national average of 59.5%, the finding of low-level HIV-related knowledge among PLHIV in coastal South India was surprising.
In our study, 85.3% of the participants incorrectly believed that HIV spreads by sharing a glass of water with HIV-infected person and 82.9% thought that a person can get HIV by sharing a swimming pool or sitting in a hot tub with PLHIV. This shows that there is still a lot of misconception about the mode of HIV transmission and this needs to be improved upon. However, 88% of them knew that HIV will not spread through coughing and sneezing and 91.9% were aware of the facts that having multiple sex partners increased the chance of getting HIV.
People living with HIV belonging to upper socioeconomic status were found to be having a higher knowledge about HIV and this association was found to be statistically significant (P < .05). Similar findings were observed in Malawi, 16 United States, 17 Mozambique, 18 and Kenya. 19 Our findings may be due to the fact that PLHIV from upper strata of society would have better access to healthcare facilities to seek treatment and information regarding their status compared to participants with lower socioeconomic status. Though the availability of ART is free of cost from National AIDS Control Organization and with regular counseling about HIV/AIDS available in our center, indirect costing like loss of daily wages, travelling expenses to reach the health care center, and so on might deter the participants from lower socioeconomic status to avail the ART services.
Literate participants were found to have a higher HIV-related knowledge than participants who are illiterate and this association was found to be statistically significant (P < .05). Studies conducted in Malawi, 16 Kenya, 19 Fiji, 20 Ghana, 21 Guinea-Bissau, 22 and Nigeria 23 also had similar associations between literacy and HIV-related knowledge.
Our study also found that participants who were adherent to ART were more likely to have a higher HIV-related knowledge than those who were nonadherent to ART (P < .05). These findings are in congruence with studies conducted in Kenya, 19 Nigeria, 24 and South Africa. 25 Higher HIV-related knowledge among adherent PLHIV could be due to their frequent contact with healthcare providers and counselors at integrated counseling and testing center at our facility, which might have enabled them to know more about their disease.
When we compare the role of gender in HIV-related knowledge, we found that males tend to have a higher HIV-related knowledge compared to females. Studies conducted in Mumbai, India, 26 Malaysia, 27 Fiji, 20 and rural South India 28 also found the similar findings. This could be due to fact that, in our setting males are considered to be the sole breadwinner for the family and females tend to stay at home to take care of the household work. As a result, men are more exposed to knowledge, awareness programs, and are ready to seek information regarding their status. Since females are mostly confined to their houses, their source of information is predominantly from mass media, family members, and friends. Also, in our study males were more literate (64.3%) compared to females (35.7%), which could be another reason for lower HIV-related knowledge among females.
Limitation of our study was we didn’t assess temporality between adherence to ART and HIV-related knowledge. In conclusion, HIV-related knowledge was high among those belonging to higher socioeconomic status and who are adherent to ART. Identifying the factors that influences HIV-related knowledge can guide the policy makers in addressing these factors and incorporating them into HIV awareness and prevention programs. Illiterates and PLHIV from lower strata of the society usually have less awareness regarding HIV and its transmission, along with limited access to treatment which makes them more vulnerable. Our study emphasizes that HIV-related knowledge is a modifiable factor that can reduce further HIV transmission. Hence, HIV educational programs should target PLHIV with lower socioeconomic status, illiterates, and those who are nonadherent to ART as this vulnerable group might become a potent source of infection and would fuel the already overwhelming burden of HIV.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.