Year : 2010 | Volume
: 35 | Issue : 1 | Page : 142--146
Awareness and attitude of the general public toward HIV/AIDS in coastal Karnataka
B Unnikrishnan1, Prasanna P Mithra1, T Rekha1, B Reshmi2,
1 Department of Community Medicine, Kasturba Medical College, Mangalore, India
2 Department of Health Information Management, Manipal College of Allied Health Sciences, Manipal, India
Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka
Objective: To assess the awareness and attitude of the general public toward people living with HIV/AIDS (PLWHA) in Mangalore, a city in Coastal Karnataka. Design: Community-based cross-sectional study. Materials and Methods: The study population included 630 individuals aged 18 years and above. The information was collected using a semi structured pre-tested questionnaire. The questionnaire consisted of 24 questions regarding awareness of the modes of transmission of HIV/AIDS (nine questions) and questions to assess the attitude toward People Living With HIV/AIDS (PLWHA) (15 questions). Statistical package SPSS version 11.5 was used, Chi-square test was conducted and P< 0.05 was considered as statistically significant. Results: About one-third of the study population thought that one could get infected by merely touching an HIV positive individual. Approximately 45% stated that they would dismiss their maid on finding out her HIV positive status. About 54% were willing to undergo the HIV test. The respondents with less than secondary school education had a discriminatory attitude toward HIV positive people, with regard to them deserving to suffer, dismissing a HIV positive maid, hesitating to sit next to a HIV positive person in the bus, divorcing the infected spouse, and willingness to get tested for HIV, which was found to be statistically significant. Conclusion: Stigma among the general public was mostly due to fear of contracting the illness. Stigma does exist to significant degrees among the educated people, which was suggested by about 45% of the participants being willing to undergo the HIV test. There is a need for greater attempts toward making information regarding HIV/AIDS available to every individual of the society.
|How to cite this article:|
Unnikrishnan B, Mithra PP, Rekha T, Reshmi B. Awareness and attitude of the general public toward HIV/AIDS in coastal Karnataka.Indian J Community Med 2010;35:142-146
|How to cite this URL:|
Unnikrishnan B, Mithra PP, Rekha T, Reshmi B. Awareness and attitude of the general public toward HIV/AIDS in coastal Karnataka. Indian J Community Med [serial online] 2010 [cited 2019 Jun 19 ];35:142-146
Available from: http://www.ijcm.org.in/text.asp?2010/35/1/142/62580
Acquired Immunodeficiency Syndrome (AIDS) is one of the most dreaded entities that modern medicine has ever had to tackle. Adult HIV prevalence in India is approximately 0.36%, which corresponds to an estimated 2 to 3.1 million people living with HIV in the country. 
Karnataka is one of the high HIV-prevalent states in India. According to the HIV Sentinel surveillance system data of 2007, HIV prevalence among pregnant women receiving antenatal care in Karnataka was 0.5% and those attending STD clinics was 8.4%. 
HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic. Stigma is increased when the disease concerned is thought to be acquired entirely by the patient's fault, for example, immoral behavior.  Stigma and discrimination can result in People Living With HIV/AIDS (PLWHA) being shunned by family and the community, poor treatment in healthcare and educational settings, an erosion of rights, and psychological damage.
Stigmatization would make people hesitant to get the test done, therefore, more PLWHA are unaware that they are suffering from HIV/AIDS, and are thereby putting his/her sexual partners and/or needle sharers at risk of getting infected, due to lack of precautionary measures. 
There are several reasons for the stigma toward PLWHA among the general population, one of them could be inaccurate information about the transmission of HIV; creating irrational behavior and misperceptions of personal risks. 
Mangalore where the study was undertaken is the chief port city of Karnataka state, it is the administrative headquarter of the Dakshina Kannada District, has a population of 3.9 lakhs as per 2001 census, has an education rate of 83%, significantly higher than the national average of 59.5%. This area has also a favorable sex ratio of 1022.  According to the District Level Household and Facility Survey 3, school enrollment for both boys and girls in this district was 100%. 
Thus this study was carried out to assess the level of awareness among the general public about HIV/AIDS, along with their attitude toward PLWHA. Based on the findings, we needed to come up with suitable strategies to correct the misconceptions by Information, Education, and Communication (IEC) activities.
Materials and Methods
A community-based, cross-sectional study was conducted in Mangalore among 630 participants over a period of three months (January to March 2007).
The calculated sample size for this study was 576; based on the anticipated proportion of awareness among the general population as 40%, with relative precision of 10%, and a Confidence Interval of 95%. After adding the 10% non-response error, the final sample size was 630.
The study area consisted of 60 wards with a total population of 0.398 million. People in the age group of 18 years and above were selected as the study population. Ten wards were selected out of the 60 wards by the simple random sampling method. The eligible populations of selected wards were listed, and a population proportionate to the sample size was calculated from each of the 10 selected wards. Selection of the households was done using convenience sampling. The information was collected using a semi-structured, pre-tested questionnaire. The questionnaire consisted of 24 questions with regard to the awareness of the modes of transmission of HIV/AIDS (nine questions) and questions to assess the attitude toward PLWHA (15 questions). During home visits the purpose and nature of the study was explained to the people and informed consent was obtained. On obtaining their consent, the investigator conducted a face-to-face interview to fill the questionnaire.
Data was analyzed using SPSS Version 11.5. Chi-square test was used to compare the awareness and attitude toward PLWHA across the educational category and p value  They found that 51% of the general population wanted names of PLWHA to be made public, as compared to 8% in our study.
A study done among slum-dwellers in another metropolitan city of India (Chennai), showed that 67% males and 55% females were aware of the sexual mode of transmission, as compared to 98% in our study population.  In the same study, 45% males and 62% females thought AIDS could spread through mosquito bites, as compared to only 9% in our study.
Another study on awareness was done in China where they compared the responses from clients and from prostitutes. Interestingly, the prostitutes had a better knowledge regarding HIV transmission through needle sharing (77%) and from mother-to-child (75%) as compared to the 53% of clients, in both cases.  It is noteworthy that only 48% of our study population knew about HIV transmission through breast feeding, but 94% were aware of HIV transmission through needle sharing.
In another Indian study, 57% felt that people living with HIV/AIDS [PLWHA] should be isolated as compared to the 81% in our study who felt that PLWHA should NOT be stopped from attending public functions. Regarding the existence of a cure for AIDS, 14% of that study and 12% in our study thought that there is a cure for AIDS at present. 
Comparison with a similar study done in the US would be meaningful to understand cross-cultural differences in attitudes.  In that study, 40% responded that HIV transmission could occur through sharing a glass as compared to 6% from our study. A total of 19% responded that persons who acquired AIDS through sex or drug use have got what they deserved as compared to a greater number (24%) in our study.
Despite the moderately positive attitude of the general public toward PLWHA and satisfactory levels of awareness regarding the modes of transmission, they also exhibited certain misconceptions about the modes of transmission of HIV/AIDS. This being the result of a study on a literate population, we can visualize what the condition of the illiterate masses would be.
This study brings to light the need to plan and implement new strategies of educating the public about the modes of transmission of HIV. Special efforts should be made to make sure this information is available to the youth also, as they are exposed to drug abuse and unsafe sexual practices, due to peer pressure and an excessive adoption of western culture. This can be implemented by integrating relevant topics into the existing sex education syllabus, if any. If there is no sex education being given to adolescents of all socioeconomic backgrounds, this is a good incentive to start the same. They should be given access to a forum with trained persons, where they can discuss anything they need to clarify, especially those issues not discussed at home. If these trained persons are young adults rather than persons of their parents' age group, the two-way communication might become more effective and easier. Whether this is really true needs to be tested by using pilot studies. Also, parents need to be educated about the need to spend time with their children to impart good moral values and a non-secretive attitude to sex. Religious views regarding pre-marital and extra-marital sex can further help in teaching the need to avoid risky sexual behavior.
Regarding attitudes of the public toward PLWHA, interactive sessions and camps where HIV-infected persons share their experiences, could help give the public a better understanding of the lives of PLWHA.
Along with new action strategies, attention should also be given to better implementation of the existing programs to reduce stigma, increase awareness, and inculcate a more positive attitude toward PLWHA. These, along with the efforts of the healthcare professionals should provide an immense progress in the global fight against AIDS.
The authors acknowledge Late Dr. B. S. Sajjan, formerly Head, Department of Community Medicine, Kasturba Medical College, Mangalore, for his valuable guidance and support in this endeavor. The present work was supported by the University of Alabama at Birmingham International Training and Research in Environmental and Occupational Health Program, Grant Number 5 D43 TW05750, from National Institutes of Health - Fogarty International Centre.(NIH-FIC).
|1||HIV data -National AIDS Control Organization. Available from: http://www.nacoonline.org. [accessed on 2010 Feb 24].|
|2||HIV sentinel surveillance and HIV estimation in India 2007- A technical brief; National AIDS Control Organization. Available from: http://www.nacoonline.org. [accessed on 2010 Feb 3].|
|3||Herek G. AIDS and stigma. Am Behav Sci 1999;42:1106-16.|
|4||Government of India - Ministry of health and family welfare: State wise HIV prevalence (1998-2004). Available from: http://www.nacoonline.org/facts_hivestimates.htm . [accessed on 2007 May 29].|
|5||Government of India - Ministry of home affairs: Census of India. Available from: http://www.censusindia.net. [accessed on 2007 Jun 18].|
|6||Ministry of Health and Family Welfare, Govt of India. District level household and facility survey under Reproductive and Child health project (DLHS -3) - 2007-2008. International Institute for population sciences, Mumbai.|
|7||Sudha RT, Vijay DT, Lakshmi V. Attitudes, awareness and beliefs in general public toward HIV/AIDS in Hyderabad, a capital city in South India. Indian J Med Sci 2005;59:307-16.|
|8||Kalasagar M, Sivapathasundharam B, Einstein T, Bertin A. AIDS′s awareness in an Indian metropolitan slum dweller: A KAP (knowledge, attitude, practice) study. Indian J Dent Res 2006;17:66-9.|
|9||Zhang K, Zuo Q, Shan GL, Xie Y. Comparison of HIV/AIDS awareness and attitudes between prostitutes and clients in south China. Proceedings of the 13th International AIDS Conference; 2000 July 9 - 14; Durban, South Africa: International AIDS Society; 2000.|
|10||Sobhan K, Kumar TS, Kumar GS, Ravikanth R, Adarsha S, Mohammad AS, et al. HIV and AIDS: Awareness and attitudes among males in a rural population. Indian J Community Med 2004;29:141 -2.|
|11||Centers for disease control and prevention. HIV-related knowledge and stigma. JAMA 2000;284:3118-9.|