|Year : 2007 | Volume
| Issue : 1 | Page : 10-14
AIDS: An understanding in rural women of South-India
Thilakavathi Subramanian, MD Gupte, R Ezhil
National Institute of Epidemiology, ICMR, Chennai, India
Asst. Director, National Institute of Epidemiology, Indian Council of Medical Research, Second Main Road, Tamil Nadu Housing Board, Ayapakkam, Chennai - 600 077, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The study aims to find out the knowledge and understanding of acquired immunodeficiency syndrome (AIDS) in 1,200 randomly selected women in the age group of 15-45 years, of 16 villages belonging to Villupuram Health Unit District, Tamil Nadu, India, using a two-stage sampling design. Data collection was done in the period from August to November 2001, using both qualitative and quantitative methods. In all, 28% of the women had not heard of AIDS at all. More than one-third of the women who had heard of AIDS considered AIDS as a serious illness; and among them, 72% ranked AIDS as the number one killer disease. The main findings showed that the rural women's knowledge was poor in areas like cause, symptoms and prevention. Level of literacy of the women was significantly associated with their knowledge of HIV/AIDS ( P <0.05), showing that literates had better knowledge than illiterates. Also, there were misconceptions and false beliefs about cause and spread of the infection, which were found to be more prevalent among illiterates. Television was found to be the major source of knowledge on AIDS among both literates and illiterates. This study suggests a need for innovative, group-based repeated education on AIDS, particularly for rural women, in order to impart better knowledge and understanding on AIDS.
Keywords: Acquired immunodeficiency syndrome, rural women, understanding
|How to cite this article:|
Subramanian T, Gupte M D, Ezhil R. AIDS: An understanding in rural women of South-India. Indian J Sex Transm Dis 2007;28:10-4
|How to cite this URL:|
Subramanian T, Gupte M D, Ezhil R. AIDS: An understanding in rural women of South-India. Indian J Sex Transm Dis [serial online] 2007 [cited 2020 Aug 13];28:10-4. Available from: http://www.ijstd.org/text.asp?2007/28/1/10/35704
| Introduction|| |
Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that 39.5 million people worldwide were living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) by the end of 2006. In this, women accounted for 48% of all adults living with HIV.  In India there were 5.2 million estimated HIV infections in 2005, with 38.4% being women and 57% of these infections were in rural areas.  At present, almost half of the new infections are in women. Young women get infected with HIV faster than any other population group.  A rural-based study  conducted in Tamil Nadu showed an overall HIV seroprevalence of 1.8% in the general community, and the rate was found to be more in rural areas (2.1%) than in urban areas (0.7%); and also higher in females (2.0%) than in males (1.4%). A study among rural tribal community  showed that AIDS awareness among women was lower than that among men (14% vs . 30%). Few studies in India attribute the prevalence of HIV/AIDS to the low level of awareness of HIV/AIDS in women in general and rural women in particular. ,,
The inability of women to control the factors that place them at risk of HIV infection is compounded by the fact that many societies define the social and cultural identity of women primarily through their role as child bearers and child rearers.  Social and cultural determinants relating to women's dependency on men and their general lower level of education and lower access to resources are accentuated in the area of health care, particularly in their incapacity to protect themselves from sexually transmitted infections.  The economic dependency, coupled with illiteracy and ignorance, particularly in rural women, increases their risk of exposure to HIV infection. If we need to slow down AIDS, understanding its distribution and determinants is very essential. In order to find out the views on, and understanding of, AIDS prevalent among rural women, a pilot study was conducted in a village at Villupuram district, Tamil Nadu, covering 262 eligible women. The results showed 78% of the women had heard of HIV/AIDS, and only about 25% of the females were aware of some of the basic facts related to spread and prevention of HIV/AIDS. Based on the pilot study, main study was conducted with the aim to find out the rural women's knowledge and understanding of HIV/AIDS.
| Materials And Methods|| |
The study was carried out in Villupuram Health Unit District, Tamil Nadu. Based on the pilot study, an estimated sample size of 1,200 women in the age group of 15-45 years was randomly selected using a two-stage sampling design. A sample of 75 women from each of the 16 selected villages, with 1 woman from each of the 75 selected households, was recruited. In the first stage, a random sample of 16 villages was selected based on the 1991 census using 'probability proportionate to size' (PPS) technique. In the second stage, a simple random sample of 75 households was selected from each of the selected villages. If the number of eligible respondents was more than one in a household, the names of such respondents were listed in order according to their age and one person was selected randomly, using the random number table.
Qualitative methods like free listing and ranking were used to collect data on how the respondents identified the seriousness of AIDS. Also, a semi-structured pre-tested interview schedule was used to collect data. The interview schedule mainly contained questions on cause, mode of spread, investigations to be done, who all could get infected, symptoms and availability of treatment and vaccine. Statement response technique was used by giving 25 statements on various aspects of HIV/AIDS to find out whether the respondents agreed or disagreed with the given statements, in order to find out their beliefs and misconceptions attached to HIV/AIDS. There were six qualified and trained interviewers used for data collection. Before proceeding with the data collection, the field staff was given enough training on qualitative and quantitative methods of data collection.
| Results|| |
Basic characteristics of the 1,200 respondents are given in [Table - 1]. More than half of the respondents (51.8%) were 15-29 years of age. Eighty-two percent were married, more than half the respondents (50.8%) were illiterates and nearly half (48.1%) were agricultural coolies. The respondents were asked to list down names of fatal/killer diseases that they knew. In this, 486 (40.5%) women included AIDS in the listing. From this listing, they were asked to rank the names of diseases in the order of seriousness. Among the persons who had included AIDS in their listing, 350 (72%) ranked it as number one killer disease. Women who had not included AIDS in their listing (714-59.5%) were asked whether they had heard of AIDS. In this, 386 (54%) women mentioned 'Yes' and 46% said that they had not heard of AIDS. In all, 336 (28%) women had not heard of AIDS at all.
The socio-demographic variables and the number of women who had heard of AIDS were compared using Chi-square test. Variables such as the village in which the responded resided, the respondent's age, education, marital status and occupation were found to be statistically associated, showing differences in each category [Table - 2]. In order to examine the effect of rural women's education on the probability of their having heard of AIDS, logistic regression technique was employed [Table - 3]. It was found that women who had primary education had a '4.4 times' probability of having heard of AIDS compared to the corresponding probability among women who were illiterates; and in the case of women who had 'above primary' education, this probability was 10.4 times.
Further analysis was done in the case of women who had heard of AIDS (n = 864; 72%). As regards the cause for this infection, 4% [Table - 4] mentioned 'through germs,' and one female who was literate said 'virus.' On the whole, 81% of the women had 'no idea' about the cause. For the question on symptoms of AIDS, 28% mentioned of fever and 39% about weight loss. In this aspect, correct response was more from literates. The non-availability of vaccine and treatment for the cure of AIDS was reported by 45% and 58% of the women respectively. Majority (84%) of them mentioned that all (men, women and children) are prone to get this infection; however, 10.1% had no idea about the same.
As regards the investigations to be done for diagnosing HIV infection, 44% of the illiterates and 62% of the literates were aware of blood test. However, 39% had no idea. 'With respect to spread of HIV, 52.5% [Table - 5] of the women mentioned that it was through unprotected sexual contact.' There was no significant difference in this response among the literates and illiterates ( P>0.05). While 13.2% of the illiterates and 26.9% of the literates said 'through infected blood,' 'infected mother to child' was reported by 0.6% in total, who were all literates. With respect to prevention of AIDS, 45% mentioned of avoiding unprotected sexual contacts; nearly one-fifth of the women reported of the use of disposable/ sterilized needles and syringes. In this aspect, correct response was more (24.2%) from literates. In all, use of condom was mentioned by only 2.5% of the women.
Since there are a number of beliefs and misconceptions associated with cause, spread and prevention of AIDS, in order to assess their knowledge in these areas, statement response technique was used by giving 25 statements and getting their responses. The analysis showed more literates got a satisfactory score (above 80% correct answers), and 59% of the illiterates got a fair score (64-80%). It was observed that there was a significant difference with respect to literacy level and correct response in the areas such as place of occurrence of HIV infection, nature, stigma, misconception and ignorance on spread of AIDS [Table - 6].
With respect to the source of their knowledge of AIDS, in all, television ranked first (59%) as a major source of providing information. Next position for literates was radio; and for illiterates, it was through their friends. When these women were asked about their opinion on knowledge of AIDS, generally in villages, nearly two-thirds of them (61%) said the awareness was there 'to some extent' in villages.
| Discussion|| |
This study showed that a little above one-fourth of the rural women had not heard of AIDS at all. In the free-listing of serious illnesses, 41% had included AIDS as one of the serious illnesses; and among them, nearly three-fourths had ranked AIDS as number one killer disease.
As expected, level of literacy was found to be closely associated with their knowledge of HIV/ AIDS, as literate women were found having better awareness than the illiterates, particularly in the areas such as cause, spread and nature of the disease. Misconceptions and wrong beliefs associated with HIV/AIDS were found to be more prevalent among women who were illiterates. Major source of their awareness of HIV/AIDS was television.
Similarly in a study  conducted on AIDS awareness and knowledge of Indian women covering 13 states, including Tamil Nadu, low rates of knowledge and awareness were reported more among rural and illiterate women. Multivariate analysis found rural, poorly educated and poor women to be the least likely to be AIDS-aware and, if aware, to be having the poorest understanding of AIDS. It was also reported  that only about one-sixth of the women had ever heard of AIDS; and among them, 18% could not identify a single mode of transmission and 42% believed that AIDS could be transmitted through kissing. AIDS knowledge was more among those older than 20 years, urban residents, more educated women and those who had greater exposure to mass media. Television was the greatest source of AIDS information. Another study conducted in a rural area near Delhi and Haryana  revealed that only 12% of the rural women had heard of AIDS, and all those who had heard of AIDS knew of the sexual route of transmission. Mass media and friends were mentioned as major sources of information on HIV/AIDS for this group. In the present study, 72% had heard of AIDS; and among them, more than half were aware of the sexual route of transmission. Also, television, radio and friends were reported as the main sources of information on AIDS in the present study.
Another study conducted in Maharashtra and Tamil Nadu  showed that although 47% of all rural women in Maharashtra were aware of AIDS, only about 28% knew that one could avoid it; and only about 16% possessed correct knowledge about its transmission. In Tamil Nadu, where overall 82% of rural women had awareness of AIDS, about 71% knew that one could avoid the disease; but only about 31% possessed correct knowledge about its transmission. In the present study, more than half of the women were aware of transmission of HIV through unprotected sexual contact.
Among pregnant women in rural southern India,  out of the total 202 women surveyed, 189 women (94%) had heard of HIV/AIDS and 60% of them had relatively good knowledge regarding risk factors for HIV transmission. However, 48% did not know that there are means to prevent mother-to-child HIV transmission.  In the present study, many of them were not aware of mother-to-child transmission (99.4%).
Though a number of IEC programs are organized by governmental and non-governmental institutions in various places, including villages, the present lower level of the basic knowledge required indicates the need for imparting innovative, group-based repeated education about AIDS to these rural women.
| Acknowledgment|| |
The authors are thankful to Mr. Paul A. Tamby, Systems Analyst, and his team for data processing and data management. The authors also thank the interviewers for data collection and the women participants, for their co-opeartion to be our respondents.
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[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]
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