1
SURVEY KAP HIV/AIDS
Supriyadi
PROJECT PROPOSALHIV and AIDS Prevention, Care and Support Project For Bali Province
Nopember 2015 INDONESIA
1 SURVEY OF KNOWLEDGE, ATTITUDE AND BEHAVIOR OF SOCIETY
TOWARDS HIV/AIDS TRANSMISSION PROBABILITY INDONESIAN RED CROSS BALI, INDONESIA
Abstract
Bali is one of tourism destinations. The numbers of HIV and AIDS cases in Bali contribute to large portion of the national HIV prevalence. The aims of this survey are capturing Balinese people‟s knowledge about HIV/AIDS, preventive attitude of Balinese people to prevent HIV/AIDS transmission, and Balinese people‟s behavior towards HIV/AIDS transmission. The sample of this research was taken from 3 districts, namely Badung, Denpasar, and Singaraja. The samples were taken with non-random sampling techniques. This research was using cross sectional-survey design. The results of this research are respondents who have knowledge about the prevention
and transmission of HIV / AIDS increased from 60.8 % to 89.5 %. The number of respondents who have a positive attitude towards the prevention and transmission of HIV / AIDS increased from 71.6 % to 91.2 %. However, the survey found that the knowledge and a positive attitude towards the prevention of the HIV / AIDs transmission from most respondents have not been implemented in practical behavior in everyday life.
Key Word: Knowledge, Attitude, Behavior, HIV/AIDS transmission, Bali.
Introduction
The Ministry of Health estimates that without increasing efforts to expand and strengthen prevention, treatment, care, and support services across the country, Indonesia will have almost twice the number of people living with HIV and AIDS in 2014 as compared to 2008, rising from an estimated 227.700 to 501.400. There are many geographic and socio-economic challenges in this country. Indonesia, the world‟s fourth most populous nation, is spread over 17.000 islands. It is governed in a decentralized system divided into 33 provinces which are again divided into
a total of 500 districts. HIV infection has now been reported by more than 200 districts and in all 33 provinces. Mounting an effective and comprehensive HIV and AIDS response in Indonesia requires a combination of efforts - strategic approaches, tackling of structural factors as well as mobilization of a wide range of partners in government, civil society, and the private sector.
2 AIDS Epidemic in Indonesia
HIV/AIDS situation in Indonesia
Special attention is needed to the potential increase of HIV infections among sexual partners (intimate partners) of people of key populations. The number of PLWHIV will increase from 371,800 (2010) to 541,700 (2014). The need for ART will increase from 50,400 (2010) to 86,800 (2014)9. This increase will be larger still if the CD4 criteria for prescription of ART rises, for example from a CD4 count of 200 to 350.
Total Population 222,781,000
% people living under USD$2 per day 52.4 %
HIV and AIDS Indicators
Number of people (all age) living with HIV 170,000 (100,000 - 290,000) Adult HIV prevalence rate (15-19 years old) 0.1 (0.1-0.2 %)
Adult (>15 years old) living with HIV 170,000 (100,000 - 290,000) Women (>15 years old) living with HIV 29,000 (15,000 - 52,000)
Deaths due to AIDS 5,500 (3,300 – 8,300)
Children (0-14 years old) living with HIV Data is not available Orphans (0-17 years old) because of AIDS Data is not available % pregnant women getting medication for
prevention of mother to child transmission
0.7%
% Women and men infected with HIV and getting ART medication
30%
% women and men separately (15-24 years old) correctly identified ways to prevent HIV
Data is not available
% women and men separately, the last time they are using condom in casual sex
1 (Source: National HIV and AIDS Strategy and Action Plan 2010-2014)
HIV Prevention in Indonesia HIV and AIDS prevention has emerged as one of the top most priorities of the Indonesian government. As signatories to the MDG‟s, the government realizes and is committed towards the contribution to halt and reverse the epidemic by 2015. The HIV and AIDS Strategy and Action Plan 2010-2014 is the basis to all the efforts of the Indonesian government jointly with other partners. It is the plan of the strategy that by 2014 eighty percent (80%) of key populations will be reached through effective programs and 60% of them will engage in safe behavior.
Bali is a tourist destination. Bali has 9 districts and 57 sub-districts with a total population of 3.409.845 in 2008 which also includes 986 foreigners who are settled in Bali. Tourism business is a profession where most people are involved in nowadays, although many other people are farmers, workers, fishermen and some work at other private sector. The literacy rate is average and though the educational system is quite strong, for some reasons such as peer influence, poverty, demands for young people to earn living at early age, there are many dropout students. Health services are not well functional. Government institutions still require improvement on providing quality and comprehensive health services
especially to the poor groups. There are 113 health centers throughout Bali. However, not all residents can be served.
Bali being a tourist hub is vulnerable to HIV/AIDS. Though Bali has a good access to information and service, HIV/AIDS is on the rise merely due to challenges in regards to behavior changes. Places outside the city are still vulnerable to it due to lack of information. The level of stigma and discrimination associated with HIV seems quite significant due to the socio-religious norms. The numbers of HIV and AIDS cases in Bali contribute to a large portion of the national HIV prevalence. The MARP are the sex workers and IDUs. So with the recommendation from PMI Headquarters and assessments on the ground, Bali is identified as the potential project location for the HIV and AIDS Prevention, Care, and Support Project.
2 their own ability to cope with the
occurrence of HIV/AIDS, including active participation in community preventive movement, preventive action, or curative action.
Method
Population and Sample
The population in this research were people who live in 9 districts in Bali (Negara, Tabanan, Badung, Gianyar, Semarapura, Bangli, Amlapura, Denpasar, Singaraja), at productive sexual age (pubescent teens and early to late adulthood) both male and female. The samples were taken from 3 of districts, namely Badung, Denpasar, and Singaraja. Specifically, samples were people who live in those regencies. The samples were taken with non-random sampling techniques. The samples voluntarily participated as participants in this research. Then, 4 villages were randomly selected from each district. Those villages were villages which are able to represent and to describe each chosen district.
Each village was randomly selected throughout simple random sampling. As many as 50 people were collected from each village and agreed to participate as respondents of this survey. The selection of the respondents from a list of residents also considered several variables, namely gender, age group, and educational level. By doing sample selection process, the researcher obtained 200 respondents for each district. Therefore, the total samples of the survey of knowledge, attitude, and behavior toward HIV/AIDS transmission prevention were 600 people.
Measurement
The data were obtained through questionnaire. This questionnaire was administrated to the respondents by
research volunteers. The research volunteers used the questionnaire as their interview guide to ask respondents based on questions served in questionnaire, with combination methods between closed and open interview. In other words, the completion of questionnaire was assisted and done by the research volunteers, but still, the answers for the question items obtained from the respondents are concerned. The questionnaire includes 3 aspect and 86 of items. They are 1) Knowledge Component, consisting of 40 items, 2) Attitude Component, consisting of 24 items, 3) Behavior Component, consisting of 22 items. Each component and items uses likert scale model which has been modified. Data Collection
The data were obtained through questionnaire. This questionnaire was administrated to respondents by research volunteers. The research volunteers used the questionnaire as their interview guide to ask respondents based on questions served in questionnaire, with combination methods between closed and open interview. In other words, the completion of questionnaire was assisted and done by research volunteers, but still, the answers for the question items obtained from the respondents are concerned. The questionnaire includes 3 aspect and 86 of items. They are 1) Knowledge Component, consisting of 40 items, 2) Attitude Component, consisting of 24 items, 3) Behavior Component, consisting of 22 items. Each component and items using likert scale models which has modified.
3 used to reveal knowledge and attitude
of people toward the HIV/AIDS transmission. Questionnaire consists of 86 items of question which were apparently quite valid and reliable. Reliability coefficient was quite, showed by the alpha value = 0.824 and 8 items were dropped from attitude components. Validity and reliability testing were not conducted for knowledge and behavior items because the knowledge that will be revealed was not for testing respondents‟ ability as well as behavior question items that will be used to reveal uncover facts about behavior that have been made by respondents. Hence, validity and reliability testing were not needed to be conducted for said questionnaire, similarly with concrete behavior. Concrete behavior is behavior that is really experienced and has done so far. Result
There were only 589 respondents‟ data that could be analyzed from the total of 600. 11 participants from pre-test and 46 from post-test were dropped, caused by their incomplete responses in their questionnaire.
Respondent Characteristic Tabel.1. Total Respondents
Total Respondents
Regency Pre-test Post-test
Freq. % Freq. % respondents, the pre-test result obtained male respondents (n=264, 44.8%), female respondents (n=325, 55.2%). While the post-test result obtained male respondents (n=247, 44.6%) which was less than the female respondents (n=307, 55.4%). Most of the respondents‟ education level was high school (57.9%) as in pre-test and
(58.8%) as in post-test. There were also graduate students who participated in this research with the percentage of 0.7% of respondents. Detailed categories of respondents by educational level can be seen in the following table 2.
Regarding marital status, based on the pre-test data, most of the respondents were single (n=364, 61.8%); one of them was a widow (0.2%), and the respondents who were
married (n=224, 38.0%). While on the post-test data obtained respondents were single (n=321, 57.9%); widow (n=2, 0.4%), widower (n=11, 2.0%), and married (n=220, 39.7%).
Tabel.2. Respondents’ Categorization Based on Educational Level
Educational Level Pre-test Post-test Freq. % Freq. %
1. Knowledge of Respondents about HIV/AIDS
4 of 589 respondents, the percentage of
respondents who were categorized as having a good knowledge about prevention and transmission HIV/AIDS in the pre-test was only 60.8% and then increased to 89.5% in
post-test. The percentage of respondents who were categorized as having enough knowledge showed in the pre-test were 26.7 % and it decreased to 7.2 % in the post-test. The percentage of respondents who were categorized as having not enough knowledge in the early pre-test was only 12.6 % and decreased to 3.2 % in the post-test. Overall, the quality of people‟s knowledge regarding HIV/AIDS has increased. The awareness of the dangerous transmission effect of HIV/AIDS is supported by the easy access of information provided by the government through socialization. 2. Attitude of Respondents toward
HIV/AIDS
The data showed that about (n=167, 28.4%) respondents still have enough attitude either toward transmission or prevention of HIV/AIDS. Whereas 422 respondents (n=422, 71.6%), were reported to have positive attitude toward HIV/AIDS transmission and prevention, this percentage has increased to (n=505, 91.2 %) in post-test. Meanwhile the percentage of respondents who were categorized as having enough attitude toward HIV/AIDS transmission and prevention has decreased from 28.4% to (n=49, 8.8%). The percentage changes that occurred both on the respondents‟ knowledge as well as attitude toward the prevention and transmission of HIV/AIDS after the statistics test was conducted also showed a significant change. The t-changes that occurred on respondents‟ knowledge and attitude toward the prevention and the transmission of HIV/AIDS were due to the contribution of the programs conducted by the Indonesian Red Cross (PMI) of Bali Province. Meanwhile, the percentage of respondents who did not believe that HIV/AIDS is a disease caused by God curse was shown to increase from (n=433, 73.5 %) to (n=466, 84.1%). 4. Sex Education Necessity and Sex
Intercourse During Dating The Necessity of Sex Education The number/percentage of respondents‟ who considered the necessity of sex education for teenagers also increased from (n=101, 17.1%) to (n=178, 32.1%). It means that people consider information and socialization about sex education to be very important especially for teenagers. Meanwhile, the number/percentage of respondents who reported that sex education is not necessary decreased from (n=10, 1.7 %) to (n=4, 0.7 %).
Sex Intercourse during Dating
5 percentage in the post-test result was
shown where the number of respondents who highly disagreed
regarding sex intercourse during dating increased from (n=237, 40.2 %) to (n=293, 52.9 %).
5. Premarital Sex and Promiscuity
Promiscuity is Normal
The number/percentage of respondents reported to disagree with the notion “promiscuity is normal” increased from (n=211, 35.8 %) to (n=259, 46.8 %). Meanwhile the number of respondents who stated their agreement toward such notion decreased from (n=20, 3.4 %) to (n=6, 1.1 %).
Premarital Sex
Premarital sex in Eastern culture is considered unfavorable by cultural and social norms. The number/percentage of respondents reported to have sex out of wedlock decreased from (n=157, 26.7 %) to (n=132, 23.8 %). Meanwhile, the number/percentage of respondents reported to not have sex out of wedlock increased from (n=421, 71.5 %) to (n=408, 73.6 %).
6. Benefits of HIV/AIDS Programs The benefits of HIV/AIDS programs number of respondents who stated that the programs are not beneficial decreased from (n=145, 24.6%) to (n=11, 2.0%).
Comparison between Pre-test Post-test on Several Ritual Behavior and Medicine Topics
Repellent Ritual (Tolak Bala) for Dispelling HIV/AIDS
The number of respondents that had done efforts of tolak bala ritual to repel HIV/AIDS as well as to avoid its did not believe in such ritual increased from (n=155, 26.3%) to (n= 204, 36.8%). Meanwhile, the number of respondents who believe in more beneficial religious rituals in general increased from 27.3% to 28.9%. This showed that the people gradually understand that HIV/AIDS cannot be avoided by repellant ritual (tolak bala). Nevertheless, doing praying ritual based on the general rule and tradition of the people will be able to help people increase their spiritual faith and increase self-protection against any illnesses. Some of them (n=155, 26.3%), doubted the rituals, whether curing or not.
Ritual Behavior
The percentage of respondents (n=161, 27.3%) who felt the need to perform ritual called tolak bala– ritual used and believed to be able to prevent HIV/AIDS. The ritual is done through drive away HIV in order to cure the patient and to prevent HIV transmission. Most of the respondents (n=422, 71.6%) didn‟t believe that
tolak bala ritual could relieve HIV from patient‟s body and also they didn‟t believe that the ritual could cure AIDS.
2 34.7%). Meanwhile, the orientation for
medical treatment place has also a little shifted. In order to treat people with HIV/AIDS, most respondents with good awareness about HIV/AIDS reported to choose treatment behavior such as taking medical check and treatment at district hospital decreased from (n=89, 15.1 %) to (n=25, 4.5 %). Respondent who chose to do medical checkup and treatment to local government clinic or puskesmas
increased from (n=11, 1.9 %) to (n=15, 2.7 %). However, the survey still found that some respondents still suggested a shaman or balian to get treatment (n=1, 0.2%). This showed that the people begin to understand that the treatment socialized by the government and the facilities provided by BPJS begins to be more demanded by the people, although some people still do medical check to shamans (Balian), although the number is so little.
Comparison between Pre-Test Post-Test on Several Discrimination Attitude towards PLWHA Topics The percentage of respondents who initially refused to socialize with the people living with HIV/AIDS was (n=253, 43.0%), and it decreased to (n=100, 18.1%). Meanwhile, the percentage of respondents who did not refuse to socialize with those people was initially (n=324, 55.0%) and it increased to (n=447, 80.7%). Similarly, the percentage of respondents who believed and saw that HIV/AIDS is a genetic disease decreased from (n=64, 10.9%) to (n=36, 6.5%), and the number of respondents who began to be aware that HIV/AIDS is not a genetic disease increased from (n=352, 59.8%) to (n=423, 76.4%). This showed that the people have begun to understand that HIV/AIDS is not a genetic disease and they have also begun to accept and to socialize with the people living with HIV/AIDs.
The number of respondents who initially thought of expelling and blaspheming the people living with HIV/AIDS, who has begun to accept and to socialize with those people was (n=214, 36.3%) and it increased to (n=248, 44.8%). This showed that the people have begun to understand that HIV/AIDS is not a curse and the patients are not the people who need to be avoided and blasphemed. Nevertheless, this attitude and view are not fully shown in their behavior. There are still respondents who demand that the people living with HIV/AIDS to be isolated and even the inclination of isolation those people increased. This condition was still found in 3 (0.5%) respondents who confessed and believed that there are people with HIV/AIDS around their neighborhood. Even more, after the Post-test was conducted, the inclination of the respondents‟ attitude toward isolation increased to nine people (1.6 %). This tendency should still be watched out and further studies regarding why respondents‟ attitudes and views are not shown yet in their behavior should be conducted. Detailed description of isolation behavior can be seen on table 3.
3 done positive attitude. The behavioral
intention was reflected from their effort to evoke the spirit of life of the people with HIV/AIDS and to provide social support such as motivation. Motivation was given to make the people with HIV/AIDS remain optimistic with any treatment process that they have been doing. Most other respondents just showed their normal and reasonable act. In concrete, they didn‟t take any action toward people with HIV/AIDS.
Comparison between Pre-Test Post-Test on Several Preventive Attitude toward HIV/AIDS Topics
Sharing about Countermeasures People begin to be aware of the importance of spreading information regarding the prevention efforts of HIV/AIDs with their own ways. The change on activities of spreading information from peer-group was shown to be significant which in the pre-test was only (n=349, 53.9%), while after the post-test it increased to (n=448, 80.9%), and the percentage of the respondents who did not do activities of spreading information (passive) decreased from (n=226, 38.4%) to (n=91, 16.4%). This showed that the people begin to be aware of the importance of preventive action against the transmission of HIV/AIDs.
Sharing Peer Subject
Sharing peer subject is an activity of spreading information conducted through peer-group. Among others, the percentage of activity conducted with peers at school increased from (n=266, 45.2 %) to (n=290, 52.3 %), the percentage of sharing peer subject activity conducted with peers in the village increased from (n=170, 28.9 %) to (n=222, 40.1 %), the percentage of information sharing subject with siblings increased from (n=224, 38.0
%) to (n=273, 49.3 %), the percentage of cousins sharing subject increased from (n=165, 28 %) to (n=180, 32.5 %) and the sharing subject with acquaintances significantly increased by 6.3 %.
Discussion
The results of this research have given ideas that in fact most of the respondents have sufficient knowledge about HIV/AIDS prevention and transmission. This is probably because most of the respondents had experienced and felt the presence of the HIV/AIDS information from various institutions which provide health promotion programs such as socialization.
Survey shows that sufficient knowledge from the respondents which gained from the experience has not been encouraging the attitude of the respondents as a precaution or alert to the possibility of HIV – AIDS transmission. It has not been able to actively encourage respondents to prevent HIV transmission probability.
It may arise because of lack of optimism or lack of efficacy against HIV – AIDS. Moreover, a belief is growing that AIDS cannot be cured. Some respondents also found out to be believing and sure with tolak bala
4 more meaningful if done by working
together, shoulder to shoulder.
Balinese people‟s behavior towards HIV/AIDS transmission cant be implemented can explained by likelihood of taking preventive action is determined by two assessment they make: their perceived threat of the health problem and the sum of pros and cons they perceive in taking action. Perceived threat of HIV/AIDS transmission is based on perceived seriousness of the HIV/AIDS transmission, perceived susceptibility of the HIV/AIDS transmission, and the cue to action. The characteristics and the demographic differrences can also influence individual‟s perceptions of benefit, barriers and threat. These factors include the individual‟s age, gender, social class, personality traits and educational level.
Another possible discrepancy between knowledge gained from life experience with attitude, behavior, and belief among individuals and group (i.e. in adolescence) may be explained based on Santrock theory. This theory explained adolescence as a transition period between childhoods and adulthood, which involves biological, cognitive, and social changes. Biological changes are characterized by height growth, hormonal changes, and sexual organ maturity marked by puberty. Cognitive maturity involves changing way of thinking and intelligence. Then, changes in social are marked by the imperative to achieve independence and changing pattern of way when building relationships with others in a social context (Santrock, 2007).
The need of affiliation with others will be high when an individual reaches adolescent developmental phase. Specifically, people will need more interaction with others in middle adolescent phase. This interaction needs to be fulfilled because humans need more judgmental evaluation from people about their attitudes, thoughts, arguments, or other things related to identity formation at this developmental phase (Papalia, Olds, & Feldman, 2007). It explains why adolescents are easy to distract and to be ambivalent by situation happening arround them, social situation, even by their self-experience. Adolescents who are less fortunate and stand in incondusive environment will be easier to slip into sexual promiscuity.
Conclusion
2. Generally, respondents knew and
understood about transmission,
prevention, and curative action
toward HIV/AIDS, approximately
about 89.5% of them knew
HIV/AIDS well. The others (3.2%) still have not enough correct understanding about HIV/AIDS. 3. Respondent‟s attitudes toward the
prevention and transmission of HIV/AIDS
(8.8 %) have enoughattitude.
While 91.2 % of respondents can be said had positive attitude towards the prevention and transmission of HIV/AIDS
4. Most of respondents had not yet
implemented their adequate
5 their spouses (decreased from 5.1 % to 3.6 %). Most of respodents
(n=422, 71.6%) didn‟t believe
that tolak bala rituals could relieve
HIV from patient‟s body and also they didn‟t believe that the rituals could cure AIDS.
5. Nearly half of respondents did not perform preventive action when deal with people with HIV/AIDS. They even refused to get along with people living with HIV/AIDS. 60 of respondents (10.2 %) who live within the people with HIV/AIDS did not show isolation behavior. But, still there were 3 respondents (0.5 %) who did that isolating behavior toward people with HIV –
AIDS.This percentage actually
decreased in the post test. Twenty one of respondents (3.8 %) who live within the people with HIV/AIDS
did not show isolation
behaviour and (1.6 %) who did that isolating behavior toward people with HIV – AIDS.
Suggestion
1. Training and socialization
program about
transmission/prevention of HIV/AIDS should be taking more concern in attitude changing into concrete behavior. So it will not be just adding more information about HIV/AIDS to the audience.
2. Message delivering method during the training should be done by HIV/AIDS facilitator and have to fit with learning method about changing behavior, so they participants are not just
learning for adding information only.
3. Attitude, efficacy, and society behavior that reflect ambivalence toward preventive action against HIV/AIDS transmission need to be directed to become more positive attitude, efficacy, and behavior by doing some skill trainings and socialization programs related to strategy to protect and to maintain self from free sex behavior.
4. Indonesian Red Cross must work with the potencies of the society regarding knowledge, efficacy, attitude, and behavior which is already „half-positive‟ toward the prevention of HIV – AIDS transmission by encouraging people to actively give information and education in their neighborhood or to people close to them, in order to prevent and to tackle the transmission of HIV/AIDS.
6 REFRENCES
Papalia, D. E., Olds, S. W., & Feldman, R. D. (2007). Human
Development. New york:
McGraw Hill.
Santrock, J. W. (2007). Remaja edisi kesebelas. Jakarta: Erlangga. Sugiyono. (2001). Statistika untuk
Penelitian. Bandung: Alphabeta. Suryabrata, S. (2000). Metodologi
penelitian. Jakarta: PT Raja Grafindo Persada.
