CHAPTER 5: PERCEPTION OF RISK OF HIV INFECTION
5.2 Awareness of HIV/AIDS
HIV/AIDS?”; “What can a person do to avoid getting HIV/AIDS?” The first question is to assess general awareness about HIV/AIDS infection. The second question intends to ascertain whether or not respondents were fully aware of the danger of HIV/AIDS. The third question aims to assess awareness of the measures available to protect against the risk of HIV infection. The fourth question was to allow respondents to name the methods available which can be used to avoid the risk of HIV infection. Table 5.1 shows the percentage of respondents who reported that they have ever heard of HIV/AIDS.
Table 5.1: Percentage of respondents who have ever heard of HIV/AIDS and knew that it was a fatal disease
Men Women n % n % Heard of HIV/AIDS
Yes 208 99.5 216 99.5 No 1 0.5 1 0.5
N 209 217
Know that it is an incurable and fatal disease
Yes 207 99.5 184 85.2 No 1 0.5 27 12.5 Don’t know 0 0.0 5 2.3
N 208 216
As shown in Table 5.1, awareness of HIV/AIDS among respondents, in the sense that they have heard of a disease called AIDS, is almost universal. In fact, nearly all respondents (99.5%) of both sexes reported that they have ever heard of HIV/AIDS. However, men were more likely than women to know that AIDS is an incurable and fatal disease, with 99.5 percent of men reporting so compared with 85 percent of women.
Table 5.2 shows the percentage of respondents who believe that there are measures that can be taken to avoid getting HIV/AIDS. Those respondents who reported that there are measures that can be taken to avoid getting HIV/AIDS were then asked about specific measures to reduce the risk of HIV infection. Each measure was read out to the respondents and they had to say whether
or not they believed that specific measure could be used to reduce the risk of HIV infection.
Table 5.2 indicates that the majority of respondents of both sexes believed that there is something a person can do to avoid getting HIV infection. Men were more likely than women to report that there is something a person can do to avoid getting HIV infection, with 96 percent of men saying so compared with 88 percent of women. On the other hand, women were more likely than men to be skeptical, believing that there is nothing a person can do to avoid getting HIV infection.
Thirteen percent of women reported that there was nothing a person could do to avoid getting HIV infection compared with 4 percent of men.
Table 5.2: Percentage of respondents who believe that is there something a person can do to avoid getting HIV/AIDS and the measures that can be taken to avoid the risk of HIV infection
Is HIV infection avoidable?
Men Women n % n %
Yes 200 96.2 189 87.5 No 8 3.8 27 12.5 N 208 216
Measures to prevent the risk of HIV infection
Abstain from sex 10 5.0 25 13.2 Use condoms 172 86.0 176 93.1
Avoid multiple sexual partners 110 55.0 50 26.5 Avoid sharing razors and blades 29 14.5 18 9.5 All 208 216
Regarding the specific methods a person can adopt to protect himself or herself against HIV infection, the use of condoms, avoiding multiple sexual partners, abstaining from sex and avoiding sharing razors blades were the most frequently mentioned measures. However, differences can be seen between men and women. In this regard, women (93 percent) were more likely than men (86 percent) to mention the use of condoms as one of the strategies a person can adopt to avoid the risk of HIV infection. In addition, women (13 percent) were slightly more likely than men (5 percent) to mention abstaining from sex. Meanwhile, men (55 percent) were
more likely than women (27 percent) to mention that avoiding multiple sexual partners is one of the strategies to avoid getting HIV infection. Likewise, men (15 percent) were more likely than women (10 percent) to mention that by not sharing contaminated instruments like razors and blades the risk of HIV/AIDS could be avoided.
In order to assess accurate knowledge about HIV/AIDS, respondents were urged to give their opinion by approving or disapproving of a set of statements regarding HIV/AIDS. Table 5.2.1 presents the percentage of respondents who agreed with specific statements regarding HIV/AIDS.
Table 5.2.1: Percentage of respondents who agreed with specific statements about HIV/AIDS
Statement Men Woman % % A person can get HIV/AIDS by having sexual
intercourse with a condom 31.6 16.1*
A person can get infected with HIV/AIDS by using a
sterilized needle 20.1 14.7 A person can get infected with HIV/AIDS through mosquito bites 38.3 21.7**
A person who looks healthy can be infected with HIV/AIDS 89.5 87.1**
People can protect themselves from HIV/AIDS by using condoms
correctly every time they have sex 89.0 64.5**
People can protect themselves from HIV/AIDS by having one
uninfected sex partner who also has no other sexual partners 90.4 67.3**
N 208 217
Note: * significant P < 0.05 percent; ** significant P < 0.01
It is noteworthy that women seemed to be more knowledgeable than men about the conditions under which one can get infected with HIV/AIDS. In this regard, women were less likely than men to agree that a person can get HIV/AIDS by having sexual intercourse with a condom, with about 16 percent of women agreeing with the statement compared with about 32 percent of men.
Similarly, women were less likely than men to agree that a person can get infected with HIV/AIDS by using sterilized needles, with about 15 percent of women agreeing with this
statement compared with 20 percent of men. Again, women were less likely than men to agree that a person can get infected with HIV/AIDS through mosquito bites, with 22 percent of women agreeing with this statement compared with 38 percent of men.
Table 5.2.1 shows that men were more likely than women to report that a person who looks healthy can be infected with HIV/AIDS. Likewise, men were slightly more likely than women to report that people can protect themselves from HIV/AIDS by using condoms correctly every time they have sex. Eight-nine percent of men agreed with that statement compared with 87 percent of women. Moreover, the findings shown in Table 5.2.1 also suggest that men were more likely than women to report that people can protect themselves from HIV/AIDS by having sex with one uninfected partner who also has no other sexual partners. Ninety percent of men agreed with this statement compared with 67 percent of women.
To assess awareness and knowledge about HIV/AIDS the following question was asked during both focus-group discussions and in-depth interviews: “Have you ever heard about AIDS? What do you think about it?” The focus-group discussions and in-depth interviews findings confirmed that participants were aware of HIV/AIDS. The interviews confirm that both men and women have heard of HIV/AIDS.
Public awareness campaigns of HIV/AIDS have been indicated by respondents as one of the main source of information about HIV/AIDS. This can be illustrated in the following interview extract:
“Yes, we have heard of AIDS. AIDS is a sexually transmitted infection that we must fight against. It is said that it does not have a cure. We had a talk where some condoms were distributed. We have been advised not to use blades or other cutting instruments before sterilizing them”.
(Rural non-married males, FGD # 15)
“I think AIDS affects everybody and everyone knows about it. We, young people in particular, are aware of AIDS because there are programs. Everything is about AIDS. All newspapers, radios and television programmes talk about AIDS.”
(Urban non-married females, FGD # 10)
As it can be seen from the above interviews extracts, respondents are aware that AIDS is a fatal disease and that sharing unsterilized instruments (such as needles, blades, scissors, etc) may increase the risk of HIV infection. In addition, the media, particularly newspapers, radio and television play a significant role in creating awareness about HIV/AIDS. However, in some situations the general information about HIV/AIDS which is provided by the media is still not enough. They would prefer a direct and more personal approach that provides information on the modes of HIV transmission and the strategies to protect against this devastating disease. The quote below illustrates this sentiment.
“I believe that there is not enough information. Not to say that we do not know that AIDS exists, we know but we just need someone to direct us. So there is a problem of lack of information, although it is not a general problem”.
(Urban non-married male, FGD # 18)
The interviews also suggest that in some situations, for example, a sudden change in one’s physical appearance may trigger gossiping and suspicions of a possible illness, particularly HIV/AIDS. In this regard, it is likely to lead to judgments and speculation about the causes of death of loved ones and acquaintances, or about the illness they may have been suffering from.
Such attitudes exacerbate stigma and fears of revealing the cause of death. The account below seems to support this interpretation.
“People have in mind that HIV/AIDS is real. I am sure about that because they are facing the harsh reality of losing their relatives. They may even know that although their relative did not do a blood test, external characteristics make them to conclude that he or she may have been infected by the ‘disease of the century’.
(Urban married male, IDI # 17)
In addition, the transmission of HIV from mother to child has become a harsh reality in the community. This also has created greater awareness of HIV/AIDS
“There are many diseases. When we see a person getting thin we suspect that it might be AIDS. This is a very serious disease and what is worst is that we can even be infected by the disease not only through sex but also in hospitals. There are babies that are born with it”.
(Rural married female, IDI # 01)
This quote indicates two important issues related to people’s awareness of HIV/AIDS. The first is that because of the secrecy surrounding HIV/AIDS suspicions that certain individuals are living with HIV/AIDS (especially if they lose weight) may arise. Attitudes such as these may exacerbate stigma and discrimination. The second issue is that respondents are aware that sexual intercourse is not the only route of HIV transmission. What is striking is that health facilities are viewed with some suspicion. The fact that babies are usually born in hospitals or clinics including those who are born HIV positive, make some people think that the institution itself might be a place of transmission. Sometimes such negative attitudes are formed because some health facilities do not take the necessary precautions to maintain high hygiene standards.
In general, people are worried about HIV/AIDS and they are fearful of getting infected with it.
But, at the same time, the adoption of protected sexual intercourse is an emotive topic. While unprotected sex may be a way of expressing intimacy, love and loyalty between partners, protective sex (e.g. condoms use) may raise suspicions of infidelity or promiscuity and mistrust, particularly in settings where there is no tradition of partner communication, a finding consistent
with other studies (Varga, 1997). The following comment seems to illustrate the doubts some respondents have with regard to personal perception of risk.
“In meetings everyone agrees that people should be careful. Condoms might even be distributed and the people accept them, but the point is whether people use them when the ‘true time’ arrives, I mean there, at the right moment [of having sex]”
(Rural married male, IDI # 18)
As can be noted, the quote above suggests that the biggest challenge facing both men and women is to translate knowledge into practice. That is, sticking to one partner, or reducing the number of partners or using condoms. In this regard, it is clear for the respondents that the challenge is not awareness of the modes of HIV transmission, but rather how people behave in their interpersonal relationships. Again, it would be misleading to think that people in interpersonal relationships decide everything according to their own volition. Studies have shown that the individual decision-making process is not a completely rational process. According to MacPhail and Campbell (2001: 1614), “the complex nature of sexuality means that individuals will conduct their sexual lives through experiences and beliefs that have been generated through their membership of a particular society and community.”
Sometimes men and women may face a dilemma of complying with protective messages spread by awareness campaigns and the daily barriers they face in protecting themselves. For example, they may be aware of the risk posed by HIV/AIDS, but context-specific and other conditions including the location, the opportunity for sex or being under the influence of alcohol may prevent them from protecting themselves. In this regard, some respondents said that sometimes, when men and women are enjoying themselves, the youth in particular, they are less likely to be careful and take precautions against the risk of HIV infection.
“I think people are aware of HIV/AIDS, although I am doubtful. However, we, the youth, sometimes when we are enjoying ourselves, we do not care about condoms, but people are aware of HIV/AIDS”.
(Rural non-married female, IDI # 09)
“I usually go out on Fridays to have a drink with my friends, in the “barracas”
[shebeens], and I always get surprised with what I see there. I see people having sex in the public. It is possible that people do not know that their behaviour may lead to them getting infected with a disease”.
(Urban non-married males, FGD # 18)
The quotes above suggest that although respondents are aware of HIV/AIDS, perception of personal risk of HIV infection may still be elusive for a large number of men and women. This may be a cause of concern in the context of a generalized HIV/AIDS epidemic.