CHAPTER 5: PERCEPTION OF RISK OF HIV INFECTION
5.6 Summary
Nearly all respondent have heard of HIV/AIDS which suggests that public health awareness campaigns having been relatively successful in raising awareness of the epidemic. Irrespective of age and gender, respondents said that people in the community were becoming ill and were dying because of HIV/AIDS. Nevertheless, participants recognized that neither men nor women seemed to have changed their sexual behaviour. A number of studies have also found high levels of awareness of the risk of HIV/AIDS but limited behaviour change in sub-Saharan Africa (MacPhail and Campbell, 2001; Maharaj and Cleland, 2004; Karlyn, 2005; National Institute of Statistic, 2005).
Indeed, if behaviour change depended only on levels of awareness, the current scenario of HIV infection in sub-Saharan Africa would be different. In this study, for example, almost all men and women have heard of HIV/AIDS. However, although not surprising, men were more likely than women to be aware of the incurability and lethality of HIV/AIDS. Overall, both men and women believe that there is something a person can do to avoid getting infected with HIV. Protective behaviour such as use of condoms, avoiding multiple sexual partners and abstaining from sex were the most commonly mentioned strategies. Women were more likely than men to mention that abstaining from sex can protect one from getting infected. Awareness of the severity of HIV/AIDS in the community was also assessed. Interestingly, women were more likely than men to admit knowing someone who is infected by HIV/AIDS. In addition, nearly half of all the
interviewed men and women said that they already knew someone who had died or they suspect that he or she might have died of AIDS.
Overall, these findings are in line with what other studies have observed about the levels of awareness of HIV/AIDS among sexually active men and women in sub-Saharan Africa including Mozambique (Mozambique Demographic and Health Survey, 2003, Arnaldo, 2004; Kibombo, Neema and Ahmed, 2007, Maharaj, 2004; Sheppard et al., 2001; Smith and Watkins, 2005). In their study in rural Malawi, Smith and Watkins (2005) found that rural Malawians were aware of the risk of HIV infection and seemed to assess with some degree of accuracy their own personal risk, either because of their own sexual behavior or their partner’s sexual behavior. During public conversations Malawians were able to identify the main routes of infection, and prevention strategies. They found that women are worried about the risk of HIV infection from their husbands, while men are more worried about the risk of HIV infection from their extramarital partners. In their study, Smith and Watkins (2005) observe that the primary prevention strategies of women centre around marriage: encouraging their husbands to be careful while men emphasized the importance of reducing their number of sexual partners, and focused on informed partner selection.
The perception of personal risk of HIV infection is deemed an important precursor for sexual behaviour change including the adoption of protective practices (Cleland, 1995; Maharaj, 2004;
Sheppard et al., 2001; Kibombo, Neema and Ahmed, 2007). The results of this study concerning perception of risk of HIV infection seem to be mixed and somehow contradictory. For example, contrary to other study findings in sub-Saharan Africa where women are more likely to report great or moderate risk of HIV infection (Maharaj, 2004; Sheppard et al., 2001; Smith and Waltkins, 2005) the survey findings suggest that women have a lower risk perception of HIV infection than men. While nearly half of men admitted that they felt themselves at moderate or high risk of HIV infection, only a quarter of women reported that they felt themselves at moderate or high risk of HIV infection. It is of particular interest that a number of women were unable to say whether or not they were at moderate or high risk of HIV infection. Indeed, in a context where perception of risk is deemed important as a prerequisite for one to adopt protective
practices (Sheppard et al., 2001, Maharaj, 2004), this figure is somehow astonishing and, it may reveal that there are other underlying causes of the spread of HIV infection in the study sites. It can be recalled here that the rates of HIV infection in both sites are 25 percent in Manhiça district and 19 percent in Matola municipality, respectively (Ministry of Health, 2005). On the other hand, qualitative findings suggest that women during both the focus group discussions and in- depth interviews showed great concern about contracting HIV infection from their marital, cohabiting or regular partners. The findings of this study regarding low perception of risk of HIV infection among women are quite consistent with the findings of a research also conducted in Mozambique (Arnaldo, 2004). In this study in Mozambique, Arnaldo (2004) found that individual perception of risk of HIV infection was higher among men than among women.
In this study, perception of risk was assessed taking into account its association with demographic and socio-economic characteristics. The demographic and socio-economic characteristics included place of residence, education, age, marital status and household socio- economic status. For men, the demographic and socio-economic characteristics did not have any association with perception of risk of HIV infection. For women, two different pictures emerged.
First, a significant proportion of women did not perceive themselves at risk of HIV infection – an unexpected result. Second, for women, the findings indicate that place of residence; age and education are important predictors of perception of risk of HIV infection. For example, women with higher level of education were more likely than less educated woman to perceive a great or moderate risk of HIV infection. In addition, the qualitative results suggest that women may feel at risk of HIV infection not because of their own sexual behaviour, but their partners’ sexual behaviour. These findings are in line with what other studies have found regarding perception of personal risk of HIV infection of women (Maharaj, 2004; Sheppard et al., 2001). For example, Sheppard et al., (2001) found that women in both Ghana and Uganda reported feeling at greater HIV risk than men. However, they felt at risk not because of their own behaviour but their partners’ sexual behaviour. In addition, although women perceived themselves at greater risk than men, they felt unable to change their behaviour due to their more subordinate position in society and particularly in sexual relationships (Sheppard et al., 2001). This seems to the case in Matola city and Manhiça district.