HIV/AIDS awareness in newly married females coming in OPD of a Medical College Hospital

Objective: To assess the awareness of HIV/AIDS in newly married females coming in Gynaecology OPD of a Medical College Hospital and to devise strategies for future programmes. Methodology : 11 villages and urban population around our hospital were taken for study. Newly married females coming in Gynaecology OPD for various complaints were surveyed. The females were asked to fill a pre-designed Performa, which included multiple choice questions. Results: In our study 489 patients were assessed. 65.4% women had knowledge about disease, 57.5% knew about complications of disease, 59.9% had knowledge about prevention of disease, 66.8% were aware about treatment of disease, 48.5% had knowledge about etiology of disease and 39.1% were aware about medico legal aspect of disease. Conclusion: The study showed tremendous lacunae in awareness of HIV/AIDS. There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for these young girls.


Introduction
The acquired immunodeficiency syndrome (AIDS) is a major emerging public health problem in India. According to an estimate made by the regional office of the World Health Organization (WHO) Southeast Asia, India accounts for over two-thirds of all human immunodeficiency virus (HIV)-infected individuals in the region [1]. Sexually active youth have been identified as a group at high risk of HIV infection. Satpathy SK, Shaukat M et al did a study on HIV/AIDS in India-The present scenario [2]. There is substantial evidence that sexually transmitted diseases (STDs) enhance the transmission and acquisition of HIV infection, and that control of STDs is helpful in preventing HIV/AIDS. Cohen MS found in his study that sexually transmitted diseases enhance HIV transmission which now is no longer a hypothesis [3].
Hence this group of sexually active young girls was taken for study and their knowledge on the subject of HIV/AIDS was assessed. Despite the fact that young females represent almost one quarter of the Indian population, their reproductive health needs are poorly understood and ill served. This paper documents the existing research on sexual and reproductive health, explores the knowledge and attitudes among this population in India, and highlights limitations of methodologies currently employed in research on reproductive health in India.
The social system in our country is such that stigma is attached to the word 'sex', and anything connected with sex is neither spoken loudly, nor discussed in public. Sex education has not yet been properly inc1uded in the formal educational curriculum in schools, while the reported proportion of students engaging in premarital sex varies from 8% to 15%. This combination of high-risk behavior among youth and the societal lack of communication about sexual matters is likely to be conducive to the spread of HIV infection in our country. Hence the youth and newly wed couples are the target group to raise awareness on this topic.
Our study sought to assess knowledge, attitudes and practices regarding sexuality, and the risk factors associated with the spread of HIV/ AIDS and STDs among these patients. Inclusion criteria-The criteria of study group were taken as females having a marital life of less than one year with age group in the range of 18 to 30 years.

Original Research Article
The patients were administered a pre-designed Performa, which included multiple choice questions. The response rate of patients was 100%. Question paper was given and while collecting back it was ensured that it did not include the name of patient, so as to make her free of pressure of low score. While collecting the filled Performa it was ensured that entries were complete.
The patients were given a set of questions which shows knowledge about disease, etiology, prevention, treatment, complications and medico legal aspect of disease.   Most common source of knowledge are television, books and neighbor and least common are family, friend and internet.

Discussion
Despite the fact that young females represent almost one quarter of the Indian population, their reproductive health needs are poorly understood and ill served. This paper documents the existing research on sexual and reproductive health, explores the knowledge and attitudes among this population in India, and highlights limitations of methodologies currently employed in research on reproductive health in India. Rural Indians due to a poor health infrastructure and high levels of poverty and ignorance, are highly vulnerable to various health problems, especially, communicable diseases including HIV/AIDS. Our study sought to assess knowledge, attitudes and practices regarding sexuality, and the risk factors associated with the spread of HIV/AIDS and STDs among these communities.
One serious limitation is the lack of attention in almost every dimension of their reproductive health, including sexuality, reproductive morbidity, abortion-seeking and reproductive choice. What is needed is more behavioral research that explores the levels, patterns, and sociocultural factors underlying these patients reproductive health; assesses reproductive health needs and ways in which health and information services can be structured to respond to these needs in light of the social, cultural and economic constraints that newly married face; and explores appropriate methodological alternatives, recognizing the need for community-based research, as well as the difficulties of conducting such research under the sociocultural constraints prevailing in India.
Jejeebhoy SJ et al studied young females for sexual and reproductive behavior, this review argues for far more attention within programs to address reproductive health service and information needs. Results of this review helped point out areas where STD risk communication for these couples needs to be improved. Despite knowing that use of condoms helps protect against contracting an STD, some young couples still regard condoms primarily as an interim method of contraception before using the pill. Authors concluded that sexually transmitted diseases

Original Research Article
Obsgyne Review: Journal of Obstetrics and Gynecology Available online at: www.medresearch.in 15 | P a g e (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries [4].
Smith KP, Watkins SC et al did their study on perceptions of risk and strategies for prevention: responses to HIV/ AIDS in rural Malawi. According to qualitative interviews and observational journal accounts, HIV/ AIDS and strategies to prevent it are a frequent topic of conversation amongst married Malawians. The authors showed that the decline in perceived risk is significantly associated with declines in the behaviors that Malawians worry most about and perceptions of risk in individuals' social networks. So it is interpreted that the newly wedsare changing their behavior in ways that may reduce the spread of HIV/AIDS [5].
In a similar study Santhya KG et al also inferred that available programmatic sexual and reproductive health initiatives have focused disproportionately on the unmarried and on premarital sexual activity. Married young people have received little attention as a vulnerable group with distinct needs because marriage is assumed to be safe and because married adolescents and young people are assumed to face none of the stigma that their unmarried counterparts experience in accessing sexual and reproductive health services. Emerging evidence highlights that neither of these assumptions are tenable. Within the sub-population of young people, married young women constitute a group with distinct risks of human immunodeficiency virus and face a host of obstacles in making informed sexual and reproductive health decision [6].
In another very similar paper by Santhya KG, Jejeebhoy SJ et al on sexual and reproductive health needs of married adolescent girls, theauthorscollate available evidence on the situation of married adolescent girls and also sheds light on ways their sexual and reproductive health situation and choices differ from adult women. There is a need to raise awareness among girls, parents, teachers and community leaders, but more importantly, there is also a need to hold the government accountable for enforcing the legal age of marriage for girls. Further programmes to enhance married girls' autonomy within their marital homes and those that encourage education and generate livelihood opportunities need to be simultaneously developed [7].
Pallikadavath S et al did their study onHIV/AIDS in India has predominantly focused on known risk groups such as sex workers, sti clinic attendees and long-distance truck drivers.There is evidence of HIV spreading to rural areas.Men and women infected with HIV who live in rural areas were used to collect experiences of testing and treatment, the social impacts of living with HIV and differential impacts on women and men. Eight focus group discussions with groups drawn from the general population in the four villages were used to provide an analysis of community level views about HIV/AIDS [8].
Bracher M et al did a study on " Moving" and Marrying.
They useda micro simulation model to estimate the proportions of rural Malawian brides and grooms who are already HIV positive when they marry. The authors estimated that HIV infection is present in between 13 and 20 per cent of couples. Although young women are more likely to be HIV positive than men of the same age, as a result of their low ages at marriage only around two per cent of brides are estimated to be HIV positive [9].  [15,16].
Add on to existing knowledge: There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for young and newly married girls.

Conclusion
The most common source of information was television i.e. most accessible. But those who came to know about HIV/AIDS from books have more comprehensive knowledge. The knowledge level are lesser in females rural areas. Overall rural patients have lesser knowledge than urban. The study showed tremendous lacunae in awareness of all Reproductive Health (RH) matters. There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for young and newly married girls.
Funding: Nil, Conflict of interest: Nil Permission from IRB: Yes