HIV/AIDS awareness in newly
married females coming in OPD of a Medical College Hospital
Singh N.1, Chandrakar K.2
1Dr. Neelam Singh, Associate Professor, 2Dr Kshma Chandrakar, Assistant
Professor, Department of Obstetrics Gynecology, J. K.
Hospital and L.N. Medical College, Bhopal, MP, India.
Address for
Correspondence: Dr Kshma Chandrakar, Assistant Professor,
Department of Obs. & Gynaecology J.K. Hospital and
L.N. Medical College, Bhopal. Email: dr.kshmachandrakar@gmail.com
Abstract
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.
Key words:
Human Immunodeficiency, STD, Attitudes, Knowledge
Manuscript received: 10th
March 2018, Reviewed:
20th March 2018
Author Corrected:
27th March 2018, Accepted
for Publication: 31st March 2018
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.
Methodology
Place of study-
Department of Obs. & Gynaecology. L.N. Medical College, Bhopal
(M.P.). Medical college Out patients department are ideal locations to
conduct study on newlyweds as they offer the opportunity to access
young people of different social backgrounds under similar
circumstances. The patients were selected from different parts of city
and rural areas keeping in mind that these patients will represent
sample from the different religions, socio economic and family back
grounds. 11 villages and urban population around the hospital were
taken in study. After explaining the purpose of the study, a
written consent was obtained from them
Period of study:
The study was conducted over a period of 9 months from 2nd July 2016 to
30th March 2017
Type of study- This
observational cross-sectional study HIV/AIDS awareness in newly married
females coming in OPD of a Medical College Hospital was carried out.
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.
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.
K/D = knowledge about disease, which includes question no.
2,3,4,9,10,14,15,18,19,20,21,22,26 and 32
K/C =knowledge about complications, which includes question no. 5,8 and
27
K/P = knowledge about prevention, Shown by question
no.7,13,16,17,23,25,31
K/T= knowledge about treatment, Judged by question no.6,24,28,29,30,35
K/E =knowledge about etiology, Access by question no. 11,12,33,34
K/ML =knowledge about medicolegal aspect, Includes question no.
36,37,38,39
And question no. 1 shows where from the patients came to know about
HIV/AIDS
Results
From the above tables, those who came to know about HIV/AIDS from
television scored well and higher than any other source of information.
Books being the second most common source of knowledge. Only 25.3%
rural patients knew about mother to baby transmission while urban
patients scored 53.3%. Only 79% females knew condom can prevent HIV.
In our study 30% female from rural areas knew about vertical
transmission and other ways of mother to baby transmission. While in
urban population 39.6% female knew about it. In our study 86.5% Rural
female knew that condom can prevent HIV transmission. Only 61.5% urban
female knows that there is HIV kit test available before blood
transfusion. We found that females of rural areas had 76.9% knowledge
about disease and 69.5% had Knowledge regarding complications of
disease.
Regarding knowledge about prevention of disease, rural females scored
63.2% while urban females scored 58.7% respectively. In regards to
knowledge about treatment rural females 71.5% while of urban areas
female scored 66.3. Knowledge regarding etiology rural female scored
53.8% in comparison to urban female. Knowledge of rural female is 38.9%
while that of urban are 40.7% respectively regarding medicolegal issues.
Statistical Analysis- Data was analyzed using SPSS 20 statistical
package. A descriptive analysis was done on all variables to obtain a
frequency distribution. The mean + SD and ranges were calculated for
quantitative variables. Continuous variables were compared by the
Student t test. Proportions were analyzed with the chi-square test. A P
value of 0.05 or less was considered statistically significant
Table No.-1: Distribution
of specific knowledge
|
|
KD
|
KC
|
KP
|
KT
|
KE
|
KML
|
|
Score
|
6846
|
1467
|
3423
|
2934
|
1956
|
1956
|
|
Percentage
|
65.44
|
57.53
|
59.95
|
66.84
|
48.52
|
39.06
|
In our study of 489 females, it was seen that overall, they scored
65.4% in knowledge about disease, 57.5% in knowledge in complication of
disease, 59.9% in knowledge about prevention of disease, 66.8% in
knowledge about treatment of disease, 48.5% in knowledge about etiology
of disease and 39.1% in knowledge about medico legal aspect of disease.
Table No.2: Distribution
of knowledge
|
Area
|
Total
|
KD
|
KC
|
KP
|
KT
|
KE
|
KML
|
|
Sum
|
Sum
|
Sum
|
Sum
|
Sum
|
Sum
|
|
Rural
|
95
|
861.0
|
142.00
|
415.0
|
410.00
|
203.0
|
141.0
|
|
Urban
|
394
|
3619.0
|
702.00
|
1637.0
|
1551.00
|
746.0
|
623.0
|
|
Total
|
489
|
4480.0
|
844.00
|
2052.0
|
1961.00
|
949.0
|
764.0
|
In our study there were 95 patients belonged to rural areas they scored
respectively 64.7% in K/D, 49.8% IN K/C, 62% in KP, 71.9% in K/T, 42.7
in KE, and 37.1% in medico legal issues while their urban counterparts
scored better than rural participants.
Table No.-3: Distribution
of knowledge on first information
|
Mode of knowledge
|
Count
|
KD
|
KC
|
KP
|
KT
|
KE
|
KML
|
|
%
|
%
|
%
|
%
|
%
|
%
|
|
Books
|
141
|
64.7
|
56.0
|
61.2
|
72.9
|
49.3
|
44.0
|
|
Family
|
1
|
57.1
|
33.3
|
42.9
|
33.3
|
50.0
|
25.0
|
|
Friend
|
6
|
57.1
|
55.6
|
57.1
|
58.3
|
50.0
|
41.7
|
|
Internet
|
32
|
62.9
|
55.2
|
55.8
|
64.1
|
47.7
|
42.2
|
|
News
|
24
|
70.2
|
50.0
|
54.8
|
68.1
|
35.4
|
34.4
|
|
Neighbors
|
89
|
64.9
|
62.5
|
61.0
|
69.3
|
50.8
|
39.9
|
|
TV
|
195
|
66.2
|
57.8
|
60.1
|
62.0
|
48.7
|
35.1
|
|
Total
|
489
|
65.4
|
57.5
|
59.9
|
66.8
|
48.5
|
39.1
|
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 socio cultural 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 socio cultural 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
(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, the
authors collate 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
used a 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].
Nath A et al did their study on HIV/AIDS and Indian youth. While men
reported contracting HIV from sex workers in the cities, women
considered their husbands to be the source of their infection. Correct
knowledge about HIV transmission co-existed with misconceptions. men
and women tested for HIV reported inadequate counselling and sought
treatment from traditional healers as well as professionals. owing to
the general pattern of husbands being the first to contract HIV women
faced a substantial burden. Implications for potential educational and
service interventions are discussed within the context of gender and
social relations[10].
Similar study was done by Tuladhar H, Marahatta R et al regarding
awareness and practice of family planning methods in women attending
gyne OPD at Nepal Medical College Teaching Hospital. Also in a survey
by UNICEFon Young people and HIV/AIDS. Nutshell of both programmes was
that lack of awareness, permissiveness of societies for premarital or
extra-marital sexual relationships, and sexual mixing patterns
predispose these communities to HIV/AIDS and STD infections. There is a
dire need for targeted interventions in order to curtail the increasing
threat of HIV and other STDs among these vulnerable populations[11,12].
Naik E, Karpur A postulated that rural Indian tribal communities are an
emerging high-risk group for HIV/AIDS. The study revealed that only 22%
of adults had even heard of AIDS, and 18% knew how it is transmitted.
In addition, only 5% knew that STDs and AIDS were related to each
other. AIDS awareness among women was lower compared to men (14%
vs.30%). Regarding sexual practices, 35% of the respondents reported
having had extramarital sexual encounters, with more males than females
reporting extramarital affairs [13].
Mullany LC, Maung C also did a study on knowledge, attitudes, and
practices among Burmese migrant factory workers. Responses were grouped
into prevention, transmission and risk categories, and percentages
answered correctly were recorded. Men consistently scored higher than
women, with significant gender differences in the prevention and
transmission questions. The survey reveals a significant lack of
knowledge about HIV among factory workers and indicates that a
sub-population of Burmese people appears to lack the most basic
information about the epidemic [14].
In a very similar study about knowledge and attitudes among STD clinic
attendees in the second decade of HIV/AIDS, Rakwar J, Kidula N et al
aimed to determine the knowledge and attitudes towards HIV/STDs among
women attending an STD clinic by interviewing 520 randomly selected
women. The quality of their knowledge of the transmission of HIV was
low in spite of the fact that most respondents have heard of
HIV/AIDS/STDs. It was concluded that there is a need for better
educative effort on the modes of transmission and prevention of HIV,
also in ‘low risk’ populations. Kunte A, Misra V et
al did similar studies on HIV sero prevalence & awareness about
AIDS among pregnant women in rural areas of Pune district, Maharashtra,
India. More work on this subject was done by Clark S, Bruce J et al
Protecting young women from HIV/AIDS: the case against child and
adolescent marriage [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 socio cultural 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 socio cultural research is needed to
find the right kind of sexual health services for young and newly
married girls
Funding:
Nil, Conflict of
interest: None initiated.
Permission from IRB:
Yes
References
1. World Health Organization. Focus on population. environment,
development. Geneva: WHO, 1995;9:7.).
2. Satpathy SK, Shaukat M. HIV/AIDS in India-The present scenario. New
Delhi, National AIDS Control Organization (NACO), Ministry of Health
and Family Welfare, 1997:1-4.
3. Cohen MS. Sexually transmitted diseases enhance HIV transmission: No
longer a hypothesis. Lancet 1998;351 (SuppI3):5-7). [PubMed]
4. Jejeebhoy SJ. Adolescent sexual and reproductive behavior: a review
of the evidence from India. Social Science & Medicine. 1998 Mar
20;46(10):1275-90.
5. Smith KP, Watkins SC. Perceptions of risk and strategies for
prevention: responses to HIV/AIDS in ruralMalawi. Soc Sci
Med.2005Feb;60(3):649-60. [PubMed]
6. Santhya KG, Jejeebhoy SJ. Early marriage and HIV/AIDS: risk factors
among young women in India. Economic and Political Weekly. 2007 Apr
7:1291-7.
7. Santhya KG, Jejeebhoy SJ. Sexual and reproductive health needs of
married adolescent girls. Economic and Political Weekly. 2003 Oct
11:4370-7.
8. Pallikadavath S, Garda L, Apte H, Freedman J, Stones RW. HIV/AIDS in
ruralIndia: context and health careneeds. J Biosoc
Sci.2005Sep;37(5):641-55. [PubMed]
9. Bracher M, Santow G, Watkins S. " Moving" and Marrying: Modelling
HIV Infection among Newly-weds in Malawi. Demographic Research. 2003
Sep 19;1:207-46.
10. Nath A. HIV/AIDS and Indian youth-a review of the literature
(1980-2008). SAHARA: Journal of Social Aspects of HIV/AIDS Research
Alliance. 2009 Mar 1;6(1):2-8. [PubMed]
11. Tuladhar H, Marahatta R. Awareness and practice of family
planningmethods in womenattendinggyneOPD at NepalMedicalCollegeTeaching
Hospital. Nepal Med Coll J. 2008 Sep;10(3):184-91. [PubMed]
12. UNICEF., Joint United Nations Programme on HIV/AIDS., World Health
Organization. Young people and HIV/AIDS: Opportunity in crisis. The
Stationery Office; 2002.
13. Naik E, Karpur A, Taylor R, Ramaswami B, Ramachandra S,
Balasubramaniam B, Galwankar S, Sinnott J, Nabukera S, Salihu HM. Rural
Indian tribal communities: an emerging high-risk group for HIV/AIDS.
BMC International Health and Human Rights. 2005 Dec;5(1):1.
14. Mullany LC, Maung C, Beyrer C. HIV/AIDSknowledge, attitudes, and
practices among Burmesemigrantfactoryworkers in TakProvince, Thailand.
AIDS Care.2003Feb;15(1):63-70. [PubMed]
15. Rakwar J, Kidula N, Fonck K, Kirui P, Ndinya-Achola J, Temmerman M.
HIV/STD: the women to blame? Knowledge and attitudes among STD clinic
attendees in the second decade of HIV/AIDS. International journal of
STD & AIDS. 1999 Aug;10(8):543-7.
16. Kunte A, Misra V, Paranjape R, Mansukhani N. HIV seroprevalence
& awareness about AIDS among pregnant women in rural areas of
Pune district, Maharashtra, India. Indian Journal of Medical Research.
1999 Oct 1;110:115.
17. Clark S, Bruce J, Dude A. Protecting young women from HIV/AIDS: the
case against child and adolescent marriage. International family
planning perspectives. 2006 Jun 1:79-88.
How to cite this article?
Singh N, Chandrakar K. HIV/AIDS awareness in newly married females
coming in OPD of a Medical College Hospital. Obg Rev:J obstet Gynecol 2018;4(1):12-17.doi: 10.17511/jobg.2018.i1.03.