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ORIGINAL RESEARCH Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 2  |  Page : 66-9
AIDS awareness in an Indian metropolitan slum dweller : A KAP (knowledge, attitude, practice) study


Department of Oral and Maxillo Facial Pathology, Meenakshi Ammal Dental College and Hospital, Alapakkam main Road, Maduravoyal, Chennai 600 095, Tamilnadu, India

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   Abstract 

OBJECTIVE : To assess the awareness and attitude towards AIDS and PLHA in slum dwellers of Chennai, an Indian metropolis by KAP (Knowledge, Attitude, Practice) study. METHODS : A cross sectional study was conducted in a representative sample of 650 subjects (400 females and 250 females), aged 15-45 years, by means of a questionnaire in the local dialect Tamil. RESULTS : The overall literacy rate was 64%, with males being 70% and females being 60% literate. 20% of males and 11% of females do not know about a disease called AIDS. Only 67% of males and 55% of females are aware of the sexual mode of transmission. 34% of males and 50% females opine that AIDS is also a hereditary disease. Also 45% of males and 62% of females feel that AIDS also spreads by air, fomites, or mosquito-bite. Only 30% of males and 22% females know about the possible symptoms of AIDS. 30% of males and 45% of females never ask for a new syringe if not provided, as they are totally unaware of its significance. 43% of males and 78% of females do not know about the risk of a barber's blade. 56% of males and 71% of females feel that AIDS can be treated at least by a traditional medicine. Lastly, 48% of males and 60% females prefer outcasting an AIDS patient from the slum. CONCLUSIONS : AIDS awareness in the slum dwellers of Chennai is very poor. Corresponding awareness in suburbs and rural areas will be much worse. Conventional IEC methods targeting general population via mass media are not reaching the slum dwellers, even in a metropolitan city. A specially designed targeted intervention is needed.

Keywords: HIV/ALDS awareness, shun dwellers, India, Cbennai, KAP study

How to cite this article:
Kalasagar M, Sivapathasundharam B, Einstein T B. AIDS awareness in an Indian metropolitan slum dweller : A KAP (knowledge, attitude, practice) study. Indian J Dent Res 2006;17:66

How to cite this URL:
Kalasagar M, Sivapathasundharam B, Einstein T B. AIDS awareness in an Indian metropolitan slum dweller : A KAP (knowledge, attitude, practice) study. Indian J Dent Res [serial online] 2006 [cited 2019 Jun 20];17:66. Available from: http://www.ijdr.in/text.asp?2006/17/2/66/29889

   Introduction Top


Come 2007 and the 60 millionth individual of this planet would have got infected with HIV totally unaware of his vulnerable state. With 5 million new cases being recorded every year, the management of this pandemic is currently off human comprehension [1]. With so much of probing already being done on the pathogenesis of this virus and most of the modes of transmission already being established, the increase in awareness of this disease is not on par with the spread ofthis disease.

India alone is hosting a whopping 4.2 million cases [2]. Taking into account even the unreported and the undiagnosed cases, the count in India would be around 1.2 million which is nearly 0.1 % of the nation's population. A number of secondary bacterial, fungal and viral pathogens invade the host magnifying the morbidity and costing the number of effective living years.

The incidence of HIV can be made zero percent if the problem of prostitution is tackled [3]. Prostitution is considered to be a main cause of HIV both as a first line of infection from brothel to a customer and as a second line of infection from husband to an innocent wife [4],[5]. Targeted interventions on brothel based on CSWs did show a certain success but again the illegal nature of commercial sex in the country makes the identification of the target population very challenging [6].

Three papers published in "The international journal of STD and AIDS" take a radical view according to which 48% of new HIV are because of unsafe needles and that unsafe injections spread more HIV than unsafe sex [7]. The view of doctor as the "Second God" and to take whatever he gives, is still standing the test of time in the hearts of the poor and illiterate people. This may be a risk factor with a medical practitioner not using a disposable syringe for his patients.

Many people of south India of various religions undergo periodic tonsuring as a part of religious practices. Few of the many reasons for this happens to be the first birth day, a restored health of a family member, anew job and the like. This maybe devastating if the subject is unaware of the serious complications of an infected barber's blade.

HIV is a potential source of TB particularly in the Indian sub-continent. An AIDS patient being thrown out of the village is an every day story in the Indian newspapers. That is the magnitude of stigma attached to this disease.

With a host of conventional ethnic medical practices and the false promises of treatment and guarantee given by the quacks for quick money, anew dimension to the spread of the disease may take its shape.

Even today AIDS vaccine is not a reality and ARVs are restricted only for an advanced stage and after athorough patient counseling.

Southern parts of India have been recording a very high rate of literacy with a few areas crossing 90% in serial demographic statistics over the decades. So we have herein made an attempt to find out HIV/ALDS awareness among slum dwellers within Chennai city metropolitan limits.


   Materials and methods Top


  1. Population and sampling
  2. Data collection


Population and sampling

The data were specifically targeted on shun dwellers, who form a considerable proportion of the general population.

The survey was conducted on a representative city sample of 650 subjects aged 15-45 years which happens to be sexually and economically the most productive age group.

Two stage cluster sampling was used. In the first stage five different localities in various parts of the city were randomly selected. In the second stage four to five slums within each locality were selected randomly. Not more than 20 to 30 were interviewed in each slum to avoid bias from cross information exchange with the first set of interviewed people.

Data collection and data analysis

Data was collected by means of a questionnaire in local Tamil dialect [Table - 1] and administered by 11 field workers. Four of the volunteers were males and seven were females, all being junior residents. Questioning of the opposite sex was avoided to eliminate any sort of confounders due to the stigma attached to the disease. Extensive training on the objectives of survey sampling methods and administration of questionnaire was given to avoid inter and intra examiner bias.

The study was conducted within Chennai city metropolitan limits. Slum dwellers were identified among a PHC out patient lot, workers at construction sites and a direct door-to-door interview in slums. 650 subjects comprising of 400 females and 250 males, all in the age group of 15-45 yrs (economically and sexually most productive age group) were selected by random sampling procedure and were interviewed by a structured interview questionnaire.

Most of the questions were selected because of their pertinence to this geographical region as discussed above and were framed to assess the KAP criteria- knowledge, attitude and practice. Information was obtained on the following matters:

  1. Sociodemographic matters: Age, gender, literacy, place of residence and occupation.
  2. Knowledge about modes of transmission of AIDS, possible clinical features and treatment.
  3. Practices regarding the use of disposable needles and a new blade at a barber's shop and attitudes towards an AIDS afflicted patient.


Care was taken to ensure that none of the questions were of the leading type. For instance, "How does AIDS spread?" rather than "Does AIDS spread by sexual contact?" Likewise for a complete assessment, even misleading questions were included "Does AIDS spread by mosquito bite?" A subject answering in positive indicated an incomplete awareness. Each subject was interviewed privately and were explained the importance of an honest answer.


   Results Top


Socio-de mog raphic factors

Age

Those individuals above 15 and below 45 yrs of age were retained in the study as most of the older people were dependent, restricted to house and mostly are uninformed about the disease process.

Literacy

70% of the males and 60% of females were literate with an overall literacy rate of 64%.

The questionnaire

What is AIDS?

80 % of males and 89 % of females could recognize it as a disease and the rest either never heard of it or gave a weird answer like a 'Periodical' or a 'TV serial'. All the 20% of males and II% of females who never knew about AIDS were illiterates.

What is the nature of the disease?

Up to 34% of males and 50% of females considered AIDS to be a hereditary disease also.

How does it spread?

Only 67% of the males and 55% of the females were aware of the sexual mode of transmission.

Does AIDS spread through contact / contaminated water / air / mosquito bite / fomites?

A whopping 45% of males and 62% of females considered even these as modes of transmission reflecting a lack of complete understanding of the modes of the spread of disease.

When do you suspect AIDS?

Only 30% of males and 22% of females know about the possible symptoms of AIDS.

Is there a treatment for AIDS?

56% of males and 71% of females feel that AIDS can be treated with either costly medicines or at least by a traditional herbal medicine. This may to some extent cause a false sense of security and add to the spread of the disease.

What is the outcome of the disease?

Only up to 10% of the subjects clearly stated that AIDS cannot be treated but can be made as a chronic disease like DM or HTN with proper medication. The rest either stated that AIDS is a potentially fatal disease or that it can be completely treated by a traditional medicine or costly allopathic medicines.

What syringe do you use when you visit a doctor?

30% of males and 45°./0 of females never ask for a new syringe if not provided as they are totally unaware of its significance.

Do you ask for a change of blade at a barber's shop?

43% of males and 78% of females do not know about the risk of a barber's blade.

Should an AIDS patient be outcast?

48% of males and 60% females prefer out casting an AIDS patient from the slum. The false concept of mosquito bite or contact spreading AIDS may be responsible for this attitude. This may prevent those affected with AIDS to reveal their disease and thereby increase the morbidity and risk of transmission.


   Discussion Top


The global AIDS population today stands at nearly 46 million [2]. New HIV infections are rising faster in Asia ­Pacific region than anywhere else in the world [8]. South­east Asia stands second only to sub-Saharan Africa with 6 million positive cases [2]. HIV in India is fuelling TB and has become a leading public health emergency with severe impact on south-east Asia[9]. Apart from this, an uniber of other bacterial, viral and fungal diseases are seen costing the number of effective living years. According to a World Bank report 15% of the healthy days are lost due to STD's among women aged 15-45 years in developing countries [10].

According to a recent UNAIDS release, there is a lack of persuasive evidence that the epidemic is tried being curbed in India on a nation wide basis [2]. Serious epidemics are under way in several states like Maharashtra, Tamil Nadu, Nagaland and Manipur. 56% of STD clinic attendees in Manipur (a state in the far eastern parts of India) are HIV positive [11]. In Nanakkal district of Tamil Nadu and Mumbai, 1 percent of delivering mothers were found to be HIV positive [2].

Worryingly, the HIV surveillance and detailed recording of the incidence of HIV/AIDS in the vast populous interiors of Uttar Pradesh and other states of North India are far from reality [2].

Previous data on AIDS were focussed on variety of target populations like nurses, rural college students and the like [12],[13]. A few institutes and NGO's regularly update the epidemic situation of HIV/ALDS in India [4]. In India 50% of AIDS/HIV clinic attendees are shun dwellers [14]. In the present study the awareness of HIV/AIDS in illiterate people was minimal owing to their inability to comprehend writings or display boards.

A few of the subjects who considered contact / contaminated water/ air/fomites/mosquito bite answered more by their intuition rather than by their true knowledge. Though this may improve the personal hygiene and sanitary practices, it may offshoot discriminatory feeling against those affected with the disease which is reflected in the results of the last question.

Stigma and discrimination towards PLHA is seen not only in common public but also in health care workers and social servicing agencies. Even the Government of India in the year 2002, in a 43-page booklet presenting the policy for AIDS prevention in India admits that PLI-IA have relatively been denied access to medicare [3].

Majority of the newly recruited interns in our own institution think twice even before conducting a preliminary examination. So these people must be made more sensitive to matters of stigma and discrimination and should be prompted to act against it. As highlighted by Piot and Seek [15], even UNAIDS gives a key priority to regularly implement basic safety procedures to allay fears of health care workers.

The pain from societal discrimination is more than the disease itself In fear of being outcast, many a patient never reveal their status and pose a major risk of transmission. These cases spreading as 'water under the mat' will on one fine day make a fiery revelation.

Though donated blood screening for HIV has reduced HIV incidence, it did not eliminate the risk of HIV transmission [16]. The recommended practice of using only sterilized or high level disinfected gloves and instruments is not religiously followed during minor procedures having a potential for transmission of blood borne infections [17]. What more, the annual HIV sentinel surveillance for year 2003 conducted in Chennai by 'TNSACS (Tamil Nadu state AIDS control society) revealed that 63.8 % of IVDUs are HIV positive as against24.5% in 2001 and 33.3 % in 2002 [18].

So only forceful enactment and proper execution of the clear recommendations put in place by the WHO and the policy makers can, if at all, make the situation in developing countries change.

According to Feacham, health systems in poor countries are dysfunctional and this is one of the main reasons for improper HIV/ALDS care in India[19].

Added to these things is a new menace of ARVs in the form a boon. An indiscriminate ART may give a new shape to the disease severity by creating drug resistance [20],[21]. ARTS are not advised until an advanced state of the disease (CD4+<200).Unfortunately in India it is said that 75% of STD out patient cases are in private sectors and are described as "low quality" and are provided by "untrained practitioners" [22]. These private institutions, by promising magic remedies resort to indiscriminate ARTS, create drug resistant strains and escalate morbidity. Even if a subject is ELISA positive, India's NACO stipulates three consecutive ELISA positives before confirming HIV positivity[23].

In 2002, WHO chartered a model of prevention and control of HIV/ALDS for Botswana and India which is a guideline for most of the Governmental and NGOs in the country [3]. New institutions are coming up which are regularly updating the epidemic situation of HIV/ALDS in India [4] but the overall situation is still not up to the mark. Even in a nation wide study done in year 2000, only 76% of Indian population between 15-49 years age group had an overall awareness of AIDS [24].

The questionnaire we put forth is brief and can act as a prototype. It can be used with necessary modifications based on the geographical factors and the problems concerning the population at which it is targeted. The same questionnaire can be used on a population after a time gap to assess the effectiveness of an education program which popularly is known as the two-source capture-recapture method [25].


   Conclusion Top


Our study targeting the urban slum dwellers reveals the poor state of their KAP. The awareness in the females is much poorer.

Conventional IEC methods targeting general population via mass media are not reaching slum dwellers. A specially designed targeted intervention is needed. Street skits even in the urban areas may be useful for the illiterate. Lack of funds should never hinder the education programs. The concept of discussing issues of sexual behaviour and STDs which is other wise a taboo in the conservative set up of India must be eliminated by newer programs like "each one teach ten" on a one-to-one basis as done in our program or "each one once-in-a-month" or "my target -my village" must be promoted and the sense of responsibility must be instilled all over as HIV/ALDS is now the problem of every citizen.

 
   References Top

1.http://www.unaids.Org/wac/2000/wad00/files/ WAR epidemic report.pdf  Back to cited text no. 1    
2.Http://www.unaids.org/wad/2003/Epiupdate 2003en/Epi03 06 en.htm#p145 38679  Back to cited text no. 2    
3.Nico JDN, JhaP, Devlas S, Koremomp EL, Mose S, Blanchard Jr, Plummer FA: Modelling HIV/AIDS epidemic in Botswana and India, Bulletin of the World Health Organisation, 80: 89-96,2002.   Back to cited text no. 3    
4.Aggarwal OP, SharmaAK, IndrayanA: HIV/ALDS research in India, NACO, 1997.  Back to cited text no. 4    
5.Realities of sexual behaviour in Tamil Nadu: A report by AIDS prevention and control project of Voluntary Health Services, Chennai, 1998.  Back to cited text no. 5    
6.Jana S, Bandyopadhyay N, Mukherjee S, DuttaN. Basu I, Saha A: STS/I-IIV intervention with sex workers in WestBengal, India, ALDS;12 (suppl B): 101-8,1998  Back to cited text no. 6    
7.Gabb C: Researchers argue that unsafe injections spread HIV more than unsafe sex, Bulletin of the WHO ' 81[4]:307,2003  Back to cited text no. 7    
8.Agnew B: HIV/ALDS surges in Europe. Asia Pacificnext7 Bulletin of the WHO, 80:78-79, 2002.   Back to cited text no. 8    
9.Lucas SB, Hounnou A, Peacock, Beaumel A, Djomand G, N'Gbichi, et al : Mortality and pathology of HIV infection in a west African city. AIDS, 7:1569-79,1993.  Back to cited text no. 9    
10.Division of publication and information, ICMR, New Delhi: Increased male responsibility and participation-A key to improving reproductive health, ICMR Bulletin, 29[6]:59,1999.  Back to cited text no. 10    
11.IIIV disease in India, Second Ed. Published by Dental Council of India, 2003.  Back to cited text no. 11    
12.Anbwar NR, Hirwaker PA, Kalekalpana M, et al : AIDS awareness among nursing students, Indian J SexTransmDis,20:18-21,1999.  Back to cited text no. 12    
13.Rahate NP, Zodpey SP, Bhatkule PR: AIDS awareness among rural junior college students, IndianJ Sex TransmDis,16:30-31,1995.  Back to cited text no. 13    
14.Bahri D: AIDS prevention, it works, APAC-VHS publication, 2002.  Back to cited text no. 14    
15.Piot P, Seek AMC: International response to HIV/AIDS epidemic: Planning for success, Bulletin of the WHO, 79:1106-12,200 1.  Back to cited text no. 15    
16.Moore A, Herrera G, Nyamongo J, Lackritz E, Granade T, Nahlem B, et al : Estimated risk of HIV transmission by blood transfusion in Kenya, Lancet, 358:657-70,2001.  Back to cited text no. 16    
17.Bhattarai M: Proper HIV/ALDS care not possible without basic safety in health set up, Bulletin of the WHO, 80:333, 2001.  Back to cited text no. 17    
18.www.hindugrouponnet.com or refer The Hindu national englisb daily dated 20-04-04 (0971-751x vol. 127 no. 79).  Back to cited text no. 18    
19.Haart FR: The need for strategically focussed investments, Bulletin of the WHO, 79: 1152-3, 2001.  Back to cited text no. 19    
20.Fleck F: GSK under pressure cuts prices of AIDS treatment for poor countries: Bulletin of the WHO, 81[6]:469,2003.  Back to cited text no. 20    
21.Wilkinson D, Squire SB, Garner P: Effect of preventive treatment of TB in adults infected with HIV: Systemic review of randomised placebo controlled h ials, Br Med J, 323:152-4, 2001.   Back to cited text no. 21    
22.Raising the sights: better health systems for India's poor. Washington (DC): World bank, 2001, Report no:22304.  Back to cited text no. 22    
23.Chinai R: Anti retroviral misuse in Mumbai, India. Bulletin of the WHO, 81[2]:153, 2003.  Back to cited text no. 23    
24.Sarkar BD: AIDS growth in India can be stopped in five years, claims Government, Bulletin of the WHO, 80 [5]:422-423, 2002.  Back to cited text no. 24    
25.Yip PSF, Bruno G, Tajemen, Scher GAF, Buckland ST, Comack RM, et al : Capture-recapture and multiple record systems estimation, 1. History and theory of development, 2. Application in human disease, American Journal of Epidemiology, 142: 1047-68,1995.  Back to cited text no. 25    

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Correspondence Address:
B Sivapathasundharam
Department of Oral and Maxillo Facial Pathology, Meenakshi Ammal Dental College and Hospital, Alapakkam main Road, Maduravoyal, Chennai 600 095, Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.29889

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