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Predictors of HIV/AIDS comprehensive knowledge and acceptance attitude towards people living with HIV/AIDS among unmarried young females in Uganda: a cross-sectional study | BMC Women’s Health

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Youth population, the major human capital of any society, should be well informed and evaluated on comprehensive knowledge about HIV/AIDS and attitude towards PLWHIV. In this study, almost all (99.3%) of young Ugandan women were found to be aware of HIV/AIDS. This is consistent with the results of the Uganda AIDS Indicator Survey (UAIDS-2011) [29]. However, only 51.9% have comprehensive knowledge on HIV/AIDS, which is contrary to the United Nations General Assembly’s (UNGASS) 2001 plan on improving HIV/AIDS knowledge among youth. The UNGASS target was to provide access on accurate information and good service to 95% of individuals aged 15–24 years worldwide by 2010 [30]. Corresponding to the present study, Uganda HIV/AIDS progress report stated that “many people are vulnerable to infection due to lack of comprehensive knowledge on HIV/AIDS as well as local misconceptions surrounding the HIV/AIDS phenomenon” [9]. Similar studies from Africa and Asia noted that comprehensive knowledge of HIV/AIDS is inadequate [14, 28, 31]. Nevertheless, studies from Europe showed a high level of HIV/AIDS-related Knowledge [32]. Participants’ inadequate knowledge about HIV/AIDS can account for inadequate access to sexual and reproductive health information [32]. Gender inequalities and dangerous traditional norms concerning issues of sexual health and sexuality could also account for the low levels of knowledge among young women [21, 33].

Methods of reducing HIV transmission include but are not limited to, loyalty to one uninfected partner and consistent use of condoms during intercourse. In this study, participants’ knowledge about prevention methods of HIV/AIDS transmission is moderately high, and hence there is still a room for improvement. Young women’s knowledge of prevention methods (condom use and having a faithful uninfected partner) was fairly high at (70.4%). These findings are similar to the reports of UDHS-2006 and UAIS-2011 [29, 34]. However, similar studies from Iran and Ethiopia showed a substantial gap in knowledge. Only 49.8% and 52% of young women were aware of the methods for prevention of HIV transmission, correspondingly [14, 35]. To determine effective techniques for HIV/AIDS prevention and eradicate popular misconceptions, it is useful to identify fallacies about HIV/AIDS [29]. Two-third (66.9%) of the respondents rejected the misconception that HIV can be transmitted through mosquito bites. About 13% believed the possibility of transmission by witchcraft or other supernatural, and 19.5% by sharing a meal with someone who is infected with HIV. The misconceptions reported in this study could exacerbate risky sexual behaviors, which may predispose them to HIV infection [36]. The findings further pointed out the need to strengthen educational activities by clarifying the puzzles about knowledge on HIV transmission and relevant misconceptions. Having adequate comprehensive knowledge about HIV/AIDS can also reflect young women’s behavior. As a consequence, they may avoid harmful practices thereby safeguarding themselves from HIV/AIDS [36].

Data from multivariable logistic regression analysis demonstrated that higher educational status of young women was significantly associated with having comprehensive knowledge about HIV/AIDS. We found out that respondents with primary, secondary and higher levels of education had more comprehensive knowledge regarding HIV/AIDS compared to those with no education at all. In line with the current findings, previous studies [14, 28, 37] demonstrated beyond doubt that education is a social vaccine and is a critical component in the fight against HIV/AIDS. Based on these findings, there is a need to provide extracurricular activities on HIV/AIDS for the young age groups. Expectedly, the current study found a higher level of knowledge among the inhabitants of urban areas than rural areas. This result is consistent with the findings from previous studies [13, 28, 38]. Moreover, a DHS survey conducted in eight settings in SSA (Uganda, Malawi, Kenya, Lesotho, Tanzania, Zambia, Swaziland, and Zimbabwe) with high HIV prevalence reported that knowledge on HIV/AIDS was higher among urban residents [39]. This could be elucidated by an uneven distribution of access to information through the media and instructional campaigns across various regions [32]. In addition, wealthier women were more knowledgeable compared to their counterparts. This could be due to their high living standards allowing them to get more access to education which in turn boosts their knowledge about HIV/AIDS [13]. In harmony with several previous studies [13, 14, 28], our study demonstrated higher odds of comprehensive knowledge among “richest”, “richer” and “middle” wealth category than the “poorest”.

Consistent with a study done in Kenya [40], despite extensive exposure to mass media (91.5%), considerable proportions of young unmarried women showed inadequate knowledge regarding HIV/AIDS. The current study revealed that women who had ever been tested for HIV/AIDS were more likely to have adequate knowledge on HIV/AIDS. This could be the result of education and counselling received from healthcare providers.

Negative attitude towards PLWHIV is common worldwide [21] and is regarded as a fundamental barrier in the struggle against HIV/AIDS [28]. However, efforts directed at lowering negative attitude rank low in the priority list of HIV/AIDS programs [16]. The spread of HIV/AIDS has generated anxiety, fear as well as prejudice to PLWHIV [29]. In Uganda, although efforts have been made to reduce the negative attitude towards PLWHIV [8], the lack of well-defined social support package and capacity gaps in traditional institutions have stymied the national response. Consequently, stigma towards PLWHIV remains high [9, 29].

Regarding attitudes towards PLWHIV, only 20.6% of the participants had a positive acceptance attitude to PLWHIV. Comparable population-based studies conducted in the Democratic Republic of Congo (DRC), Nigeria, Iran, and India also found a high level of stigma ranging from 3.2 to 37% [28, 32, 41]. In concordance with an Iranian study [32], majority (86.2%) exhibited willingness to care for a relative with HIV. Approximately 36% of young unmarried women reported that they would not want HIV infection in a family to remain secret. This low rate of disclosure shows negative attitude is becoming a major concern in tackling the burden of HIV/AIDS. Nearly 30% of the participants had negative beliefs toward buying fresh vegetables from a vendor with HIV or attending a lecture taught by a female HIV-positive teacher. This discriminatory attitude on PLWHIV could be a barrier to voluntary counselling and testing for HIV and the productive dissemination of enlightenment programs [36]. The high level of stigma uncovered in this study might be attributed to the inadequate knowledge about preventing HIV transmission and fallacies regarding HIV/AIDS [32, 42, 43]. Similar studies done in Nigeria, India, Kenya, and Burundi [21, 28, 44, 45] noted that women aged 20–24 years had a better attitude towards PLWHA than those aged 15–19 years. In this study, young women aged 20–24 years were 1.54 times more likely to have a better attitude towards PLWHIV than those aged 15–19 years. However, no significant association was seen after adjusting for age in multivariable logistic regression. Effective and efficient educational instruction attained from educational institutions about HIV/AIDS can change one’s negative attitude [28, 46] and may subsequently encourage healthy behaviors [14]. In addition to this, young women who are not in school might lose the chance of obtaining knowledge about HIV/AIDS [13]. In the current study, no association was found between educational status and a positive attitude towards PLWHIV. Easy access to health-related information or services from mass media by urban residents could help them acquire better knowledge about HIV/AIDS and accepting attitude than rural residents [21]. However, in this research, the variation in accepting attitude among the different places of residence (rural and urban) as well as access to mass media (no access at all and once a week) were insignificant. This finding is contrary to UAIS-2011 report [29] and other studies [14, 32, 47,48,49]. Besides, many other studies have demonstrated that wealth status is significantly associated with positive attitude towards PLWHIV. Although the pattern among the four wealth quartiles was not uniform, previous studies had reported that those with higher socio-economic status were more likely to have accepting attitude towards PLWHIV than those with lower socio-economic status [21, 28, 50, 51]. Contrary to that assumption, wealth status was not significantly associated with accepting attitude towards PLWHIV in the bivariate analysis. Since economic solvency assures access to indispensable necessities such as standard of living, healthcare services, and education; the absence of relationship between wealth status and positive attitude towards PLWHIV is hard to explain. Indeed, additional studies are warranted in the future with regard to this issue.

As indicated in various studies, knowledge has been identified as a major driver of positive attitude towards PLWHIV. On the other hand, negative attitudes appear to be the outcome of poor access to appropriate and accurate HIV/AIDS-related information [52]. However, knowledge may occasionally stem risky sexual behaviors [14]. In this regard, our findings revealed that those with comprehensive knowledge on HIV/AIDS were highly likely to have accepting attitude compared to the reference group. This finding is in agreement with many similar studies existing in the literature [37, 42, 43, 48, 53]. The health education sessions provided by health experts, especially those visiting HIV/AIDS testing centers could have a positive effect on attitude towards PLWHIV. In this study, women who ever had HIV/AIDS testing were more likely to show positive attitudes towards PLWHIV.

Limitation

In this study, we have noted some limitations. Firstly, since DHS is a household survey, the exclusion of people living in institutions or on the street might limit the generalizability of the results. Secondly, we failed to report cause and effect due to the cross-sectional nature of the study. Thus, our results can be explained referring to observed associations between explanatory and outcome variables. Thirdly, this kind of study can be affected by recall bias which might affect the findings. Moreover, the research participants could fail to express their real feelings and attitudes in a face-to-face interview which could affect the quality of the data. Finally, we could not use complex sampling procedure due to the fact that one of the elements (sample strata for sampling errors V022) was unavailable.

https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01176-w

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