- Email: [email protected]
AIDS
ARTICLE IN PRESS Public Health (2007) 121, 223–226
www.elsevierhealth.com/journals/pubh
Short Communication
Knowledge and awareness of schoolteachers in Chandigarh about HIV/AIDS S. Parmara,, V. Bhatiaa, V.R. Parmarb a
Department of Community Medicine, Government Medical College and Hospital (GMCH), Sector 32-B, Chandigarh 160 031, India b Department of Paediatrics, Government Medical College and Hospital (GMCH), Sector 32-B, Chandigarh 160 031, India Received 28 May 2005; received in revised form 18 August 2005; accepted 28 June 2006
KEYWORDS HIV/AIDS awareness; Schoolteachers; India; Adolescents
With 5.1 million adults infected, India has the second largest prevalence of HIV/AIDS cases globally and youths between 15 and 25 years of age constitute 60% of all new infections.1 Peer pressure combined with inadequate knowledge of sex and sexuality make adolescents likely to indulge in high-risk behaviour and thus more vulnerable to acquiring HIV/AIDS.2,3 The need for an intensive campaign against its spread and introduction of health education prior to onset of high-risk behaviour can hardly be over-emphasized. Teachers being in contact with adolescents can act as informal health educators and counsellors for HIV/AIDS prevention, and is in consonance with the UNESCO and WHO consensus statement.4 To be effective educators and to be able to impart the right knowledge, the teachers themselves need to Corresponding author. Tel.: +91 9417350511.
E-mail address: [email protected] (S. Parmar).
have an in-depth knowledge of HIV/AIDS. This study aimed to assess the current knowledge and awareness of schoolteachers in Chandigarh about HIV/ AIDS. The study was conducted from August to October 2003. The teachers from the randomly selected schools from a central list (three government (two urban and one rural) and four private) who consented to participate were then selected at random with proportionate allocation. A pretested, open-ended, semi-structured, self-administered questionnaire, which tested their knowledge, awareness and beliefs related to HIV/AIDS, was offered. The teachers were encouraged to fill the pro forma on the spot and without any consultation with each other. The data collected were analysed on Epi Info version 6.04b. w2 test and Fisher’s exact probability ratio were calculated. From an initial sample of 150 teachers, 139 (93%) completed the questionnaire. Sixty-five (47%) of
0033-3506/$ - see front matter & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2006.06.014
ARTICLE IN PRESS 224 these teachers were from government schools and 74 (53%) from private schools. Their sources of information about HIV/AIDS were: television 60%, newspapers 50%, posters/pamphlets 60%, friends 38% and the Internet 5%. None of the teachers had received any formal education or training in HIV/AIDS. Most teachers knew about the established routes of transmission, i.e. sexual (91%; 97% government vs. 86% private, w2 ¼ 3.55, P ¼ 0.05), unsafe blood transfusion (83%; 85% government vs. 82% private) and use of infected needles (85%; 89% government vs. 81% private). Only 46% (49% government vs. 43% private) teachers knew about mother-to-child transmission and three about transmission through breast milk. The most common modes of transmission mentioned were unsafe sex by 80% and unsafe blood transfusion by 14%. The high-risk populations identified for getting HIV/AIDS were commercial sex workers (32%; 40% government vs. 26% private), truck drivers (19%; 29% government vs. 9% private, w2 ¼ 7.64, P ¼ 0.005) and drug abusers (16%; 18% government vs. 13% private). The methods to prevent transmission mentioned were: safe sex (48%; 43% government vs. 54% private), use of disposable syringes (15%; 11% government vs. 20% private) and health education (16.5%; 9% government vs. 25% private). However, 20% (27% government vs. 15% private, w2 ¼ 4.32, P ¼ 0.03) of teachers felt abstinence still to be the best preventive measure. Similarly, use of condoms (85%; 88% government vs. 82% private) and abstinence (5%) were mentioned as methods to prevent transmission if a person ever happened to visit a commercial sex worker. Eighty-six per cent of teachers were aware of the availability of tests (85% government vs. 86% private) for diagnosis but only 19% ((20% government vs. 19% private); 10% science vs. 36% humanities, w2 ¼ 3.74, P ¼ 0.05) knew about drug treatment and 27% of them opined that one could not live beyond 5 years after getting HIV/AIDS. Sixteen per cent of teachers felt that babies could not become infected with HIV/AIDS. Kissing (10%; 20% humanities, w2 ¼ 4.40, P ¼ 0.01) and one or more of factors such as hugging, sharing food and towels, co-travelling and playing, handshake, etc. were mentioned as modes of transmission by 18% of teachers (32% government vs. 5% private, w2 ¼ 15.20, P ¼ 0.0009) (Table 1). Though more than 83% of teachers had mentioned use of unsafe blood as an important mode of transmission, only 63% opined that a person having HIV/AIDS could spread it by donating blood. Five per cent of teachers said that a person having
S. Parmar et al. HIV/AIDS looks sickly and can be recognized by appearance. Overall, general awareness of Chandigarh teachers about HIV/AIDS was good and consistent with the 90% reported in the literature5–8 and the difference between HIV and AIDS was known to 35%, higher than the 25% reported by Chu et al.8 The knowledge of established modes of transmission in 85–93% of our teachers was similar to reports in the literature5,6,8 but higher than the reported 31% and 64% from Calcutta9 and South Africa,10 respectively. Mother-tochild transmission known to 46% of our teachers was also better than the 16% reported from Calcutta9 but poorer than the 78% reported from Delhi.6 Awareness about prevention of HIV/AIDS was quite inadequate in our study subjects. Only 48% of our teachers in contrast to 85–90% in other studies5,6 mentioned safe sex as a method of prevention. However, the need for use of condoms during visits to commercial sex workers opined by 85% of them was higher than the 60% reported from Calcutta9 and similar to the 85–90% reported from Tygerberg, South Africa5 and Delhi.6 Similarly, very few of our teachers (16%) in comparison to those from Calcutta (53%) and Delhi (76%) knew about the use of disposable syringes as a method of prevention. Knowledge about health education as an effective preventive tool was known to only 18% and abstinence to 21% of our teachers. It was better in comparison to the reported 9% and 16%, respectively, from South Africa.5 Misconceptions such as kissing (10%), and one or more of hugging, sharing food, co-travelling, coplaying and shaking hands (18%) as modes of transmission still exist and were similar to the high prevalence of misconception reported by others from India and abroad.5–10 Though general awareness and knowledge about the common modes of transmission of HIV/AIDS was good amongst most of the school teachers from Chandigarh, awareness regarding its prevention, methods to check further transmission, and drug treatment were highly inadequate. In spite of free access to information, misconceptions related to the transmission of HIV/AIDS still prevailed and were nearly as high as reported 5–10 years ago. The present observations justify the need and importance for an organized and focused education of the teachers before they can be expected to act as resource persons for imparting HIV/AIDS-related health education to adolescents.
Myths and misconceptions related to HIV/AIDS.
Attributes
Other (hugging, sharing food, towel, clothes and comb, cotravelling and playing, shaking hands, etc.) Can breast milk transmit HIV? Yes No No response a b
Speciality Unspecified ¼ 84 n (%)
Science ¼ 30 n (%)
Humanities ¼ 25 n (%)
P valueb
w2 1.06 P ¼ 0.30
15 (18)
2 (7)
4 (16)
w2 0.09 P ¼ 0.67
5 6
w2 0.03 P ¼ 0.86
4 (5) 3 (4)
1 (3) 2 (6)
2 (8) 3 (12)
w2 0.03, P ¼ 0.58 w2 0.05, P ¼ 0.65
5 (7)
10
9 (11)
Nil
5 (20)
21 (32)
4 (5)
18
w2 1.92 P ¼ 0.16 w2 15.20 P ¼ 0.0009
20 (24)
2 (7)
3 (12)
w2 4.40 P ¼ 0.01 w2 0.07, P ¼ 0.64
1 (1.5) 45 (69) 19 (29)
2 (3) 46 (62) 26 (39)
2 65 32
w2 0, P ¼ 1 w2 0.37, P ¼ 0.54 w2 0.31, P ¼ 0.57
Nil 55 (65) 29 (36)
2 (6) 16 (53) 12 (40)
1 (4) 14 (56) 10 (40)
Govt. ¼ 65 n (%)
Private ¼ 74 n (%)
Total ¼ 139 %
P value
13 (18)
9 (12)
16
3 (5) 5 (8)
4 (5) 3 (4)
9 (14)
a
w2 0.03, P ¼ 1 w2 0.01, P ¼ 0.94
Government vs private school. Science vs humanities.
ARTICLE IN PRESS
Can babies (infants) get HIV No Can HIV/AIDS be recognized from appearance of a person? Yes No response Modes of transmission Kissing/saliva
Schools
Knowledge and awareness of schoolteachers about HIV/AIDS
Table 1
225
ARTICLE IN PRESS 226
Acknowledgement We would like to acknowledge all our respondents for participating in the study and the secretarial assistance of Ms Usha Vashist.
References 1. World Health Organization. Facts and figures; facts about the South East Asia region, 2004. Available at: http:// www.who.org (accessed 7th May 2005); information, education and communication, WHO SEA Region, Delhi 1995, NACO. Available at: www.naco.nic.in/IndiaScene/esthiv. html 2. Brown EJ. AIDS-related risk behavior of young college students. ABNF J 2000;11:37–43. 3. Nwokocha AR, Nwakoby BA. Knowledge, attitude, and behavior of secondary (high) school students concerning HIV/AIDS in Enugu, Nigeria in the year 2000. J Pediatr Adolesc Gynaecol 2002;15:93–6.
S. Parmar et al. 4. UNESCO Consensus statement, Asian Regional planning seminar on AIDS and education within the school system. New Delhi: UNESCO; 1994, p. 1. 5. Ayo-Yusuf I, Naidoo S, Chikte UM. The role of primary school teachers in HIV prevention in South Africa. SADJ 2001;56: 596–8. 6. Kumar A, Mehra M, Singh S, Badhan SK, Gulati N. Teachers’ awareness and opinion about AIDS: implications for school based AIDS education. J Commun Dis 1995;27:101–6. 7. Glenister AM, Castiglia P, Kanski G, Haughey B. AIDS knowledge and attitudes of primary grade teachers and students. J Pediatr Health Care 1990;4:77–85. 8. Chu CS, Chan TW, Hui HM, Samaranayake LP, Chan JC, Wei SH. The knowledge and attitude of Hong Kong secondary school teachers and students towards HIV infection and dentistry. Community Dent Health 1995;12:110–4. 9. Chatterjee C, Baur B, Ram R, Dhar G, Sandhukhan S, Dan A. A study on awareness of AIDS among school students and teachers of higher secondary schools in North Calcutta. Indian J Public Health 2001;45:27–30. 10. Peltzer K. Knowledge and attitudes about HIV/AIDS of a sample of schoolteachers, South Africa. Psychol Rep 2000; 87:1065–6.
www.elsevierhealth.com/journals/pubh
Short Communication
Knowledge and awareness of schoolteachers in Chandigarh about HIV/AIDS S. Parmara,, V. Bhatiaa, V.R. Parmarb a
Department of Community Medicine, Government Medical College and Hospital (GMCH), Sector 32-B, Chandigarh 160 031, India b Department of Paediatrics, Government Medical College and Hospital (GMCH), Sector 32-B, Chandigarh 160 031, India Received 28 May 2005; received in revised form 18 August 2005; accepted 28 June 2006
KEYWORDS HIV/AIDS awareness; Schoolteachers; India; Adolescents
With 5.1 million adults infected, India has the second largest prevalence of HIV/AIDS cases globally and youths between 15 and 25 years of age constitute 60% of all new infections.1 Peer pressure combined with inadequate knowledge of sex and sexuality make adolescents likely to indulge in high-risk behaviour and thus more vulnerable to acquiring HIV/AIDS.2,3 The need for an intensive campaign against its spread and introduction of health education prior to onset of high-risk behaviour can hardly be over-emphasized. Teachers being in contact with adolescents can act as informal health educators and counsellors for HIV/AIDS prevention, and is in consonance with the UNESCO and WHO consensus statement.4 To be effective educators and to be able to impart the right knowledge, the teachers themselves need to Corresponding author. Tel.: +91 9417350511.
E-mail address: [email protected] (S. Parmar).
have an in-depth knowledge of HIV/AIDS. This study aimed to assess the current knowledge and awareness of schoolteachers in Chandigarh about HIV/ AIDS. The study was conducted from August to October 2003. The teachers from the randomly selected schools from a central list (three government (two urban and one rural) and four private) who consented to participate were then selected at random with proportionate allocation. A pretested, open-ended, semi-structured, self-administered questionnaire, which tested their knowledge, awareness and beliefs related to HIV/AIDS, was offered. The teachers were encouraged to fill the pro forma on the spot and without any consultation with each other. The data collected were analysed on Epi Info version 6.04b. w2 test and Fisher’s exact probability ratio were calculated. From an initial sample of 150 teachers, 139 (93%) completed the questionnaire. Sixty-five (47%) of
0033-3506/$ - see front matter & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2006.06.014
ARTICLE IN PRESS 224 these teachers were from government schools and 74 (53%) from private schools. Their sources of information about HIV/AIDS were: television 60%, newspapers 50%, posters/pamphlets 60%, friends 38% and the Internet 5%. None of the teachers had received any formal education or training in HIV/AIDS. Most teachers knew about the established routes of transmission, i.e. sexual (91%; 97% government vs. 86% private, w2 ¼ 3.55, P ¼ 0.05), unsafe blood transfusion (83%; 85% government vs. 82% private) and use of infected needles (85%; 89% government vs. 81% private). Only 46% (49% government vs. 43% private) teachers knew about mother-to-child transmission and three about transmission through breast milk. The most common modes of transmission mentioned were unsafe sex by 80% and unsafe blood transfusion by 14%. The high-risk populations identified for getting HIV/AIDS were commercial sex workers (32%; 40% government vs. 26% private), truck drivers (19%; 29% government vs. 9% private, w2 ¼ 7.64, P ¼ 0.005) and drug abusers (16%; 18% government vs. 13% private). The methods to prevent transmission mentioned were: safe sex (48%; 43% government vs. 54% private), use of disposable syringes (15%; 11% government vs. 20% private) and health education (16.5%; 9% government vs. 25% private). However, 20% (27% government vs. 15% private, w2 ¼ 4.32, P ¼ 0.03) of teachers felt abstinence still to be the best preventive measure. Similarly, use of condoms (85%; 88% government vs. 82% private) and abstinence (5%) were mentioned as methods to prevent transmission if a person ever happened to visit a commercial sex worker. Eighty-six per cent of teachers were aware of the availability of tests (85% government vs. 86% private) for diagnosis but only 19% ((20% government vs. 19% private); 10% science vs. 36% humanities, w2 ¼ 3.74, P ¼ 0.05) knew about drug treatment and 27% of them opined that one could not live beyond 5 years after getting HIV/AIDS. Sixteen per cent of teachers felt that babies could not become infected with HIV/AIDS. Kissing (10%; 20% humanities, w2 ¼ 4.40, P ¼ 0.01) and one or more of factors such as hugging, sharing food and towels, co-travelling and playing, handshake, etc. were mentioned as modes of transmission by 18% of teachers (32% government vs. 5% private, w2 ¼ 15.20, P ¼ 0.0009) (Table 1). Though more than 83% of teachers had mentioned use of unsafe blood as an important mode of transmission, only 63% opined that a person having HIV/AIDS could spread it by donating blood. Five per cent of teachers said that a person having
S. Parmar et al. HIV/AIDS looks sickly and can be recognized by appearance. Overall, general awareness of Chandigarh teachers about HIV/AIDS was good and consistent with the 90% reported in the literature5–8 and the difference between HIV and AIDS was known to 35%, higher than the 25% reported by Chu et al.8 The knowledge of established modes of transmission in 85–93% of our teachers was similar to reports in the literature5,6,8 but higher than the reported 31% and 64% from Calcutta9 and South Africa,10 respectively. Mother-tochild transmission known to 46% of our teachers was also better than the 16% reported from Calcutta9 but poorer than the 78% reported from Delhi.6 Awareness about prevention of HIV/AIDS was quite inadequate in our study subjects. Only 48% of our teachers in contrast to 85–90% in other studies5,6 mentioned safe sex as a method of prevention. However, the need for use of condoms during visits to commercial sex workers opined by 85% of them was higher than the 60% reported from Calcutta9 and similar to the 85–90% reported from Tygerberg, South Africa5 and Delhi.6 Similarly, very few of our teachers (16%) in comparison to those from Calcutta (53%) and Delhi (76%) knew about the use of disposable syringes as a method of prevention. Knowledge about health education as an effective preventive tool was known to only 18% and abstinence to 21% of our teachers. It was better in comparison to the reported 9% and 16%, respectively, from South Africa.5 Misconceptions such as kissing (10%), and one or more of hugging, sharing food, co-travelling, coplaying and shaking hands (18%) as modes of transmission still exist and were similar to the high prevalence of misconception reported by others from India and abroad.5–10 Though general awareness and knowledge about the common modes of transmission of HIV/AIDS was good amongst most of the school teachers from Chandigarh, awareness regarding its prevention, methods to check further transmission, and drug treatment were highly inadequate. In spite of free access to information, misconceptions related to the transmission of HIV/AIDS still prevailed and were nearly as high as reported 5–10 years ago. The present observations justify the need and importance for an organized and focused education of the teachers before they can be expected to act as resource persons for imparting HIV/AIDS-related health education to adolescents.
Myths and misconceptions related to HIV/AIDS.
Attributes
Other (hugging, sharing food, towel, clothes and comb, cotravelling and playing, shaking hands, etc.) Can breast milk transmit HIV? Yes No No response a b
Speciality Unspecified ¼ 84 n (%)
Science ¼ 30 n (%)
Humanities ¼ 25 n (%)
P valueb
w2 1.06 P ¼ 0.30
15 (18)
2 (7)
4 (16)
w2 0.09 P ¼ 0.67
5 6
w2 0.03 P ¼ 0.86
4 (5) 3 (4)
1 (3) 2 (6)
2 (8) 3 (12)
w2 0.03, P ¼ 0.58 w2 0.05, P ¼ 0.65
5 (7)
10
9 (11)
Nil
5 (20)
21 (32)
4 (5)
18
w2 1.92 P ¼ 0.16 w2 15.20 P ¼ 0.0009
20 (24)
2 (7)
3 (12)
w2 4.40 P ¼ 0.01 w2 0.07, P ¼ 0.64
1 (1.5) 45 (69) 19 (29)
2 (3) 46 (62) 26 (39)
2 65 32
w2 0, P ¼ 1 w2 0.37, P ¼ 0.54 w2 0.31, P ¼ 0.57
Nil 55 (65) 29 (36)
2 (6) 16 (53) 12 (40)
1 (4) 14 (56) 10 (40)
Govt. ¼ 65 n (%)
Private ¼ 74 n (%)
Total ¼ 139 %
P value
13 (18)
9 (12)
16
3 (5) 5 (8)
4 (5) 3 (4)
9 (14)
a
w2 0.03, P ¼ 1 w2 0.01, P ¼ 0.94
Government vs private school. Science vs humanities.
ARTICLE IN PRESS
Can babies (infants) get HIV No Can HIV/AIDS be recognized from appearance of a person? Yes No response Modes of transmission Kissing/saliva
Schools
Knowledge and awareness of schoolteachers about HIV/AIDS
Table 1
225
ARTICLE IN PRESS 226
Acknowledgement We would like to acknowledge all our respondents for participating in the study and the secretarial assistance of Ms Usha Vashist.
References 1. World Health Organization. Facts and figures; facts about the South East Asia region, 2004. Available at: http:// www.who.org (accessed 7th May 2005); information, education and communication, WHO SEA Region, Delhi 1995, NACO. Available at: www.naco.nic.in/IndiaScene/esthiv. html 2. Brown EJ. AIDS-related risk behavior of young college students. ABNF J 2000;11:37–43. 3. Nwokocha AR, Nwakoby BA. Knowledge, attitude, and behavior of secondary (high) school students concerning HIV/AIDS in Enugu, Nigeria in the year 2000. J Pediatr Adolesc Gynaecol 2002;15:93–6.
S. Parmar et al. 4. UNESCO Consensus statement, Asian Regional planning seminar on AIDS and education within the school system. New Delhi: UNESCO; 1994, p. 1. 5. Ayo-Yusuf I, Naidoo S, Chikte UM. The role of primary school teachers in HIV prevention in South Africa. SADJ 2001;56: 596–8. 6. Kumar A, Mehra M, Singh S, Badhan SK, Gulati N. Teachers’ awareness and opinion about AIDS: implications for school based AIDS education. J Commun Dis 1995;27:101–6. 7. Glenister AM, Castiglia P, Kanski G, Haughey B. AIDS knowledge and attitudes of primary grade teachers and students. J Pediatr Health Care 1990;4:77–85. 8. Chu CS, Chan TW, Hui HM, Samaranayake LP, Chan JC, Wei SH. The knowledge and attitude of Hong Kong secondary school teachers and students towards HIV infection and dentistry. Community Dent Health 1995;12:110–4. 9. Chatterjee C, Baur B, Ram R, Dhar G, Sandhukhan S, Dan A. A study on awareness of AIDS among school students and teachers of higher secondary schools in North Calcutta. Indian J Public Health 2001;45:27–30. 10. Peltzer K. Knowledge and attitudes about HIV/AIDS of a sample of schoolteachers, South Africa. Psychol Rep 2000; 87:1065–6.