3. Quantitative Results (cont.)
3.3 Uniformed services, transport workers, the rural population and factory workers
3.3.1 Uniformed services (ground forces and the air force)
3.3 Uniformed services, transport workers, the rural population and factory workers
3.3.1 Uniformed services (ground forces and the air force)
3.3.1.1 Socio-demographic characteristics
Interviews were conducted with a total of 1872 men belonging to the uniformed services. Participants were from the two major Ethiopian Defense Forces; ground forces stationed in the eastern parts of Ethiopia (n = 1250) and air force personnel (n = 622) stationed in Debre Zeit.
Age
Respondents were between 18 and 45 years old (mean and median = 26.2 and 25.0 years old, respectively). The majority (77.4%) of uniformed services participants were less than 30 years old. More than 49% were between 18 and 24 years old. This target group included a small proportion (7.7%) of young people between 18 and 19 years old.
Education
A significant proportion of the respondents had attended school (72.5 and 93.9% of the ground forces and air force, respectively) indicating that many of the uniformed services respondents were literate. The mean number of years of schooling was 7.0 years for the ground forces and 11.1 years for the air force.
Marital status
About 43.8% of the uniformed services group had ever been married. Mean age at first marriage was 26.0 years for the ground forces and 27.4 years for the air force. Data indicated that a considerable proportion of the target group had married at <20 years old (48.5 and 19.5% of the ground forces and air force, respectively).
Amongst the ground forces and air force, 62.9 and 43.4%, respectively, reported that they were not married or living with any sexual partner. Only a few (7.2%) of the ground forces were married and living with their spouses; considerably more of the air force respondents (41.6%) were married and living with their spouses. A greater proportion of ground force than air force personnel was married but currently living alone (26 vs. 6.8%, respectively). Very small numbers reported that they were currently married but living with other sexual partners (0.6 and 0.2% of the ground forces and air force respondents, respectively). In addition, a small proportions of the participants were unmarried but living with sexual partners (3.3 and 7.9% of the ground forces and air force respondents, respectively).
Residence, mobility and employment
Data showed that the uniformed services, particularly the ground forces, were highly mobile. More than 90% of the ground forces respondents reported that they had been stationed at their current bases for less than a year. In contrast, the air force personnel were less mobile; only 21.7% reported that they had been stationed at their base for less than a year. About one third of respondents (30 and 26.5% of the ground forces and air force, respectively) had been based away from their units for over a month in the previous 12 months
Amongst uniformed services participants, the mean number of years of service was 3.4 and 9.1 years for the ground forces and the air force, respectively. The majority of the uniformed services participants (97.6 and 81.4% of ground forces and air force, respectively) were privates and their air force equivalents.
Religion
Most participants were Christians (83 and 95.3% of ground forces and air force, respectively) whilst 15.6 and 4.0% of the ground forces and air force participants, respectively, were Muslims.
Circumcision
More than 90% of the uniformed services group was circumcised.
3.3.1.2 STIs, HIV/AIDS and related knowledge
Knowledge of STIs
Amongst uniformed services respondents, more than 90% were aware of the existence of STIs. Of the group that knew STIs existed, respondents were asked whether they knew any symptoms of STIs. The most commonly mentioned symptom of STI in women was genital discharge, followed by burning pain on urination and foul smelling discharge. For STIs in men, genital discharge was also the most commonly mentioned symptom, followed by burning pain on urination and genital ulcers/sores. Respondents were more aware of male than female STI symptoms.
Knowledge and misconceptions about HIV/AIDS
Over 99.5% of both ground forces and air force respondents had heard of HIV/AIDS. Amongst these, 60.1% of the ground forces and 84.0% of the air force respondents knew someone who was infected with HIV or had died of AIDS. Of these groups which reported first-hand knowledge of HIV/AIDS, 25.8% of the ground forces and 42.3% of the air force reported that the affected person/people were close relatives or close friends.
Knowledge of the three major preventive methods and level of misconceptions and incorrect beliefs about HIV transmission were the major indicators used to assess the knowledge about HIV/AIDS amongst the uniformed services.
Knowledge of the three preventive methods was similar in the two defense forces, with 78.5% of ground forces and 73.8% of air force respondents mentioning the three major methods of HIV prevention correctly (see Annex 4A).
Various statements (common misconceptions about HIV/AIDS) were read out to respondents and they were asked to agree or disagree with each (see Annex 4B). Those respondents with at least one incorrect response were identified as having misconceptions. Selected UNAIDS indicators of misconception are presented in the summary indicator table (see Annex 4B).
Almost all (99.6 and 99.4% of ground forces and air force, respectively) of all the uniformed services had at least one misconception about HIV/AIDS transmission.
Amongst the uniformed services, the three major misconceptions relating to HIV transmission were that the virus could be contracted by eating uncooked egg from a chicken that had swallowed a condom (97.2%), eating raw meat prepared by a person infected by HIV (55.5%) and from mosquito bites (41.9%).
To assess comprehensive knowledge of the uniformed services, both composite indicators (i.e. knowledge of the three preventive methods and no incorrect belief about HIV/AIDS transmission) were combined. Overall, 33.5% of the ground forces and 48% of the air force had comprehensive knowledge.
Knowledge about condoms
Amongst uniformed services respondents, more than 95% had heard of male condoms. Of those aware that male condoms existed, 86.9% of ground forces and 69.5% of air force respondents knew where they could obtain condoms. The most commonly mentioned sources were shops and uniformed services health institutions (85.0 and 78.0%, respectively), followed by health centers/hospitals (30.8%) and pharmacies (25.3%). A proportion of respondents (20.0%) reported that they could obtain male condoms from FSWs. Respondents said that they had to travel less than 30 minutes from their respective deployment areas/work places to obtain male condoms.
Only 31.6% of ground forces and 43.6% of air force respondents had ever heard of female condoms.
Stigma and discrimination
Amongst all the uniformed services respondents: 68.9% were not willing to eat food prepared by a person whom they knew to be HIV positive; 62.8% believed that an army officer who has HIV but appears healthy should not be allowed to continue to work in the army; and 61.6% would not buy food from a shop keeper if they knew that he had HIV. Moreover, 51% of the respondents believed that PLWHA should be quarantined in health care facilities.
Mother-to-child transmission of HIV/AIDS
More than 90% of respondents knew that an HIV infected woman could transmit the virus to her unborn child; this group of respondents was asked to agree or disagree with suggestions of various strategies a pregnant woman could take to reduce the risk of HIV transmission to her unborn child. Only 9.1% replied that taking antiretroviral therapy could reduce the risk of transmission of HIV to an unborn child. However, 30.9% responded that nothing could be done. In general, it was clear that the majority of respondents did not know how to reduce the risk of mother-to-child transmission during pregnancy.
Considerable proportions of ground forces (85%) and air force respondents (69%) knew that an HIV infected mother could transmit the virus to her baby through breastfeeding.
3.3.1.3 Alcohol and drug use
Regular alcohol drinking coupled with drug use was a risk factor for unprotected sex amongst the uniformed services respondents. Data showed that amongst the ground forces and air force respondents, 47.4% had consumed drinks containing alcohol in the previous four weeks. Amongst all groups of uniformed services respondents, alcohol was consumed regularly (at least once a week) by 22.5%.
Fewer respondents had ever used drugs, 13.4% of the ground forces and 10.5% of the air force. Table 3.3.1 shows the percentages of respondents who had ever used various types of drug. Khat was the major drug used by the uniformed services respondents; amongst those who had ever used khat, 16.4% were regular users.
Table 3.3.1 ‘Ever use’ of specific types of drugs by uniformed services respondents.
Target group |
Number (%) | |||||||
Khat |
Shisha |
Benzene |
Hashish |
Mandrax |
Cocaine |
Crack |
IDU* | |
|
Ground forces |
167 (13.4) |
3 (0.2) |
1 (0.1) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
7 (0.6) |
|
Air force |
65 (10.5) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
4 (0.6) |
*IDU = injecting drug user
3.3.1.4 Sexual behavior
Across both groups of uniformed services respondents, average age at first sex was 18.8 years. In general, the ground forces were younger than the air force respondents when they first had sex (18.5 and 19.5 years old, respectively; P<0.001).
Most (85.2%) of the uniformed services respondents had been sexually active during the previous 12 months. Amongst sexually active respondents in the ground forces, 25.5% had regular partners, 76% reported commercial partners, 11.2% reported non-regular partners with whom they had had sexual relations for less than 12 months and 2.1% reported non-regular partners with whom they had had sexual relations for 12 months or more. The pattern of regular and commercial partners differed markedly between the ground forces and air force respondents. Amongst sexually active air force respondents, 63.4% had regular partners, 21.0% reported commercial partners, 22.0% reported non-regular partners with whom they had had sexual relations for less than 12 months and 3.5% reported non-regular partners with whom they had had sexual relations for 12 months or more.
Multiple partners
Amongst those who had been sexually active, 63.5% of ground forces and 20.8% of air force respondents reported having more than one sexual partner during the previous 12 months. Amongst the married uniformed services respondents, 52.7% of the ground forces and 10.7% of the air force respondents had had extramarital sex during the previous 12 months.
Condom use
Amongst the ground forces respondents with regular sex partners, 15% used condoms during their most recent sexual encounter; the same proportion used condoms consistently. Amongst those with commercial sex partners, 91% used condoms during their most recent sexual encounter and 80% used condoms consistently. Amongst ground forces respondents with non-regular partners, 78% used condoms during their most recent sexual encounter and 66% used condoms consistently.
Amongst air force respondents with regular sex partners, almost 20% used condoms during their most recent sexual encounter and almost 15% used condoms consistently. Amongst those with commercial sex partners, 88% used condoms during their most recent sexual encounter and 79% used condoms consistently. Amongst those with non-regular partners, 77% used condoms during their most recent sexual encounter and 60% used condoms consistently. There was no indication that condoms were too expensive for use by the uniformed services respondents, a further indicator that male condoms were accessible to this group.
3.3.1.5 STIs and treatment seeking behavior
Respondents who reported that they had had symptoms of STIs in the previous 12 months were asked whether they had sought medical treatment (see Table 3.3.2). Amongst this subgroup, 46.3% reported that they sought advice/medicine from a work-place clinic or hospital, while 12.2% sought advice/medicine from a government clinic/hospital.
Table 3.3.2 Proportion of uniformed services respondents who reported that they had experienced STI symptoms during the previous 12 months.
|
Symptoms |
Percentage | |
Ground forces (n = 706) |
Air force (n = 220) | |
|
Genital discharge |
4.4 |
0.9 |
|
Genital ulcers/sores |
2.7 |
1.4 |
3.3.1.6 HIV testing and exposure to interventions
HIV testing
Similar proportions (about 47% each) of the ground forces and air force respondents knew places where confidential HIV testing was available. About 16% of the ground forces and 27% of the air force had been tested for HIV; amongst these respondents, 43.5% reported that the test was voluntary, 72% returned to collect their test result and about 33% had been tested during the previous 12 months. Although less than 28% of all uniformed services respondents had been tested for HIV, 97% said that they would be willing to use VCT services in the future.
Exposure to interventions
Amongst the uniformed services, 75, 82 and 49% of respondents, respectively, listened to radio, watched television and read printed media at least once a week. Of those exposed to the mass media, 93, 89 and 68% of respondents had heard or seen messages about HIV/AIDS on the radio, on TV and in the printed media, respectively, during the previous 12 months; most respondents commented that the messages were clear. Amongst all uniformed services respondents, 65% participated in anti-AIDS activities, 36% had discussed HIV/AIDS with an outreach worker (health service provider) and 46% had discussed HIV/AIDS with a peer group educator.
3.3.1.7 Perception of risk
Amongst the uniformed services respondents, 66.0% perceived themselves to be at no or low risk of HIV infection while 16.5% considered themselves to be at moderate or high risk. The most common reasons given for these perceptions by those who perceived themselves to be at low or no risk were as follows: 54.8% said that they always used condoms; 34.0% said that they trusted their sexual partner; and 16.0% said that they practiced abstinence. The most common reasons given by respondents who perceived themselves to be at moderate or high risk were as follows: 51% said they participated in unprotected sex; 28% said they had sex with commercial partners; and 22% said that they had more than one sexual partner.
3.3.2 Transport workers
3.3.2.1 Socio-demographic characteristics
A total of 1793 male drivers and their assistants took part in the study; these included truckers and their assistants (n = 746) from the Ethio-Djibouti transport corridor, intercity bus drivers and their assistants (n = 537) from the central bus station and minibus drivers and their assistants in Addis Ababa (n = 510). Hereinafter, the terms truckers, intercity bus drivers and minibus drivers are used to refer to both the drivers and their assistants.
Age
Many of the drivers and their assistants were over 30 years old (>80% of truckers, >50% of intercity bus, >30% of minibus). The mean age of the respondents was 36.6, 31.0 and 26.7 years for truckers, and intercity and minibus drivers, respectively.
Education
Nearly all the respondents had attended school (99.1% of truckers, 97.6% of minibus drivers and 97.2% of intercity bus drivers) indicating that many of them were literate. Mean number of years of schooling was 8.8 years for the truckers, 9.0 years for the minibus drivers and 9.1 years for the intercity bus drivers.
Marriage and relationships
About 46, 21.6 and 56.4% of the intercity bus, minibus and trucker respondents, respectively, had ever been married. The mean age at first marriage was 26.6 years for intercity bus and minibus drivers, and 26.9 years for truckers. For the whole group of transport workers, the median age at first marriage was 27 years. Of the currently married respondents, 58.6% of truckers, 18.6% of minibus drivers and 36.7% of intercity bus drivers reported that they lived with their spouses.
Amongst the trucker, minibus and intercity bus respondents, 30.4, 71.0 and 50.5%, respectively, reported that they were not married or living with any sexual partner. Small proportions of the transport workers (7%) were unmarried but living with sexual partners. Moreover, a few of the transport workers reported that they had more than one wife: 8.7, 1.6 and 3.6% of trucker, intercity bus and minibus respondents, respectively.
Residence and mobility
More than 93% of all the transport workers lived in cities. As was expected, considerable proportions of the long distance transport workers (56% of truckers and 34.8% of intercity bus respondents) had been away from home for more than a month during the previous 12 months; in contrast, only 11.8% of minibus drivers had traveled away from home for similar periods of time.
Employment and support
Amongst the trucker, minibus and intercity bus respondents, 57.5, 33.7 and 47.5%, respectively, had worked as transport workers for more than 5 years. More than 66% of intercity bus drivers, 59% of minibus drivers and 84.3% of truckers were supporting their families. About 25% of minibus drivers, 17.8% of truckers and 12.5% of intercity bus drivers used less than half of their monthly income to support their relatives. Nearly all of the transport workers were supporting other adults (96.0, 93.8 and 91.0% of truckers, intercity bus and minibus respondents, respectively) whilst more than 70% of the transport workers were supporting one or more child.
Religion
Most transport workers (79.6, 83.3 and 87.3% of the truckers, minibus, and intercity bus drivers, respectively) were Christians. A smaller proportion (19.3 and 15.5 and 12.1% of the truckers, minibus drivers and intercity bus drivers, respectively) was Muslim.
Circumcision
More than 96% of the transport workers were circumcised.
3.3.2.2 STI/HIV/AIDS related knowledge
Knowledge of STIs
Over 95% of all transport workers were aware of the existence of STIs. Of this subgroup, 49.1 and 46.1% could spontaneously name one correct symptom of STIs in women and men, respectively. The most commonly mentioned symptoms of STIs were genital discharge, followed by burning pain on urination and foul smelling discharge.
Knowledge and misconceptions about HIV/AIDS
More than 97% of all transport workers had heard of HIV/AIDS. Amongst those who were aware that HIV/AIDS existed, over 86% knew someone who was infected with HIV and/or someone who had died of AIDS; 44.5% reported that the infected person/people were close relatives and/or close friends.
Amongst trucker, intercity bus and minibus respondents, 61.7, 71.3 and 72%, respectively, were able to name all of the three major HIV preventive methods.
Transport workers scored less for their ability to correctly identify misconceptions than for their knowledge of preventive methods. In general, misconceptions reduced the comprehensive knowledge levels of the transport workers. Overall, 61.6% of the respondents had at least one misconception about HIV transmission. The commonest misconceptions about HIV transmission were that the virus could be contracted by eating raw meat prepared by an infected individual (46.3%), by eating uncooked egg laid by a chicken that had previously swallowed a used condom (42.3%) and from mosquito bites (56.6%). Only 42.8, 31.1 and 32.9% of the trucker, intercity bus and minibus respondents, respectively, had comprehensive knowledge about HIV/AIDS.
Knowledge about condoms
Over 95% of transport workers had heard of male condoms. Amongst these respondents, about 75% knew of places or people from whom they could obtain condoms. The most commonly mentioned sources of condoms were shops (97%), pharmacies (75%), and bars or hotels (>50%).
Most of the respondents reported that male condoms were available within a 30-minute journey of their residential area or workplace.
About one third of the transport workers (38.1, 34.5 and 32.0% of truckers, intercity bus drivers and minibus drivers, respectively) had heard of female condoms.
Stigma and discrimination
About two thirds of all transport workers expressed at least one stigmatizing attitude. Many respondents were not willing to share meals with an HIV positive person or to buy food from a shopkeeper or food seller whom they knew was HIV positive (reported by about 25 and 33% of respondents, respectively). Amongst intercity bus, minibus and trucker respondents, 26.4, 19.4 and 21.8%, respectively, thought that HIV infected but seemingly well transport workers should not continue to work. Nevertheless, 95% of respondents said that they were willing to care for male/female relatives who were HIV positive.
Mother-to-child transmission of HIV/AIDS
Over 84% of transport workers were aware that an HIV infected pregnant woman could transmit the virus to her unborn child. This subgroup of respondents was asked to agree or disagree with suggestions of various strategies a pregnant woman could take to reduce the risk of HIV transmission to her unborn child. Anti retroviral medication (19%) and abortion (12%) were the most frequently selected strategies. A further 28% of respondents thought that nothing could be done. In general, most transport workers had no idea that it was possible to reduce the risk of mother-to-child transmission of HIV during pregnancy.
About 70% of the transport workers knew that an HIV infected woman could transmit the virus to her child by breastfeeding.
3.3.2.3 Alcohol and drug use
For drivers and their assistants, regular alcohol drinking coupled with drug use was a risk factor for the practice of unprotected sex. In the previous four weeks, 52.5% of transport workers had consumed drinks containing alcohol while 44, 43.2 and 40% of truckers, intercity bus and minibus drivers, respectively, had drunk alcohol regularly.
Table 3.3.3 ‘Ever use’ of specific types of drugs by transport workers.
Target group |
Number (%) | |||||||
Khat |
Shisha |
Benzene |
Hashish |
Mandrax |
Cocaine |
Crack |
IDU* | |
|
Truckers |
293 (39.3) |
30 (4.0) |
4 (0.5) |
4 (0.5) |
4 (0.5) |
6 (0.8) |
4 (0.5) |
4 (0.5) |
|
Intercity bus drivers |
210 (39.1) |
33 (6.2) |
0.0 |
0.0 |
0.0 |
0.0 |
0.0 |
2 (0.4) |
|
Minibus drivers |
275 (53.9) |
58 (11.4) |
10 (2.0) |
0.0 |
0.0 |
0.0 |
0.0 |
2 (0.4) |
*IDU = injecting drug user
The proportion of transport workers who had ever used specific types of drugs is shown in Table 3.3.3. Across all groups, the most commonly used drug was khat. Moreover, amongst those transport workers who used khat, many chewed khat regularly (82.3, 73.3 and 81.8% of truckers, intercity bus and minibus drivers, respectively).
3.3.2.4 Sexual behavior
Mean age at first sex was 18.5, 19.3 and 20.1 years for minibus respondents, intercity bus respondents and truckers, respectively.
The majority of transport workers reported that they had been sexually active during the previous 12 months (82.9, 68 and 81.4% of intercity bus, minibus and truckers, respectively).
During the previous 12 months, >48% of the transport workers reportedly had regular sex partners, >13% had commercial sex partners and about 10% had non-regular sex partners.
Multiple sexual partners
Amongst those who were sexually active, 31.8% minibus of the, 23.2% of intercity bus and 20.8% of truckers respondents reportedly had more than one sexual partner during the previous 12 months. Amongst those who were married, 7.8% of truck, 2.9% of minibus and 7.1% of intercity bus respondents reported having had extramarital sex in the previous 12 months.
Condom use
Amongst truckers with commercial sex partners, 91% used condoms during their most recent sexual encounter and 84% used condoms consistently during the previous 12 months. Amongst those with non-regular sex partners, 80% used condoms during their most recent sexual encounter and 73% used condoms consistently during the previous 12 months.
Amongst intercity bus respondents with commercial sex partners, 97% used condoms during their most recent sexual encounter and 91% used condoms consistently during the previous 12 months. Amongst those with non-regular sex partners, 82% used condoms during their most recent sexual encounter but only 12% used condoms consistently during the previous 12 months.
Amongst minibus respondents with commercial sex partners, 98% used condoms during their most recent sexual encounter and 92% used condoms consistently during the previous 12 months. Amongst those with non-regular sex partners, 74% used condoms during their most recent sexual encounter and 51% used condoms consistently during the previous 12 months.
There were no indications that condoms were too expensive for the transport workers.
3.3.2.5 STIs and treatment seeking behavior
All respondents were asked whether they had experienced any genital discharge and/or genital ulcers during the previous 12 months. Overall, 2% of the transport workers reported having had STIs (genital discharge or ulcer/sore). The proportion of transport workers who had experienced symptoms of STI during the previous 12 months is shown in Table 3.3.4.
Table 3.3.4 Proportion of transport workers who reported that they had experienced STI symptoms during the previous 12 months.
Symptoms |
Number (%) | ||
Truckers (n = 746) |
Intercity bus drivers (n = 537) |
Minibus drivers (n = 510) | |
|
Genital discharge |
2 (1.0) |
2 (0.9) |
6 (2.1) |
|
Genital ulcers/sores |
1 (0.5) |
0 (0.0) |
2 (0.7) |
Transport workers who had experienced an STI during the previous 12 months were asked what treatment they had received. A list of treatment behaviors was read out to the respondents and they could answer in one of four ways: yes, no, don’t know or no response. Multiple responses were possible. Overall, 62.5% of the transport workers had sought medical care from health service institutions.
3.3.2.6 HIV testing and exposure to interventions
HIV testing
Amongst truckers, 10% had been tested for HIV. Of those tested, 80% said the test was taken voluntarily and 95% returned for their test results; 47% had been tested within the previous 12 months. Amongst all truckers, 80% said that they would volunteer to undergo VCT in the future.
Amongst minibus drivers, 35% said that it was possible to get confidential HIV tests. Only 7% had been tested for HIV. Of those tested, 70% said the test was taken voluntarily and all of them returned for their test results; 44% had been tested within the previous 12 months. Amongst all the minibus respondents, 91% said that they would volunteer to undergo VCT in the future.
Amongst intercity bus drivers, 36% said that it was possible to get confidential HIV tests. Only 11% had been tested for HIV. Of those tested, 74% said the test was taken voluntarily and all of them returned for their test results; 62% had been tested within the previous 12 months. Amongst all the intercity bus respondents, 93% said that they would volunteer to undergo VCT in the future.
Exposure to interventions
During the previous four weeks, 77, 55 and 28% of truckers, respectively, had listened to radio, watched TV and read printed media at least once a week. Amongst those who had ever heard of HIV/AIDS, 96, 92 and 73% of truckers had been exposed to HIV messages by radio, TV and printed media, respectively; the majority of these respondents commented that the messages were clear. Amongst truckers, only 12% participated in anti-AIDS activities in their communities, 9% had been in contact with an outreach worker and 26% had discussed HIV/AIDS issues with a peer group educator during the past year.
During the previous four weeks, 87, 63 and 37% of minibus drivers, respectively, had listened to radio, watched TV and read printed media at least once a week. Amongst those who ever heard about HIV/AIDS, 96, 86 and 70% of minibus respondents had been exposed to HIV messages by radio, TV and printed media, respectively. The majority of these respondents commented that the messages were clear. Amongst minibus drivers, 25% participated in anti-AIDS activities in their communities, 12% had been in contact with an outreach worker and 29% had discussed HIV/AIDS issues with a peer group educator during the past year.
Around 78, 61 and 37% of intercity bus drivers, respectively, had listened to radio, watched TV and read printed media at least once a week. Amongst those who ever heard about HIV/AIDS, 95, 86 and 70% of intercity bus respondents had been exposed to HIV messages by radio, TV and the printed media, respectively. Amongst intercity bus drivers, 23% participated in anti-AIDS activities in their communities, 13% had been in contact with an outreach worker and 39% had discussed HIV/AIDS issues with a peer group educator during the past year.
3.3.2.7 Perception of risk
When asked about their perception of risk, 60% of truckers felt that they were at no or low risk for HIV infection because they trusted their partner (60%), had no contact with infected people (20%) or because they practiced abstinence (17%). The small percentage of truckers (3%) who felt at moderate or high risk for HIV infection, said that they perceived their risk level as moderate or high because they had more than one sexual partner or had experienced condom breakage.
About 69% of minibus drivers said they felt at no or low risk for HIV infection because they trusted their partner and/or always used condoms. The 11% of minibus respondents who perceived themselves to be at moderate or high risk for HIV infection did so because they had more than one sexual partner and/or practiced unprotected sex.
Amongst intercity bus drivers, 70% felt themselves to be at no or low risk for HIV infection because they trusted their sexual partner, regularly used condoms and/or never had any injections. Those who perceived themselves to be at moderate or high risk (7.3%) felt so because they practiced unprotected sex, had more than one sexual partner and/or had sex with FSWs.
3.3.3 Rural population groups (farmers and pastoralists)
3.3.3.1 Socio-demographic characteristics
A total of 1489 individuals from two rural population groups were studied: farmers from the locality of Butajira (n = 798) and pastoralists from Borena (n = 703). There were 743 females amongst the rural respondents (61% of total) including 390 farmers and 353 pastoralists.
Age
Amongst rural groups, considerable proportions of the respondents were over 30 years old (46.9% of pastoralist and 35.2% of farmers); mean ages for the groups were 31.7 years for the pastoralists and 28.5 years for the farmers.
Education
Many of the rural respondents had not attended school (70.0% of pastoralists and 65.5% of farmers). Amongst those who had attended school, the mean number of years of schooling was 6.9 and 4.6 years for pastoralists and farmers, respectively.
Marital status
About 70.6% of the farmers and 87.8% of the pastoralists had ever been married. Out of those who reported marriage, 66.9% of the farmers and 79.4% of the pastoralists were currently married and living with their spouse. About 32% of the farmers and 17.8% of the pastoralists were unmarried and were not living with a sexual partner. Age at first marriage was below 20 years for 48.5 and 60.1% of the farmers and pastoralists, respectively.
Amongst the married pastoralists and farmers, 26.7 and 17.4%, respectively, had polygamous marriages.
Residence and mobility
A relatively higher proportion of pastoralists (23.8%) than farmers (2.6%) had been away from home for more than a month in the previous 12 months.
Religion
About 72% of the farmers and 59% of the pastoralists were Muslims. A further 27.7% of farmers and 13.1% of pastoralists were Christians. About 27.3% of the pastoralists reported ‘no religion’ as compared with only 0.1% of farmers (one respondent).
Circumcision
About 99% of the farmers and 93% of the pastoralists were circumcised. In the case of females, 100% of the female farmers and 90.6% of the female pastoralists had been circumcised.
3.3.3.2 STIs/HIV/AIDS and related knowledge
Knowledge of STIs
Amongst the pastoralists, 90.9% had heard of STIs; in contrast, only 20.9% of the farmers were aware that STIs existed. The rural respondents, who knew that STIs existed, were asked whether they knew any symptoms of STIs for men and women, separately (symptoms were not read out to the respondents). Compared with farmers, the pastoralists were better able to name the most common symptoms of STIs. Amongst pastoralists, the most commonly mentioned three symptoms of STIs in women were genital discharge (56.8%), burning pain on urination (71.2%) and foul smelling discharge (40.4%); in comparison, the same symptoms were mentioned by only 11, 12.2 and 2.4% of farmers, respectively. The most commonly mentioned symptoms of STIs in men were genital discharge (57.7% of pastoralists vs. 22.6% of farmers), burning pain on urination (75.5% of pastoralists vs. 26.2% of farmers) and genital ulcers/sores (66.4% of pastoralists vs. 7.9% of farmers). In general, respondents were more aware of male than female STI symptoms.
Knowledge and misconceptions about HIV/AIDS
Over 95% of the rural respondents were aware that HIV/AIDS existed. Of the respondents who had heard of HIV/AIDS, 76.1% of pastoralists but only 34.7% of farmers knew someone who was infected with HIV and/or had died of AIDS. Amongst this subgroup, 10.3% of the farmers and 17.0% of the pastoralists reported that the affected person/people were close relatives and/or close friends.
Amongst farmers and pastoralists, respectively, only 17.7 and 24.5% were able to name all three of the major HIV preventive methods.
The three most common misconceptions amongst the pastoralists and farmers were that HIV could be contracted by eating uncooked egg from a chicken that had swallowed a condom (92.3 and 88.5%, respectively), by eating raw meat prepared by a person infected with HIV (66.4 and 65.4%, respectively) and by mosquito bites (54.2 and 64.3%, respectively). These misconceptions lowered the comprehensive knowledge level of the respondents. Only 8.8 and <1.0% of the male and female farmers, respectively, were considered to have comprehensive knowledge of HIV/AIDS; in contrast, 11.7% of male pastoralists and 9.1% of female pastoralists were considered to have comprehensive knowledge.
Knowledge about condoms
Most pastoralists (84.6%) and 52.2% of farmers had heard of male condoms. Of those who were aware that male condoms existed, considerable proportions (87.9% of pastoralists and 51.4% of farmers) knew where they could obtain male condoms.
Only 13.5% of pastoralists and 2.6% of farmers were aware of the existence of female condoms.
Stigma and discrimination
Indicators used to assess stigma and discrimination are shown in Annex 4B. More than 98% of the rural respondents had at least one stigmatizing attitude (pastoralists 99.3% and farmers 97.4%). Amongst all rural respondents, the three major stigmatizing attitudes were: an unwillingness to buy food from a shop-keeper who was known to have HIV (92.8 and 84.2% of pastoralists and farmers, respectively); a belief that PLWHA should be quarantined (77.1 and 71.5% of pastoralists and farmers, respectively); and an unwillingness to allow PLWHA to participate in community meetings or to allow infected youth to look after cattle (71.2 and 67.8% of the pastoralists and farmers, respectively).
Mother-to-child transmission of HIV/AIDS
About 79.3% of the pastoralists and 77.4% of the farmers were aware that an HIV infected pregnant woman could transmit the virus to her unborn child; however, only a small proportion of these (9.9 and 2.9% of pastoralists and farmers, respectively) knew that antiretroviral medication could be used to reduce the risk of transmission. Other respondents thought that nothing could be done (45.7 and 42.1% of pastoralists and farmers, respectively). Most rural respondents had no idea that it was possible to reduce the risk for mother-to-child transmission of HIV during pregnancy.
More than 80% of the rural respondents were aware that an HIV infected mother could transmit the virus to her baby through breastfeeding.
3.3.3.3 Alcohol and drug use
Very few pastoralists and farmers drank alcohol regularly (4.9 and 7.5% of pastoralists and farmers, respectively).
Amongst pastoralists and farmers, 27.3 and 47%, respectively, reported ‘ever use’ of khat. Furthermore, amongst those who had ever used khat, 76.2% of the farmers and 62.5% of the pastoralists were regular users. A few pastoralists (2.4%) but no farmers reported ‘ever use’ of shisha. No pastoralists or farmers reported any use of hashish, Mandrax, cocaine, crack, benzene or injected drugs.
3.3.3.4 Sexual behavior
On average, farmers and pastoralists had been 19.8 and 17.4 years old, respectively, at sexual debut. Female respondents were younger than male respondents at sexual debut: 17.8 vs. 22.1 years old, respectively, for farmers (P<0.001) and 16.2 vs. 18.7 years old, respectively, for pastoralists (P<0.001).
Amongst those who had ever had sex, the majority of respondents (93.5 and 81.2% of farmers and pastoralists, respectively) reported that they had been sexually active during the previous 12 months. Virtually all of these farmers and pastoralists reported having regular sex partners (87.4 and 99.8%, respectively); in contrast, none of the farmers and only 0.28% of the pastoralists reported having had commercial sex partners. A small proportion of pastoralists (12.4%) and only 0.2% of farmers reported having non-regular sex partners during the previous 12 months.
Amongst those who were sexually active, 3.8% of farmers and 22.6% of pastoralists reported having had more than one sexual partner during the previous 12 months. Amongst the respondents who were married, only 0.2% of farmers but 15.7% of pastoralists reported having extramarital sex during the previous 12 months.
Condom use
Only 2 of 703 pastoralists reported having had a commercial sex partner in the previous 12 months; one of these men used condoms with their commercial sex partner. None of the farmers reported having a commercial sex partner and none reported condom use with their regular or non-regular partners.
STI symptoms
To assess the prevalence of STIs, the respondents were asked whether they had experienced genital discharge and/or genital ulcers/sores in the previous 12 months. Amongst the pastoralists, 11.0 and 2.6%, respectively, reported that they had experienced genital discharge and genital ulcers/sores. However, none of the farmers reported either genital discharge or genital ulcers/sores.
3.3.3.5 HIV testing and exposure to interventions
HIV testing
Amongst farmers, 11% said it was possible to get confidential HIV tests in their community; however, only 0.8% had ever had an HIV test. Of those farmers who had taken an HIV test, 50% said it was voluntary and 50% returned for their test results. Nevertheless, 83% said that they were willing to undergo VCT in the future.
Amongst pastoralists, only 1.4% said it was possible to get confidential HIV tests in their community; a similar proportion (1.9%) had taken an HIV test. Of those pastoralists who had taken an HIV test, 85% said it was voluntary and 82% of them returned for their test results. Nevertheless, 77% said that they were willing to undergo VCT in the future.
Exposure to interventions
Amongst farmers, 40% listened to radio, 3% watched TV and 1.5% read printed media regularly during the previous four weeks. Of those who used the mass media regularly during the previous four weeks, 64% had listened to HIV/AIDS messages on the radio, 4.5% had seen HIV messages on TV and 4% had read about HIV in the printed media; most of these respondents commented that the meaning of the messages was clear. In the previous year, only 2% of farmers had participated in anti-AIDS activities in their communities, 2% had discussed HIV/AIDS with an outreach worker and 17% had discussed HIV/AIDS with a peer educator.
Amongst pastoralists, 35, 5 and 0.4%, respectively, listened to radio, watched TV and read printed media regularly during the previous four weeks. Of those who used the mass media regularly during the previous four weeks, 61% had listened to HIV messages on the radio, 25% had seen HIV messages on TV and 4.5% had read articles about HIV; most of these respondents commented that the meaning of the messages was clear. In the previous year, only 10% of pastoralists had participated in anti-AIDS activities in their communities, 16% had discussed HIV/AIDS with an outreach worker and 26% had discussed HIV/AIDS with a peer educator.
3.3.3.6 Perception of risk
When asked about their perception of risk, 96% of the farmers reported that they felt at no or low risk for HIV infection because they trusted their partners and had no contact with infected people. A very small proportion of farmers (0.6%) felt at moderate or high risk of HIV infection because they practiced unprotected sex.
Amongst pastoralists, 89% felt that they were at no or low risk for HIV infection because they trusted their partners, took no injections and had no contact with infected people. A small proportion (6.3%) of pastoralists felt that they were at moderate to high risk because they had more than one sexual partner, had practiced unprotected sex or had taken ‘unsafe’ injections.
3.3.4. Factory workers
3.3.4.1. Socio-demographic characteristics
A total of 599 factory workers, 434 male and 165 female, participated in the study.
Age
The respondents were between 15 and 49 years old. Most of the factory workers (72.6%) were over 30 years old (mean = 35.1 years old).
Education
A considerable proportion of the respondents (88.3%) had attended school (mean number of years of schooling = 8.8 years) indicating that most of the factory workers were literate.
Marital status
More than 70% of the factory workers had ever been married (84.2 and 67.3% of females and males, respectively). For female factory workers, age at first marriage ranged from 9 to 34 years with a mean age of 17.9 years. For male factory workers, age at first marriage ranged from 9 to 38 years with a mean age of 23.8 years.
Circumcision
Of the factory workers, 95.6% of the males and 84.8% of the females were circumcised.
Religion
Most of the factory workers were Christians (93.5 and 92.1% of male and female workers, respectively). Only 6.2% of the male and 6.7% of the female factory workers were Muslims.
Residence and mobility
The majority of the factory workers lived in Akaki. Duration of residence in Akaki ranged from less than one year (2.2%) to 50 years (1.0%). Most of the factory workers (53.7%) had lived in Akaki for more than 24 years (mean and median 25.7 and 25.0 years, respectively).
Only 6.7 and 5.5% of the female and male factory workers, respectively, reported that they had been away from their homes for more than a month within the previous 12 months.
Employment and support
Amongst the factory workers, 19.2% reported that their spouses or sexual partners were employees of the factory. Of those whose spouses or sexual partners were employed at the factory, 23.5% said that they worked the same shifts as their partners. The mean and median monthly incomes were ETB 296.50 and 255.00, respectively.
Most of the factory workers (80.1%) reported that they supported someone (children, parents or others). The proportion of monthly income shared with family differed between the factory workers: 19.5% reported that they gave up to half of their monthly income; 38.7% said that they gave more than half; and 11.5% gave all of their monthly income to their family.
3.3.4.2 STIs, HIV/AIDS and related knowledge
Knowledge of STIs
Most factory workers (95%) had heard of sexually transmitted diseases. Those who had heard of STIs were asked to describe STI symptoms in women and men. The most commonly mentioned symptoms of STIs in women were genital discharge (21.8%), burning pain on urination (17.7%) and foul smelling discharge (12.1%). The most commonly mentioned symptoms of STIs in men were genital discharge (43.2%), genital ulcers/sores (40.9%) and burning pain on urination (37.2%).
Knowledge and misconceptions about HIV/AIDS
Most factory workers (97.3%) had heard of HIV/AIDS. Of those who had heard of HIV/AIDS, 75.1% knew someone who was infected with HIV and/or had died of AIDS; 39.3% reported that the individual was a close relative and/or a close friend (see Annex 4B). About 55 and 30% of the male and female factory workers, respectively, could correctly name the three major methods for preventing HIV infection.
Misconceptions relating to HIV transmission were read out and the respondents were asked to agree or disagree with each statement (see Annex 4B). Respondents with one or more incorrect response were considered to have misconceptions. A summary of the responses to the individual indicator statements (selected from UNAIDS indicators of misconception) is presented in Annex 4B.
Nearly all of the factory workers (99.1 and 100% of male and female respondents, respectively) were found to have at least one misconception about HIV/AIDS. The three major misconceptions relating to modes of HIV transmission were that: HIV could be contracted by eating an uncooked egg, laid by a chicken that had previously swallowed a condom (97.4%); HIV could be contracted by eating raw meat prepared by a person infected by HIV (69.4%); and that HIV transmission could be prevented by drinking local alcoholic liquor and eating hot pepper (21%).
The composite indicators, knowledge of the three preventive methods and absence of misconceptions about HIV/AIDS transmission, were combined to examine comprehensive knowledge about HIV/AIDS. On this basis, only 19% of the factory workers had comprehensive knowledge. Although many factory workers knew the three major preventive methods, their inability to identify misconceptions greatly reduced the levels of comprehensive knowledge.
Knowledge about condoms
The majority of factory workers (96.1%) had heard of male condoms. Most of those who had heard of male condoms knew where to get them (84.6%). Shops and pharmacies were the most commonly mentioned sources (90.8 and 61.1% respectively), followed by health centers/hospitals (41.1%), family planning centers (15.7%) and bars/guest houses/hotels (15.1%). A very small number of factory workers (0.6%) reported that they could obtain male condoms from FSWs.
Regarding accessibility of condoms, most factory workers (90.0%) reported that they could obtain condoms at locations less than 30 minutes (by foot) from their home or work. There was no indication that condoms were expensive to obtain.
Nearly 25% of all the factory workers mentioned that they had heard of female condoms.
Stigma and discrimination
Amongst the factory workers, 59.2% said that they would be unwilling to buy food from a shopkeeper or food seller if they knew that he/she was HIV positive. Moreover, 40% of the respondents were not willing to share a meal with an HIV positive person. In addition, 27.6% of the respondents believed that if a worker in their factory had HIV but was not sick, he/she should not be allowed to work in the factory.
Mother-to-child HIV transmission
Most factory workers were aware that HIV could be transmitted from an HIV infected mother to her unborn child (84.3 and 92% of male and female factory workers, respectively).
Respondents who knew that HIV could be transmitted from an HIV positive mother to her unborn child were asked what a pregnant woman could do to reduce the risk for transmission of HIV to her unborn child. Possible actions were suggested to which respondents could answer ‘yes’ or ‘no’. The majority of participants said that nothing could be done (41.5%) whilst 14.3% recommended seeking medical advice and 8.3% suggested abortion. Of all the respondents, only 11.5% recommended antiretroviral therapy.
Factory workers (male and female) were more aware that HIV could be transmitted from a pregnant woman to her unborn child than that HIV could be transmitted through breastfeeding. Results showed that slightly more women than men were aware of the risk of HIV transmission during breastfeeding (74.8 and 69.8% for women and men, respectively; see Annex 4B).
3.3.4.3 Alcohol and drug use
Amongst the factory workers, 41.4% had ever drunk alcohol and only 29.4% drank alcohol regularly.
Overall, 22.1% of male and 3.6% of female factory workers had ever used drugs (see Table 3.3.5). The most commonly used drug was khat; it was used by 102 (17.0%) of the male and female factory workers.
Table 3.3.5 ‘Ever use’ of specific types of drugs by factory workers.
Target group |
Number (%) | |||||||
Khat |
Shisha |
Benzene |
Hashish |
Mandrax |
Cocaine |
Crack |
IDU | |
|
Male factory workers |
96 (22.1) |
7 (1.6) |
7 (1.6) |
3 (0.6) |
3 (0.6) |
3 (0.6) |
3 (0.6) |
0 (0.0) |
|
Female factory workers |
6 (3.6) |
1 (0.6) |
1 (0.6) |
1 (0.6) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
3.3.4.4. Sexual behavior
Amongst the factory workers, average age at first sex was 19.2 years for males and 17.1 years for females (P<0.001). In the previous 12 months, most factory workers had had regular sex partners (89%); a further 8% reported having non-regular sex partners and 1% (6 men) reported having commercial sex partners.
Amongst those who were sexually active, only 5.8% had had multiple sexual partners in the previous 12 months. Amongst married factory workers, 2.9% had had extramarital sex in the previous 12 months.
Condom use
Of those who ever used male condoms, 88.0% of the male and 76.1% of the female respondents knew where they could obtain condoms.
Amongst those who had been sexually active in the last 12 months, 46.4% of males and 75% of females had used condoms the last time they had sex with a non-regular sexual partner of less than 12 months; in contrast, 53.3% of males and 33.3% of females had used condoms the last time they had sex with a non-regular partner of 12 months or more.
Amongst those who had been sexually active in the last 12 months, 53.8% of males and 100% of females used condoms consistently with non-regular partners of less than 12 months; in comparison, 37.5% of males and 100.0% of female factory workers used condoms consistently with non-regular partners of 12 months or more.
The six male factory workers who reported sex with commercial partners were asked whether they used condoms. All six men had used condoms the last time they had sex but only four (66.7%) of them used condoms consistently with commercial partners.
STIs and treatment seeking behavior
Factory workers who reported that they had experienced symptoms of STIs in the previous 12 months (see Table 3.3.6) were asked whether they had sought medical treatment (some respondents gave more than one answer). About 50% of those reporting symptoms had sought advice/treatment from a workplace clinic or hospital, 33.3% had sought advice/treatment from a government clinic/hospital, 16.7% sought advice/treatment from traditional healers and 33.3% said that they didn’t seek any advice/treatment.
Table 3.3.6 Proportion of factory workers who reported that they had experienced STI symptoms during the previous 12 months.
|
Symptoms |
Number (%) | |
Male factory workers (n = 434) |
Female factory workers (n = 165) | |
|
Genital discharge |
2 (0.5) |
3 (2.0) |
|
Genital ulcers/sores |
2 (0.5) |
1 (0.7) |
3.3.4.5 HIV testing and exposure to interventions
HIV testing
Amongst the factory workers, 35.8% reported that it was possible to get a confidential HIV test in their community.
It was noted that some workers at factories in the area were part of an Ethio-Netherlands AIDS Research Project (ENARP) cohort and had undergone VCT; unfortunately, further information about this testing was not available when this report was prepared.
Exposure to mass media
Of the factory workers, 71% listened to radio, 53% watched TV and 19.5% read printed media regularly during the previous four weeks. In the previous 12 months, a considerable number of the factory workers had heard or seen HIV messages on radio, on TV or in the printed media (88, 69 and 42%, respectively); the majority commented that the messages were clear.
Exposure to interventions
In the past year, 64% of the factory workers had participated in HIV/AIDS interventions, 11% had discussed HIV/AIDS with an outreach worker and 23% had discussed HIV/AIDS with a peer educator.
3.3.4.6 Perception of risk
Amongst factory workers, 69% felt at little or no risk for HIV infection, primarily because they trusted their partner, had taken no injections or practiced abstinence. A small proportion of factory workers (4.6%) felt at moderate or high risk for HIV infection because they had multiple sexual partners, had practiced sex without a condom or had received unsafe injections.
3.3.5 Comparisons between the adult groups
3.3.5.1 Alcohol and drug use
Transport workers reported the highest rates of regular alcohol intake in the previous four weeks. Drug use was highest amongst minibus drivers and farmers. The uniformed services (ground forces and air force) reported the lowest rates of regular alcohol consumption and drug use.
3.3.5.2 Sexual behavior
Multiple sexual partners
Across all adult groups, almost a third of those who were sexually active during the previous 12 months reported that they had had more than one sexual partner in the last 12 months (see Figure 3.3.1). Multiple sexual partners were most common amongst ground forces personnel (63.5%) and least common amongst farmers (3.8%) and factory workers (5.8%).
Extramarital sex
Overall, 33% of married respondents from the uniformed services, transport workers, rural population and factory worker groups had had extramarital sex in the previous 12 months (see Figure 3.3.2). Extramarital sex was most common amongst ground forces personnel (60%) and least common amongst factory workers (8%).
Figure 3.3.1 Adults with more than one partner in the last year (as a percentage of sexually active). N.B. Data for farmers and pastoralists include those for respondents who had polygamous marriages.
Figure 3.3.2 Extramarital sex in the previous 12 months – by adult group.
Condom use
Condom use with commercial and non-regular sexual partners was examined and comparisons were made between the adult groups. Figures 3.3.3 and 3.3.4 show the data for commercial and non-regular sexual partners, respectively.
At last sex with a commercial partner, the majority of the adult groups had used condoms (overall, >95% of uniformed services, transport workers, rural population groups and factory workers). Only two pastoralists and none of the farmers surveyed had commercial sexual partners; one of the two pastoralists used condoms and used them consistently.
At last sex with a non-regular partner, many of the adults had used a condom. Condom use at last sex with a non-regular sexual partner was highest (82%) amongst intercity bus drivers, about 62% amongst factory workers and lowest (1.6%) amongst pastoralists. Across all adult groups (uniformed services, transport workers, rural population groups and factory workers) around 60% had used condoms consistently with non-regular partners during the previous year; however, amongst intercity bus drivers only a small percentage (12.4%) had used condoms consistently.
Figure 3.3.3 Condom use in sex with commercial partners – by adult group.
3.3.5.3 HIV testing and exposure to interventions
Access to confidential HIV testing was greatest amongst the uniformed services (46.6%) and least (1.4%) amongst pastoralists. A greater percentage of air force respondents than other groups had ever taken HIV tests (27.3%); other adult groups reported much lower percentages, ranging from 0.8% amongst farmers to 15.6% amongst the ground forces. In the majority of cases (approximately 70%) testing was voluntary, except amongst the uniformed services where 55.4% of those tested said that they were required to have the test.
Figure 3.3.4 Condom use in sex with non-regular partners – by adult group.
Of the uniformed services respondents who took HIV tests, only 75% collected their test results. Nevertheless, in other adult groups, most of those who took HIV tests also obtained their test results.
Participants reported that much of the HIV testing was provided without counseling. The proportion of HIV tested respondents who had received pre- and post-test counseling ranged from 38.3% amongst uniformed services personnel to 92.3% amongst pastoralists. Interestingly, most of the adult group respondents who had taken an HIV test had taken the test during the previous 12 months.
Exposure to mass media HIV messages
The majority of respondents in the adult groups had listened to the radio or watched television during the previous four weeks (71, 87, 54 and 82% of the uniformed services, transport workers, rural residents and factory workers, respectively). Most respondents had heard HIV/AIDS messages on the radio in the past year; amongst the various adult groups, exposure to radio messages was highest amongst intercity bus drivers (95.7%) and minibus drivers 95.3%, and lowest amongst pastoralists (61.4%). Most respondents (85%) in each adult group thought that the radio messages were clear. Across all the adult groups, fewer respondents had seen HIV/AIDS messages on TV than had heard HIV/AIDS messages on the radio. As with radio messages, most respondents considered the TV messages to be clear. Exposure to HIV/AIDS messages on TV was highest amongst truckers (92.2%) and lowest amongst farmers (4.5%).
Overall, more than 62% of the adult group respondents had been exposed to HIV/AIDS messages through at least one of the three mass media channels.
Many adult group respondents reported that they had participated in at least one community HIV/AIDS intervention in the previous 12 months (96, 80.8, 46.4 and 45.9% of uniformed services, truckers, pastoralists and farmers, respectively). Nevertheless, none of the farmers and pastoralists, and <25% of the uniformed services and truckers knew of organizations in their communities that provided assistance to PLWHA.
To assess the role of the media in increasing knowledge about HIV/AIDS and influencing behavior change, the relationship between exposure to media HIV/AIDS messages and knowledge of the three HIV preventive methods was examined. Amongst the adult groups, exposure to HIV/AIDS messages in the last year was positively correlated with knowledge of the three major preventive methods for HIV/AIDS (P<0.001). However, exposure to HIV/AIDS messages in the media had no significant impact on the reported number of misconceptions. Higher levels of exposure to HIV/AIDS messages in the media were associated with higher levels of condom use with commercial sex partners. Most (94%) of those who reported media exposure to HIV/AIDS messages had used a condom the last time they had sex with a commercial partner; in contrast, condom use at last sex with a commercial partner was considerably less (82%) amongst those who had not seen or heard HIV/AIDS messages in the media. Nevertheless, exposure to media HIV/AIDS messages had no obvious effect on condom use during extramarital sex (i.e. when both commercial and non-regular sex partners were considered).
3.3.5.4 Relationships between knowledge, sexual behavior, HIV testing and perception of risk for HIV infection
Relationships between knowledge of HIV/AIDS and sexual behavior were examined. Adult group respondents were found to engage in risky sex (any unprotected sex with a non-regular or commercial partner), irrespective of whether they knew that abstinence and faithfulness protected against HIV infection.
Amongst adult group respondents who knew that faithfulness with one uninfected partner could prevent HIV infection, 24% reported having more than one sexual partner in the previous year. Moreover, amongst adult group respondents who knew that consistent condom use could protect against HIV/AIDS, 13.9% had risky sex in the previous year (see Figure 3.3.5). The most frequently given reason for not using a condom was trust in the partner.
Figure 3.3.5 ‘BC’ vs. sexual behavior – by adult group.
Across all adult groups, 13% of respondents reported that they had had risky sex in the previous year. Ground forces respondents and minibus drivers reported that around 18% of all sex in the previous year had been risky sex. The most frequently cited reason for not using a condom was trust in the partner. These findings were examined in relation to use of VCT services. Data showed that only 13% of adult respondents who had risky sex in the previous year had also undergone VCT.
Most (91%) adult group respondents perceived themselves to be at low or no risk for HIV infection, primarily because they trusted their partners. Amongst uniformed services respondents who perceived themselves to be at low or no risk, the majority (54.8%) justified their perceptions by saying that they used condoms consistently. Amongst factory workers who perceived themselves to be at low or no risk for HIV infection, 17% justified their perceptions by saying that they practiced abstinence. Across all adult groups, those who perceived themselves to be at moderate or high risk for HIV infection did so primarily because they had practiced unprotected sex and/ or had multiple sexual partners.
Amongst adult group respondents who reported that they had had unprotected sex in the previous 12 months, only 27% perceived themselves to be at moderate or high risk of HIV infection (see Figure 3.3.6).
Figure 3.3.6 Perception of risk for HIV infection amongst adult group respondents who had unprotected sex in the previous 12 months. (N.B. Data for farmers are not included as only four farmers had any unprotected sex during the previous 12 months).
