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Introduction
At the initial stage, the victim
of AIDS were generally male homosexual, but later on it
was established that the people who used un-sterilized
needles to inject drug to their body, people who had
been transfused blood, females whose male sexual
partners were infected with AIDS, children of such
parents. Till 1989, hetero sexual attachment was
believed to be safe from AIDS, but it was then found
that such sex acts as careers of AIDS virus, as in that
year about 90 percent of the cases recorded were found
to be originated from heterosexual involvement
(Compton's Interactive Encyclopedia: 1999). It is
possible for people to avoid high risk behavior or to
engage in low or safe behavior practicing condom use
while engaging in potential risky sexual activities, to
clean / bleach / sterilize needle and syringe before
using/ sharing; otherwise to use disposable needle and
syringe for injection and to receive only tested
certified blood for blood transfusion. Therefore, to
reduce the risk of HIV infection the only priority is
the prevention of HIV infection (Keithellakpam: 1999).
Twenty
five years ago the first HIV infected patient was
diagnosed in India but after that the rate in which
HIV/AIDS infection has spread in the country is
alarming. India homes the fourth largest population
suffering from AIDS. As per report of National Aids
Control Organization (NACO), a
semiautonomous organization under the Ministry of
Health, the estimate of India’s population living with
HIV is 2.31 million in 2008. The number showed a
diminishing pattern compared to the previous figure of
2.73 million in 2002. Even then, some of the north
eastern states of India have high prevalence rates like
Manipur (1.57 %), Mizoram (0.75 %) and Nagaland (0.6 %)
as per NACO Report of 2007, mainly because of injecting
drug use.
The
main sculpt of HIV pretension in developing countries is
the ABC model, which is based on three pillars:
abstinence, faithfulness, and condom use (Araujo: 2008).
However, the success of the model depends on the
awareness of the citizens. In India, discussions about
sex remain off-limits in most households, in schools,
colleges and even in institutes of higher learning.
Traditionally, most Indian health officials and the
health care establishments viewed HIV as a “foreign”
disease or an “imported” infection, confined to people
returning from foreign countries or port cities and to
marginalized groups such as sex workers and drug users
and unlikely to spread to the general population (Mitra:
2004). However, the reduction of risk of the disease can
only be done if the people, at large, are aware of the
reasons that may lead to HIV infection. Several steps
are taken by government, semi-government and other
voluntary organization to arouse public awareness
related to the disease.
The
North-Eastern
region (NER) of India comprises of seven states,
Assam, Arunachal Pradesh, Manipur, Meghlaya, Mizoram,
Nagaland, Sikkim and Tripura, and has been
described as the most diverse, complex and resourceful
region of the country (Agarwal, 1997). Whereas the vast
region accounts for nearly 7.8 percent of India’s total
land area (262230 sq. km.),
the population density is indexed by approximately 151
persons per sq. km (Census, 2001). The hilly terrains
have naturally divided the population into different
cultures, religions, languages and traditions. The
geographical isolation also hinges on lack of
infrastructural development, leaving a narrow corridor
to connect the NER states with the rest of the country (Agnihotri,
2004; Kumar, 2002).
In the region, language has always
remained a barrier for communication. There are around
420 languages and dialects of different language
families that make North East India a different
socio-linguistic area (Samuel, 1993). Thus, a uniform
language for promoting awareness about the disease would
not produce mass impact. The campaign in print and
electronic media should be in different languages and
hence not only the central government but also the state
and local governing bodies should have to play their
role is raising the awareness of the people about HIV
infection by bringing about campaigns in different local
languages.
The
present paper looks into the awareness level among the
married couples of the different states of North East
India using different statistical tools and compares the
awareness level of various cross-section of the said
population. The remainder of the paper is organized as
follows. The next section discusses the relevant
literature. Section 3, 4 and 5 describes the objective
of the study, data and methodology respectively. Section
6 provides the results of the study and the last section
concludes the paper highlighting the major findings.
Review of Literature
Studies related to the spread of
HIV-AIDS in the North Eastern region of India and the
awareness level of the disease amongst the masses are
rare and far between. A few such studies include
Keithellakpam (1999), Mitra (2004), Cohen (2004), Panda
(2002). The initial concerns that HIV/AIDS may come out
as a serious pandemic in India was expressed in the
works of Ghosh (1986), Piot and Over (1993). On
awareness about the disease, Bharat, Aggleton, and Tyrer
(2001) using data from Mumbai conclude that HIV/AIDS
denial and stigma are very high in India reaching
hospitals, place of employment, schools, and even
families. Ambati, Ambati, and Rao (1997) using data from
educated individuals in southern India conclude that
this subgroup of the population have very good knowledge
about the disease and support policies to increase AIDS
awareness in the population; however, stigma was still
found to be somewhat high. Godwin (1998) concludes that
AIDS remains widely
misunderstood due to strong national cultural taboos and
a lack of education. Mitra (2004) finds that in
India stigma and misconceptions, coupled with
complicated social norms and conservative attitudes
toward sex, make it difficult for politicians and
policymakers to get beyond taboos when responding to the
epidemic.
Araujo (2008) shows that knowledge about AIDS in the
population is actually very low, but increases with
education and wealth. For some recent literature related
to cross-sectional studies on HIV infected patients in
India one may read Srikanth
and others (2010).
Objective of the Study
Knowledge is all that a person
knows. It is having an understanding of something or
whole – many be material or immaterial. It can be
acquired through others experience or by own experience.
However, misconception is wrong knowledge of something
or whole of animate or inanimate. It may be due to lack
of scientific approach of understanding or pre-conceived
idea, which compels one not to have clear approach to
know something. The paper is thus designed keeping in
view the following objectives:
(i)
To study the
knowledge on HIV-AIDS among the married couple of North
Eastern Region (NER).
(ii)
To measure the
impact of education of both husband and wife and
residential type on the categorical value of the
knowledge about the transmission of HIV.
(iii)
To compare the
knowledge regarding transmission of HIV among the rural
and urban people.
Data and Methodology
Data has been taken from the
Reproductive and Child Health Survey (RCH II) in 2005.
The variables considered in this study are:
(i)
State
(ii)
Type of residence
(Rural = 0, Urban = 1)
(iii)
Husband’s education
( Ability to read and write = 0, Inability = 1)
(iv)
Wife’s
education ( Ability to read and write = 0, Inability
= 1)
(v)
Awareness of AIDS
(Misconception = 0, Complete Knowledge = 1), which is
considered as the dependent variable.
(vi)
Respondent's
perception about one can get HIV/AIDS from someone who
has HIV/AIDS by :
(a)
shaking hands with
him/her;
(b)
hugging with
him/her;
(c)
kissing with
him/her;
(d)
sharing clothes
with him/her;
(e)
sharing eating
utensils with him/her;
(f)
stepping on urine
or stool of that person;
(g)
bites of mosquito,
flea or bedbug.
If a
respondent provides correct answer to all the responses
from (a) through (g), then the respondent is considered
to have complete knowledge, else the respondent is
supposed to have misconception. Thus the awareness level
of the respondent is divided into two heads either the
respondent has misconception about HIV/AIDS or has
complete knowledge. As discussed ‘Awareness of AIDS’ can
be represented by a dummy variable that has the value
‘1’ if the individual has complete knowledge and ‘0’ in
case of misconception. The study was performed on 25044
individuals. The composition of the sample is shown in
table 1.
Results
Table 1 below shows the
composition of the sample. It classifies the respondents
belonging to the different states classified by their
awareness level about the disease viz. Misconception or
Complete Knowledge as well as by the type of residence
viz. Rural or Urban.
From Table 1, it
can be seen that in the rural area the proportion of the
population with misconception about HIV/AIDS is more
compared to the people with complete knowledge. This is
true for all the states except for Manipur where more
people are found to have complete knowledge. However, in
the urban area more people seems to have complete
knowledge about the matter in the states of Arunachal
Pradesh, Manipur and Sikkim. While in the states of
Assam, Mizoram and Nagaland more people are found to
have misconception. The proportion of people having
misconception about HIV/AIDS and those with complete
knowledge are close to each other in the states of
Meghalaya and Tripura.
The following
table shows the knowledge on
HIV-AIDS among the married couple of North Eastern
Region (NER) having awareness of HIV-AIDS.
From the table we
find that if we consider the entire population of the
north eastern states the misconception about HIV/AIDS is
more compared those with complete knowledge. This is
true amongst all the cross section of the population
viz. rural-urban or any of the states in particular. The
only exception is Manipur, where the percentage of
people having complete knowledge is more than those
having any misconception and this is true for both the
rural and urban area of the state.
However, it may be noted that Manipur
has the highest number of HIV positive cases amongst the
northeastern states and third amongst the Indian states
after Tamil Nadu and Maharashtra (Sinlung, 2007).
According to the last
epidemiological report of HIV/AIDS in Manipur, brought
out by the Manipur State AIDS Control Society (September
1986 to April 2003), 15,166 out of a total of 95,734
blood samples screened were HIV-positive. In a state
which has an area of 22,327 sq km and a population of
around 2.3 million (2001 census), this is the highest
concentration of HIV/AIDS infection in India (Ahanthem,
2003).
The effects of
the explanatory variables over the response variable are
studied with the help of the logistic regression. The
output of the logistic regression is given below:.
From the above
table it has been revealed that if husband with
education is taken as the reference category then there
is a significant relation between education level of
husband with their knowledge about HIV/AID. Those men
without education is 30 percent less likely (odds ratio
0.692) to have complete knowledge about HIV/AIDS
compared to those with education. However, for the women
the level of education has a week association (p-value
0.092) with complete knowledge about HIV/AIDS. In case
of the place of residence, if rural is taken as a
reference variable then there is a significant relation
between place of residence with the knowledge of the
respondents about HIV/AID. The urban people with an
odds ratio of 1.408, implies that the rural population
is 41 percent more informative compared to their urban
counterpart.
From the above
table it has been revealed that in the rural population
if husband with education is taken as the reference
category then there is a significant relation between
education level of husband with their knowledge about
HIV/AID. Those men without education is 27 percent less
likely (odds ratio 0.733) to have complete knowledge
about HIV/AIDS compared to those with education.
However, for the women the level of education has a week
association (p-value 0.046) with complete
knowledge about HIV/AIDS.
From the above
table it has been revealed that in the urban population
if husband with education is taken as the reference
category then there is a significant relation between
education level of husband with their knowledge about
HIV/AID. Those men without education is half as likely
(odds ratio 0.506) to have complete knowledge about
HIV/AIDS compared to those with education. However, for
the women the level of education has no association (p-value
0.726 > 0.05) with complete knowledge about HIV/AIDS.
Conclusion
As obvious
the people in the rural areas of northeast India have
more misconception about HIV/AIDS compared to those
residing in the urban areas irrespective of the sex. The
educated men have more knowledge compared to the
uneducated group. But in case of women the difference
between the percentage of people with complete knowledge
about HIV/AIDS amongst those with education and those
without education is negligible. This is true for both
rural and urban women. This factor needs to be attended;
it means that even education of women of the northeast
India does not play a significant role to do away with
the misconception that they have about HIV/AIDS. Thus
special program is to be designed to enhance the
awareness of women about it. Though Manipur has the
highest prevalence rate of HIV cases but here the
maximum proportion of people has complete knowledge
about HIV/AIDS irrespective of the place of residence.
The greater proportion of complete knowledge may be
attributed to the high prevalence rate which has made
the people aware of the reasons responsible for HIV
transmission.
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