http://doi.org/10.33698/NRF0034 – Suksham Chopra, Indarjit Walia, Karobi Das
Abstract : Worldwide, 39.4 million people are living with HIV/AIDS. In India, the number of HIV positive cases has risen to 5.3 million, and it is rising consistently. Women due to their vulnerability are facing the greatest challenge of handling this menace. The study was carried out with randomly selected 235 antenatal mothers seeking antenatal care both in rural and urban areas of Chandigarh, during 2003-2004. It was disheartening to note that despite so much health awareness campaigns more than one third of them had not heard of HIV/AIDS (33.6%). Of those who had heard about AIDS, majority of them were aware that HIV can be transmitted either through sex or blood and blood products. HIV can also be transmitted through mother-to-child or through breast feeding to the infant was known to nearly fifty percent of the respondents. Media played an important role in creating awareness about this deadly menace. NGO’s too can play an important role in counselling antenatal mothers to start antiretroviral therapy and create awareness about AIDS and its consequences in different sections of the society.
Key Words :
Acquired Immuno Deficiency Syndrome, awareness, routes of transmission.
Correspondence at :
Indarjit Walia
Principal,
National Institute of Nursing Education, PGIMER, Chandigarh, India.
Introduction
Ever since the first case of AIDS (Acquired Immuno Deficiency Syndrome) was reported in India (1986), the number of HIV positive cases has been on the increase.1 Currently, the number of persons in the grip of HIV/AIDS has risen to 5.3 million.2 Worldwide, 39.4 million people are living with HIV/AIDS, and of these, 8.2 million are in the Asian region. Reportedly in India, serious epidemics are under way in states such as Maharashtra, and Tamil Nadu. Even in Manipur, a high prevalence of HIV has been found among injecting drug users (IDUs) for the last one decade and it is rising consistently.3
Women all over the world are facing the greatest challenge of handling this menace because of their greater vulnerability. Preventive measures including health education seem to be the only means to put a halt to HIV transmission. We are aware that in developing countries, Mother-to-Child Transmission (MTCT), is responsible for 5- 10 percent of the total number of new cases of HIV infections each years4. Thus, physicians, nurses, and other health care workers, who deal with the patients with HIV, are confronted with complex challenges. In 2001, the United Nations General Assembly Special Sessions (UNGASS) had emphasized the importance of reducing the proportion of infants infected with HIV by 20 percent, by end of 2005, and by 50 percent, by 20105. It was also emphasized that 80 percent of pregnant women who received antenatal care had access to HIV prevention services. It has been brought out that the risk of Mother-to- Child transmission can be reduced in several ways: (i) prevention of new infections in parents to be; (ii) prevention of unwanted pregnancies in HIV infected women; and (iii) transmission from an HIV infected mother to her infant.6
A decade ago, it was recommended that all health care professionals should counsel the pregnant women about HIV and to encourage testing7 HIV, and, if indicated, initiate Zidovudine therapy.8 Pregnant women are at risk of not only acquiring the disease but also transmitting it to their infants. Keeping this background in mind, study was had undertaken to assess antenatal mothers’ awareness about HIV/AIDS. For this purpose, respondents were selected from urban and rural areas of Chandigarh. The focus was on this group because at this stage, women are more receptive to health-related matters and their role in caring and rearing of family also acquires importance.
Materials and Methods
A group of 235 pregnant women seeking antenatal care, both in rural and urban areas of Chandigarh, was randomly selected for interviews, during 2003-2004. Only those women were included in the study who had shown willingness to participate in it after being clearly explained about its objectives. The interviews were carried out in the local language so as to facilitate communication and to understand their viewpoint clearly. Data were gathered with the help of a semi- structured interview schedule, which was prepared after pretesting, by a female investigator, trained in social sciences. Certain selected findings per taining to their sociodemographic background and their awareness about HIV/AIDS are presented here.
Results
- Sociodemographic characteristics of antenatal mothers’ and their awareness about HIV/AIDS
Despite so much stress on AIDS awareness campaigns, it is somewhat disheartening to note that nearly one third of the pregnant women interviewed had not heard of HIV/AIDS (33.6%). A significant relationship was found with their rural /urban background and awareness about AIDS. In particular, a highly significant relationship was observed between their educational status and their awareness about AIDS. A similar relationship also emerged in regard to their caste-status. It was found that antenatal mothers representing upper caste or middle caste groups or belonging to higher economic status were more aware of AIDS as compared to those who belonged to the lower or backward classes. However, no significant relationship was found between age of the respondents and the stage of pregnancy during which antenatal mothers were
Table 1 : Antenatal mothers’ characteristics and their awareness about AIDS
| Sociodemographic Characteristics | Awarence about AIDS
Yes No |
x2
Total |
||
| n =156 n =79 | n=235 | |||
| I. Habitat | ||||
| i. Rural | 37.2 | 53.1 | 42.5 | |
| ii. Urban | 62.8 | 46.9 | 57.5 | 5.48*
df = 1 |
| II. Educational Status
i. Illiterate |
10.1 |
48.5 |
23.4 |
|
| ii. Upto primary or secondary level | 43.1 | 51.5 | 45.4 | |
| iii. Graduates and above | 46.8 | – | 31.2 | 71.92**
df = 2 |
| III Caste Status
i. Upper caste |
28.2 |
13.9 |
23.4 |
|
| ii. Middle Caste | 41.1 | 10.3 | 30.5 | |
| iii. Lower or Back ward Caste | 30.7 | 75.8 | 46.1 | 44.2** df = 2 |
| IV Age (in years)
i. Less than 25 |
44.8 |
51.8 |
47.2 |
|
| ii. 26-30 | 41.1 | 34.3 | 38.7 | |
| iii. 31 and above | 14.1 | 13.9 | 14.1 | 1.17 n.s. df = 2 |
| V Family Type
i. Joint |
51.9 |
26.6 |
43.4 |
|
| ii. Nuclear | 48.1 | 73.4 | 56.6 | 13.71**
df = 1 |
| VI Number of living Children
i. Ist para |
26.9 |
32.9 |
28.9 |
|
| ii. 1-2 | 67.9 | 59.4 | 65.2 | 8.85** |
| iii. 3 and more | 5.2 | 7.7 | 5.9 | df = 2 |
| VII Stage of Pregnancy
i. Less than 12 weeks |
21.8 |
15.2 |
19.6 |
|
| ii. 13-24 weeks | 33.3 | 31.6 | 32.8 | 1.96 n.s. |
| iii. 25 weeks and above | 44.9 | 51.2 | 47.6 | df = 2 |
* p<0.05; **p<0.01; n.s. = non significant
Table 2 : Antenatal mothers’ awareness about routes of HIV transmission
| Routes of transmission |
Rural |
Habitat Urban |
Total x2 |
||
| n=58 | n =98 | n=156 | |||
| One can get infected | |||||
| I. Sexual Route | I | 96.5 | 85.7 | 89.7 | |
| II | – | – | – | 4.65* | |
| III | 3.5 | 14.3 | 10.3 | ||
| II. Blood and blood products | I | 72.4 | 90.8 | 83.9 | |
| II | 24.1 | – | 8.9 | 26.79** | |
| III | 3.5 | 9.2 | 7.2 | ||
| III Mother to child | I | 51.7 | 56.1 | 54.4 | |
| II | 5.2 | 5.2 | 5.2 | .61 n.s. | |
| III | 43.2 | 38.7 | 4.4 | ||
| IV Breast feeding the infant | I | 41.3 | 56.2 | 50.6 | |
| II | 34.6 | 15.3 | 22.5 | 7.80* | |
| III | 24.1 | 28.5 | 26.9 | ||
| V Sharing personal items | I | 8.6 | 12.2 | 10.9 | |
| II | 70.8 | 81.6 | 77.5 | 7.69* | |
| III | 20.6 | 6.2 | 11.6 | ||
| VI Hugging and Kissing | I | 25.8 | 20.1 | 10.9 | |
| II | 60.3 | 87.8 | 77.5 | 22.91** | |
| III | 13.9 | 10.1 | 11.6 | ||
| VII Mosquito bites | I | 17.2 | 5.2 | 9.6 | |
| II | 20.6 | 28.5 | 25.6 | 6.57* | |
| III | 62.2 | 66.3 | 64.8 | ||
| VIII Coughing and sneezing | I | 20.6 | 15.3 | 17.3 | |
| II | 51.8 | 46.9 | 48.8 | 1.88 n.s. | |
| III | 27.6 | 37.8 | 33.9 | ||
| IX Condoms provides protection | I | 65.4 | 69.4 | 67.9 | |
| II | 3.5 | 4.1 | 3.9 | .37 n.s. | |
| III | 31.1 | 26.5 | 28.2 | ||
I = Yes, II= No; III = Do not know/No idea.
*p<0.05; **p<0.01; n.s. = non significant
df= 2
interviewed. But a significant relationship was found in relation to their family type (joint vs nuclear) and the number of their living children. (Table 1).
- Antenatal mothers’ awareness about the routes of HIV transmission
Studies have revealed that HIV can be transmitted mainly through three routes, namely, sex, blood and blood products, and mother to child9-10. Data were gathered specifically, from those respondents who had heard about AIDS, regarding their awareness about the routes of HIV transmission. The findings showed that nearly ninety percent of these respondents were aware of the sexual route of HIV transmission. A significant relationship was also found in relation to their background and their awareness about the sexual route of transmission. Similarly, a significant relationship was found in regard to their awareness about transmission of HIV through blood and blood products. As mentioned earlier, mother-to-child transmission of HIV is responsible for 5 to 10 percent of the total cases. The findings in this regard showed no significant relationship between mothers’ background and their awareness about this route of HIV transmission. That HIV can be transmitted through breast-feeding was known nearly to 50.6 percent of the respondents.
On the positive side, a majority of the respondents were found to be aware of the fact that HIV can not be transmitted either through sharing of personal items (undergarments, utensils) or (kissing or hugging) yet, there were some who had misconceptions about the transmission of HIV through mosquito bites, coughing or sneezing. (Table 2).\ C Antenatal mothers’ sources of information aboutHIV/AIDS
It is widely known that the media plays an important role in creating awareness about HIV/ AIDS among the people. In this study too, a majority of the antenatal mothers, both in rural and urban areas, were found to have heard about HIV/AIDS, either through television or radio. Interestingly, the radio was found to be more popular among rural women as compared to their urban counterparts. Because of their low educational status, the print media was responsible for creating awareness among less than ten percent of the respondents (8.3%). Even the camp approach of health workers was found to be less popular as only 5.8 percent of the antenatal mothers had heard about AIDS from health workers. Keeping in view that sexual route is the predominant route of HIV transmission, people feel shy of discussing this disease among themselves. These findings too have shown that only 3.8 percent (urban women) had heard about this either through their friends or relatives (Table 3).
- Antenatal mothers’ awareness about AIDS symptoms, testing, and treatment A majority of the antenatal mothers were not aware of the exact symptoms of AIDS. In their opinion, AIDS patients generally suffered from weakness, weight loss, fever, cough and tuberculosis. Only five of them
Table 3 : Antenatal mothers’ sources of information about HIV/AIDS
| Sources of Information | Rural n = 58 | Habitat Urban |
Total |
| n = 98 | n = 156 | ||
| I Media | |||
| Television | 60.3 | 73.5 | 68.6 |
| Radio | 25.9 | 6.1 | 13.5 |
| II Print Media | |||
| Newspapers/ Magazines etc. | 5.2 | 10.2 | 8.3 |
| III Others | |||
| Health Workers/Camps etc. | 8.6 | 4.1 | 5.8 |
| Friends and Relatives | —- | 6.1 | 3.8 |
Table 4 : Antenatal mothers’ awareness about different aspects of AIDS
| Awareness about various aspects of AIDS |
Rural |
Habitat Urban |
Total |
| n = 58 | n = 98 | n = 156 | |
| I AIDS Symptoms Yes |
13.9 |
11.2 |
13.7 |
| No | 86.1 | 88.8 | 86.3 |
| II HIV/AIDS Test
Yes |
27.6 |
30.6 |
29.4 |
| No | 72.4 | 69.4 | 70.6 |
| III Ever tested For HIV/AIDS | |||
| Yes | 3.5 | 12.2 | 8.9 |
| No | 96.5 | 87.8 | 91.1 |
| IV HIV/AIDS Treatment No cure |
13.7 |
36.8 |
28.2 |
| Can be treated if diagnosed early | 24.2 | 18.4 | 20.5 |
| No idea/Don’t know | 62.1 | 44.8 | 51.3 |
pinpointed the role of poor body immune system. When enquired whether they had seen any AIDS patients only seven of them gave a positive response. It was found that less than one-third of them were aware that one can be tested for HIV (29.4%). Only 8.9 percent of them had also reported that they had undergone HIV test and were found negative. Studies have shown that in the developed countries it is mandatory for every antenatal mother to undergo HIV testing but in the developing countries, the situation is quite different11.
The findings also revealed that there were many misconceptions about the treatment of AIDS. While 28.2% percent of the respondents had clearly mentioned that there was no cure for AIDS; 20.5 percent were of the view that AIDS can be treated, if it was diagnosed at an early stage. But more than fifty percent (51.3) of them stated that they had no idea about its treatment (Table 4).
Discussion
There is hardly need to highlight the general recommendations that all health care workers should counsel pregnant women about HIV testing. It is stressed that introduction of antiretroviral drugs and avoidance of breast feeding reduces the transmission of HIV by 51 percent, to 67.5 percent4. On the positive side, this study showed that more than fifty percent of the antenatal mothers were aware that HIV can be transmitted to the fetus during antenatal period and to newborn through breast feeding in the postnatal period. Studies have also pointed out that mor tality among HIV-I infected was higher in women who breastfed their babies with formula11. Studies have also reported that Nevirapine was more effective (47 percent) than Zidovudine in preventing perinatal transmission12-13. In order to reduce perinatal transmission it is essential to treat STDs as treatment of STDs not only decrease HIV exposure to genital tract but also reduces perinatal transmission14.In this study too, of those subjects who had heard about AIDS, 67.9 percent were aware of the fact that transmission of HIV can be prevented by the use of condoms. In one study, it has been brought out that condoms are protective against HIV infections and reduce the probability of HIV transmission per sex act by as much as 95 percent and reducing the incidence of serodiscordant couples by 95 percent when used consistently15. Thus, the use of condoms remains as an essential weapon to fight against HIV, but women need to be educated to protect themselves against HIV in regular partnership. Women also should be counselled to start antiretroviral therapy, if needed. Recently, comprehensive reviews of HIV/ AIDS studies have shown that women who are in need of antiretroviral prophylaxis do not begin interventions either due to programme based barriers or due to socio- cultural and economic circumstances16-18. Thus, Non Government Organizations (NGOs) and media can play an important role in creating greater awareness about AIDS and its consequences among different sections of the society.
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