Existing Knowledge on HIV/AIDS of Women at the Border Area in Bangladesh

	1. Md. Aminul Haque, Assistant Professor, Department of Population Sciences, University of Dhaka. 2. Hafizur Rahman, Monitoring and Evaluation Officer, Family Planning Association Bangladesh, (FPAB)
	Md. Aminul Haque E-mail: aminul1975@yahoo.com

ABSTRACT This paper studies existing knowledge on HIV/AIDS of women at the border area in Bangladesh. A woman is depressed from before her birth, by gender preference and she faces various types of depression in her life at various ages. Women and girls are commonly discriminated against in terms of access to education, employment, credit, health care, land and inheritance. A woman can acquire HIV through unprotected sex with an infected partner, through receiving contaminated blood or through non-sterile instruments or medical procedures.

INTRODUCTION

Bangladesh is a low HIV prevalence country with several well-documented at risk groups, the most prominent of which is brothel-based sex workers and injecting drug users. Today's low level of HIV infection in our country does not guarantee low prevalence tomorrow. Experience teaches us that early epidemics do not show their magnitude at the beginning^[1]. According to government statistics, a cumulative total of 874 cases of HIV/AIDS had been confirmed and reported as of 31st December 2006. A total of 240 AIDS cases were detected so far of which 109 had already died^[2].

Many risk factors like, high prevalence of HIV in the neighboring countries, increased population movement both internal and external, lack of awareness of HIV infection, existence of commercial sex and MSM with multiple clients, high prevalence of STIs amongst the commercial sex workers, spread of HIV through bridging population (transport workers, drug users), the trend of rise of HIV among injecting drug users (IDUs), low condom use and lack of voluntary blood donation make Bangladesh vulnerable to HIV infection^[3].

However, we must not adopt a complacent attitude in respect to these facts as our country has all the determinants for an explosive outbreak of an HIV/AIDS epidemic. Curses of poverty, illiteracy, ignorance, proximity of Bangladesh to the so-called 'Golden Triangle' & high prevalence of STDs, make our country seriously vulnerable. Drug use increases the HIV risk and can start very early, for example, glue-sniffing by youngsters living or working on the streets. The danger of becoming infected with HIV by sharing injecting equipment is well known, and real.

Unemployment, slum housing, family fragility, frequent cross-border movement of people, lack of information, unsafe blood transfusion, physical and sexual abuse create a "risk environment" of violence for many young people in the region. In addition increased number of migrant workers, unsafe practice in health services, unsafe sex practices etc. movement of population, less use of condoms, polygamy, homosexuality, extra-marital relations, further increases the susceptibility^[3].

Bangladesh behavioral surveillance survey (BSS) reports on several high-risk factors: (a) larger number of men buying sex than in other countries in Asia, (b) Low levels of knowledge about HIV/AIDS, (c) low perception of personal risk among vulnerable populations, and (d) low condom use rates among sex workers^[1].

Rationality

Women are most vulnerable in this country for their low economic and social status; the inequality between men and women, and economic deprivation helps to drive the epidemic. Women and girls are commonly discriminated against in terms of access to education, employment, credit, health care, land and inheritance. A woman can acquire HIV through unprotected sex with an infected partner, through receiving contaminated blood or through non-sterile instruments or medical procedures. However, HIV is usually introduced into the family through the woman's sexual partner. A government survey found that out of 216 new HIV positive cases identified in 2006, unemployed people were on top of the list at 39.35% followed by housewives at 21. 29% and businessmen at 10.18 percent^[2]. It is noted that those unemployed and businessmen with HIV positives are risky for women, since HIV/AIDS is a sexually transmitted disease. Information on knowledge and on the level and intensity of risk behaviors related to HIV/AIDS is essential in identifying populations at most risk for HIV infection and in better understanding the dynamics of the epidemic. The indicators on knowledge and misconceptions are an important prerequisite for prevention programs to focus on increasing people's knowledge about sexual transmission, and, to overcome the misconceptions that act as a disincentive to behavior change^[1].

Objectives of the Study
The major objective in this paper is to identify the knowledge on HIV/AIDS of women at the border area in Bangladesh. There will be specified some objectives such as,
1. To assess the knowledge about HIV/AIDS.
2. To assess the knowledge about the spread and prevention of HIV/AIDS.
3. To asses the knowledge about the groups vulnerable to AIDS.

Review of Literature

Bangladesh is considered a high-risk country for several reasons: the presence of covert multi-partner sexual activity and denial, the low level of knowledge and low condom use, unsafe professional blood donation, high incidence of self-reported sexually transmitted infections among vulnerable groups, coming back of expatriates working in different countries, and high levels of HIV/AIDS in the two neighbouring countries, India and Myanmar, all contribute to the spread of HIV^[4-8,9]. On the other hand, the country's vulnerability is very high compared to other parts of South Asia and infection rates within the vulnerable groups are increasing, leading to an ever-greater possibility that the virus will spread to the general population^[4,5,10]. In this critical situation, public awareness can play a dominating role preventing an HIV/AIDS epidemic^[11]. But awareness level with knowledge of correct ways to avoid HIV/AIDS among the general people in Bangladesh is quite low. Among the men aged 15-54, 18% have never heard of HIV/AIDS, 24% have heard but don't know any correct ways to avoid it and only 58% know one or more correct ways to avoid the disease^[12]. On the other hand, 40% ever-married women have never heard of HIV/AIDS, 19% have heard but don't know any correct ways to avoid it and only 41% know one or more correct ways to avoid the disease^[12].

These situations have raised serious concern among the government and various stakeholders and they are seeking to increase the public awareness on HIV transmission and prevention. So, it is important to identify the reasons that are associated with level of awareness, which will be helpful in strengthening Govt./NGO/development-partner agencies' capacity for program planning, implementation, monitoring and evaluation regarding AIDS awareness. In this regard a few national and international researchers have made attempts to understand the reasons and come up with some explanations^[11,13,14].

METHODOLOGY

This study is an explanatory research which is based on survey research method. It is also based on primary data and used a questionnaire for data collection. After data collection data were coded in the proper way and coded data entered into a well recognized statistical software SPSS (windows) and inputted data edited and cleaned. At last cleaned data was analyzed. Sample size was determined by using the following formula:
= 384
S is the sample size for the population.
Z is the percentile of standard normal distribution determined by specified confidence level. It is 1.96 for 95% confidence level.
d is the desired precision considered as 5%.
P= 0.50; about 50% are women in Bangladesh
1-P = 1-0.50 = 0.50

A total of 384 women were interviewed in this study. A quantitative survey was conducted from among 384 women living in Banapole land port area of Bangladesh by using a systematic sampling method.

FINDING AND DISCUSSION

All the respondents were female in this study; the mean age was 23.40 years and maximum numbers of respondent (62.0%) were aged below 25. Around 51.3 percent of respondents were currently married. Respondents had a low level of education, with 15.6 percent of women study respondents who had completed secondary level and 45.6% had completed primary level. (Table 1)

Women were tested on a variety of general knowledge issues relating to HIV/AIDS. Almost two-third (65.9 per cent) have heard about AIDS. Out of them, most women (87.0 per cent) know that AIDS is a serious disease, half (50.2) of women know that it has no treatment, more than two-fifths (43.5 per cent) of women know that it is a disease created by HIV virus and almost the same number of women (41.9 per cent) women know that it means death. Only one fourth (26.9) women know that, when a person has HIV/AIDS, his/her body is unable to defend itself against common illnesses and diseases.

Most women (75.1 per cent) identified unsafe sexual activities, almost seven tenths (69.2 per cent) cited the sharing of unsafe drug needles, almost half (45.1 per cent) and more than two-fifths (43.9 per cent) indicated that it could be transmitted through blood transfusions. Approximately one in five provided more generic responses including that HIV is transmitted through infected mother to child (19.8 per cent). Approximately one-fifth (19.4 percent) were unable to provide an answer.

More than three-fourths (77.1 per cent) indicated that safer sex would be practiced primarily to reduce the risk of AIDS. More than half (55.7 per cent) of women indicated that avoiding risky sexual intercourse would help, almost half (44.7 percent) indicated that receiving blood after screening, two-fifths (40.3 per cent) cited sex with a reliable partner, almost two-fifth (36.8 percent indicated that safe needle use to prevent AIDS while almost two-fifths (17.8 per cent) said to avoid drugs and a few (5.9 percent) indicated that early treatment, if present, of sexually transmitted diseases. More than one-tenth (12.6 percent) were unable to provide an answer.

Respondents perceive that hand shaking, embracing, mild kissing, coughing, using the same bath room, and using the same pond are not risky behaviors of HIV/AIDS carriers (38.3, 36.0, 39.5 and 32.0 per cent, respectively). Excluding these behaviors, respondents indicated a wide range of other behaviors, such as to use same utensil (53.8 per cent), to sleep in the same bed (45.5 per cent), to play with an infected person (24.5 per cent) and to be bitten by a mosquito, fly and other insect bites are not risky. It is also mentioned that 12.6 per cent said that they don't know which behaviors are not risky.

The maximum number of women (64.4 per cent) indicated that rapid weight loss is the main symptom of AIDS. Respondents perceive suffering from a fever for a long time, severe illness, and swollen glands are the symptoms of AIDS (38.7, 32.0 and 25.7 per cent respectively). Excluding these symptoms, respondents indicated that suffering from long time diarrhea, unwillingness to take food and infection in the mouth are the symptoms of AIDS (17.0, 13.8 and 11.9 percent respectively).

Respondents perceived an infected person should be given healthy food, get regular treatment, regular exercise and avoid drugs (58.5, 49.8, 36.4 and 39.5 per cent, respectively). Excluding these respondents indicated an infected person should avoid mental and physical stress (14.2 per cent). It is also mentioned that 23.7 per cent said that they don't know what should be done for an infected person.

Respondents most often perceive sex worker, polygamy male and injecting drug users as groups that have been most affected by HIV/AIDS (79.1, 49.4 and 31.6 per cent, respectively). Excluding these specific groups, respondents indicated a wide range of other members of the population who have been affected by the disease. These include people engaging in polygamy female (26.1 per cent), truck driver (13.0 per cent), and homosexual person (5.5 per cent). It is also mentioned that 15.4 per cent said that they don't know who is vulnerable.

CONCLUSION

Almost two-thirds (65.9 per cent) of women have heard about AIDS. It indicates that a major portion of women have not ever heard about AIDS. Out of them, most women know that AIDS is a serious disease and it has no treatment; only one fourth of women know that, when a person has HIV/AIDS, his/her body is unable to defend itself against common illnesses and diseases.

Most women identified unsafe sexual activities, almost seven tenths cited the sharing of unsafe drug needles, almost half and more than two-fifths indicated that it could be transmitted through blood transfusions. Approximately one-fifth were unable to provide an answer. A maximum number of women indicated that safer sex would be practiced primarily to reduce the risk of AIDS. More than half of the women indicated that avoiding risky sexual intercourse, almost half indicated receiving blood after screening. More than one-tenth of women were unable to provide an answer. Respondents indicated a wide range of other behaviors such as to use the same utensil, to sleep in the same bed, to play with an infected person and to be bitten by a mosquito, fly and other insects are not risky. It is also mentioned that more than one-tenth of respondents said that they don't know which behaviors are not risky. A maximum number of women indicated that rapid weight loss is the main symptom of AIDS. Respondents perceive suffering from fever a long time, severe illness, and swollen glands are the symptoms of AIDS.

Respondents perceive an infected person should be taking healthy food, get regular treatment, regular exercise and avoid drugs. It is also mentioned that one fourth of respondents said that they don't know what should be done for an infected person. Respondents most often perceive sex worker, polygamy male and injecting drug users as groups that have been most affected by HIV/AIDS. It is also mentioned that more than one seventh of respondents said that they don't know who is vulnerable. From the above discussion, it is revealed that a maximum number of women know AIDS is a sexually transmitted disease and a large number of women didn't know aboutits spread, prevention, or what should be done for an infected person, symptoms, vulnerable groups, etc. of AIDS.

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