COMPARATIVE EVALUATION OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS HIV/AIDS IN HIV SEROPOSITIVE AND HEALTHY INDIVIDUALS

Background: Acquired immune deficiency syndrome (AIDS), caused by HIV is a serious threat to human society. There has been no effective cure for the disease and it is considered to be the leading cause of death. Insufficient knowledge and misconceptions have made tackling of AIDS a challenge. Therefore, assessing the awareness in healthy individuals and HIV infected patients makes the disease a point of prime concern. Objectives: To compare the knowledge of and attitude towards HIV/AIDS in HIV seropositive and healthy individuals. Materials and Methods: The study comprised of healthy individuals and HIV seropositive patients 250 in each group in the age range of 15-65 years from Lucknow. A self structured questionnaire was used to assess the knowledge, attitude and practice towards HIV/AIDS in both the groups after their consent. Results: Among the study group, the healthy individuals had higher knowledge, positive attitude and knew the right practices towards HIV/AIDS as compared to infected individuals. Conclusion: Peer educational programs related to healthy sexual practices and right attitudes should be developed. Government and Health educators should provide educational campaigns and media especially for HIV infected individuals.


INTRODUCTION
AIDS when first emerged, no one foresaw how it would change many million lives across the world. There was no idea of what it caused and how to prevent it (Haridra V, 2008).
AIDS was first recognised in United States (1981). In 1983, Human Immunodeficiency Virus (HIV) was isolated from a patient with lymphadenopathy and by 1984, it was clearly demonstrated to be the causative agent (Fauci SA and Lane HC, 2005). Nearly 40 million people across the globe are affected with HIV/AIDS, with approximately 1600 new cases being reported everyday (Hiremath SS, 2013). The first case of HIV in India was detected in 1986 among Commercial Sex Workers (CSW) in Tamil Nadu Singh (SK et al, 2013). It is estimated that there are about 5.134 million HIV infected individuals in India (Singh A et al, 2012). Uttar Pradesh has an estimated population of 196 million with HIV prevalence of less than 1% (HIV Sentinel Surveillance and HIV Estimation, 2006). AIDS being an infectious disease lacks curative treatment; the only option to halt its progression is to increase the awareness. Widespread ignorance, poor information and misconceptions are responsible for social stigma and discrimination. Understanding about the knowledge, attitude and practices about HIV/AIDS among the infected and the general public will help us formulate strategies for prevention, treatment and improving compliance to treatment (Meena LP et al, 2013). Moreover, to bridge the gap between HIV patients and healthy individuals, it is necessary to assess the awareness among the two groups.

RESULTS
Among the 500 samples evaluated, the age of controls and cases ranged from 17 to 60 years and 15 to 60 years respectively, with mean (± SD) 35.12 ± 13.29 years and 35.93 ± 9.40 years.   Attitude: Table 2 shows the correct attitudes i.e. AIDS patients should be isolated, should be allowed to attend school, continue with the job and sex education be provided in schools; lowered significantly in cases as compared to controls (p<0.001).
Practice: Table 3 shows the correct practices i.e. use of latex condoms to prevent HIV/AIDS (78.0% vs. 42.8%) and discussion about AIDS with parents/relatives; which lowered significantly in cases as compared to controls. However, cases underwent prior blood screening for fear of acquiring the disease; which was significantly high (p=0.025).

DISCUSSION
AIDS is the most destructive epidemic in recorded history. Uttar Pradesh has an estimated population of 196 million with an HIV prevalence of less than 1%; making it a low prevalence but highly vulnerable province (HIV Sentinel Surveillance and HIV Estimation, 2006 59.6% controls and 32.4% cases in our study agreed that AIDS is an infectious disease. These findings were similar with reported studies (Bansal RK, 1994, Benjamin AI and Zachairah P, 1997, Singh SK et al, 2007, Singh S, 2002 The correct knowledge about the spreading of HIV from mother to child was 74.4% in controls and 46.8% in cases, the findings were in contrast to Chauhan T et al, 2013 who reported that 4.9 % HIV seronegative and 7% HIV seropositive individuals were aware about the fact.
In the present study, majority of people in both the groups were aware that AIDS does not spread by mosquito bite. Nevertheless, 13.6% of controls and 17.6% cases still had this misconception because mass media has limitation in establishing two way communications to clear up misunderstandings (Tadese A et al, 2013). The frequency of incorrect knowledge that HIV spreads by sharing meals with HIV Seropositive patients were low and found to be similar in both groups. Our findings were in favor with the reported literature (Singh SK et al, 2007 andNagdeo NV et al, 2010). Both groups, in the present study had correct knowledge that HIV doesn't spread by shaking hands with infected patients which favored the findings of reported studies (Selcuk K et al, 2005, Bhalla S et al, 2005and Pramanik S et al, 2006.
The correct knowledge of HIV/AIDS spread by unscreened blood transfusion was 65.6% in controls and 43.6% in cases. Our findings for control group were in accordance with those of Singh SK et al, 2007 andReddy CB et al, 2013; whereas for cases the findings were in contrast to Meena LP et al, 2013. In the present study, both groups believed that talking to an infected person will not spread the disease. However 18.8% controls and 28.8% cases believed that HIV can spread by kissing an infected person. Similar observations were reported by Malleshappa K et al, 2012 andAggarwal A et al, 2012.
The knowledge about the spread of HIV through multiple sex partners were 72.8% in controls and 48.4% in cases. Our findings were in accordance with previously reported research of Singh SK et al, 2007 andShewta C et al, 2011. In the present study, 16.8% controls believed that AIDS is curable as compared to 36.8% cases. The findings of Aggarwal A et al, 2012 andUnnikrishnan B et al, 2010 supported our findings amongst controls. Meena LP et al, 2013 revealed that 35.3% AIDS patients and 47.5% of general population believed that there is complete cure for AIDS. A negligently low number in both the groups of our study felt that AIDS can be cured by traditional/spiritual means.
The awareness about the tests available for diagnosis of HIV was 80.8% in controls and 53.2% in cases. The low level of awareness among AIDS patients suggest the need to increase proper interventions so that more people identify risk taking behaviors and make informed health decisions.
14.8 % cases in our study knew about ELISA. Although rapid testing should leave a positive impact on HIV infected patients the awareness was low due to difficulty in perceiving the technical name of the test.
43.2% controls believe that HIV/AIDS patients should be kept away from the society in comparison to cases (26.8%). Our findings in controls were in accordance with the findings of Sobhan K et al, 2004 but in contrast to Malleshappa K et al, 2012. 76.8% Controls believed that HIV/AIDS patients should be allowed to attend school/college as compared to 51.2% Cases. Similar findings were reported by Unnikrishnan B et al, 2010. 77.6% controls believed that AIDS patients should be allowed to continue in their jobs as compared to 50.8% cases. The findings amongst healthy group were higher in reports by Pramanik S et al, 2009. We believe that stigmatization would make people hesitant to continue working with healthy individuals. Further it can result in people living with HIV being shunned by the community, thereby not letting them to attend offices.
80.8% controls believe that sex education should be a part of curricula in schools as compared to 37.6% cases. Pramanik S et al, 2006 stated that 18.2% adolescents in their study felt that sex education should only be given to those who are going to be married while 27.6 % adolescents believe that sex education should be restricted to home. The present study also revealed that AIDS patients had agreed that their change of status being positive has made them alert and conscious.
78.0% controls and 42.8% cases in this study believed that latex condoms can prevent HIV/AIDS; our findings was in contrast to Chauhan T et al, 2013 who reported that only 15.7% seropositives and 21.4% seronegatives had knowledge about condom as a means of prevention. This indicates that the financial constraints in the lower strata of the society could be redeemed as the reason for not using protection. Moreover, people were shy and have wrong notions related to condoms. More easily available and economical options should be provided to the public to practice safer sexual habits.
In the present study, the prior blood screening done for fear of acquiring the disease was significantly higher in cases (18.8%) as compared to controls (11.6%) correlating with the findings of Chauhan T et al, 2013 who has reported that 22% of seronegatives as compared to 16% of seropositives agreed to get screened before marriage. Compulsory blood screening prior to marriage or at specific intervals will prove efficacious in reducing the number of HIV cases.
48.8% controls in the present study agreed that they have discussed about the disease with their parents/ relatives in comparison to 26.4% Cases. Our findings for controls were in accordance with the findings of Basir G et al, 2003. Ajayi B et al, 2013 in their study revealed that 61 % of people living with HIV/AIDS in Nigeria had discussed with a confidante about their HIV status while 58% HIV patients had told their partners. Fear and guilt of having contracted the virus perhaps kept the patients away from openly discussing their doubts on HIV (Pallikadavath S et al, 2006). India is a country where discussing sex is a taboo, unless the society opens up to freely discussing such topics, stigma to AIDS will remain.
24.4% of cases in the present study agreed that they attended counseling centres for HIV/AIDS which was nearly in accordance with the findings of Chauhan T et al, 2013. This variation may be attributable to one's health belief and health seeking behavior, social networks, income, perceived health status and severity of the disease. Fear of positive results and stigma were the reasons for not attending Voluntary Counseling Testing services. 16.4% HIV patients agreed that they are now doing social efforts to improve awareness among others. This indicates that despite of knowing the disaster caused by this deadly disease, HIV individuals are still ignorant about the disease.

CONCLUSION
Higher awareness was observed in healthy individuals when compared to HIV seropositive patients among the population of Lucknow. A series of approaches is needed especially among HIV seropositive individuals including interventions that focus on psychological patterns, behavioral skills and dynamics of sexual interactions and relationships. More role-play is needed from the government/administration to launch various information, education and communication (IEC) campaigns/ workshops to halt the spread of the disease.