Background
In 1992, India’s National AIDS Control Programme (NACP) was established to prevent and control the spread of HIV/AIDS across the country. This program has evolved significantly over the years and is currently in its fourth phase. The primary focus of this phase is multifaceted, aiming to address various aspects of the HIV/AIDS epidemic comprehensively. One of the key priorities of the NACP is to prevent new HIV infections through a combination of strategies, including promoting safe practices, increasing access to preventive measures such as condoms and clean needles, and enhancing the availability of testing services. This effort is crucial in reducing the overall incidence of HIV in the population. Additionally, the programme places a strong emphasis on providing comprehensive care, support, and treatment for people living with HIV. This includes the provision of antiretroviral therapy (ART), which helps in managing the virus and improving the quality of life for those infected.
The NACP also focuses on preventing the transmission of HIV from parents to their children, ensuring that pregnant women receive the necessary interventions to reduce the risk of mother-to-child transmission. Raising awareness about HIV/AIDS is another critical component of the NACP. The programme works to educate the public about the disease, its transmission, and the importance of testing and treatment. This educational effort is aimed at reducing stigma and discrimination against people living with HIV, which is essential for encouraging individuals to seek testing and treatment without fear of social repercussions. Furthermore, the NACP strives to generate demand for HIV services, particularly among women and youth. This involves targeted outreach and education campaigns designed to inform these groups about the availability and importance of HIV services. By focusing on these populations, the programme aims to address the specific vulnerabilities and risk factors that they face. Overall, the fourth phase of India’s National AIDS Control Programme represents a comprehensive approach to tackling the HIV/AIDS epidemic, encompassing prevention, treatment, care, support, and public education. Through these efforts, the programme seeks to create a supportive environment that encourages individuals to access necessary services and reduce the impact of HIV/AIDS on individuals and communities.
The assessment of HIV/AIDS knowledge among Indian women and men is based on two key domains, utilizing data from the National Family Health Survey (NFHS). These domains encompassed Basic Knowledge of HIV/AIDS and Knowledge of HIV/AIDS Prevention Methods. In order to ensure a thorough understanding of Knowledge of HIV/AIDS Prevention Methods, various indicators associated with HIV/AIDS prevention methods were incorporated into the analysis.
Initially, the primary level of knowledge associated with HIV/AIDS is assessed by examining whether men and women have heard about HIV/AIDS across various demographic, economic, and spatial factors. This parameter provides insight into whether HIV/AIDS receives sufficient exposure within the population or not.
Gender disparities in HIV knowledge
Fig: 1
In the 4th round of the National Family Health Survey (NFHS-4), 89% of men and 76% of women reported that they have heard about HIV or AIDS. In the subsequent 5th round of the National Family Health Survey (NFHS-5), this knowledge increased to 94% for men and 87% for women. Since NFHS-4, knowledge of HIV/AIDS has increased more among women (11%) than men (5%). Additionally, the gender gap has also decreased by 6% from NFHS-4 (13%) to NFHS-5 (7%).
Fig: 2
Individuals aged 15-19 and 40-49 exhibit comparatively lower knowledge of HIV/AIDS than those aged 20-39, regardless of gender. In the 15-19 age group, 82% of women and 91% of men have heard about HIV/AIDS, whereas among individuals aged 40-49, 86% of women and 94% of men possess knowledge about the disease. In contrast, individuals aged 20-39 show higher awareness, with 89% of women and 95%-96% of men reporting knowledge. Men consistently demonstrate better knowledge than women, with an approximate 8% gender gap in the 15-19 and 40-49 age groups.
Urban residents show greater knowledge of HIV/AIDS compared to their rural counterparts. In urban areas, 93% of women and 97% of men are aware of HIV/AIDS, while in rural areas, these figures drop to 84% for women and 93% for men. The gender gap in knowledge is more pronounced in rural areas (9%) than in urban areas (4%).
Higher levels of education correlate with better knowledge of HIV/AIDS for both genders and a reduction in the gender gap. Among individuals with no schooling, 76% of women and 86% of men are knowledgeable. For those with 12 or more years of education, the figures rise to 97% for women and 99% for men.
Women who have been away from home for one month or more in the past 12 months demonstrate better knowledge of HIV/AIDS compared to those who have not. Conversely, men show the opposite trend. The gender gap in knowledge is larger among women who have not been away from home for extended periods.
Jain women (98%) and Buddhist men (98%) have the highest knowledge of HIV/AIDS. The Muslim community shows the lowest level of knowledge, with 84% of women and 93% of men reporting awareness. The gender gap is most significant among Muslims and Sikhs, at around 9%, while it is lowest among Jains (-2%).
Among Scheduled Tribes (ST), knowledge of HIV/AIDS is the lowest, with 83% of women and 91% of men being aware. Individuals from advantaged caste groups report higher knowledge levels, with 89% of women and 95% of men. The gender gap in knowledge is highest among Scheduled Castes (9%).
Knowledge of HIV/AIDS increases sharply with wealth for both women and men. In the lowest wealth quintile, 74% of women and 88% of men are knowledgeable. These figures rise to 96% for women and 98% for men in the highest wealth quintile. The gender gap is largest in the lowest wealth quintile (14%) and decreases with increasing wealth.
General awareness about HIV/AIDS prevention methods
To gain insights into the knowledge of HIV/AIDS prevention methods among Indian men and women, we examine several key parameters: the percentage who believe that using condoms can reduce the risk of getting HIV/AIDS, the percentage who believe that limiting sexual intercourse to one uninfected sex partner can reduce the risk. Additionally, we consider the percentage of people who believe that HIV/AIDS can be transmitted through blood products or blood transfusions and those who believe it can be transmitted by injecting drugs. These parameters collectively provide a comprehensive understanding of the awareness and misconceptions surrounding HIV/AIDS transmission and prevention within the population.
Condoms are highly effective in reducing the risk of HIV transmission when used correctly and consistently. They act as a barrier that viruses like HIV cannot effectively pass through, protecting against HIV and other sexually transmitted infections (STIs). When used reliably and consistently, condoms can offer over 95% effectiveness in preventing HIV transmission.
Fig: 3
In the 15-19 age group, awareness that condom use can reduce the risk of HIV/AIDS is significantly lower among women (60%) and men (76%). For individuals aged 20-39, awareness levels are slightly higher than in the 15-19 and 40-49 age groups.
In rural areas, the gender disparity (15%) in knowledge about the effectiveness of condoms in preventing HIV/AIDS is more pronounced than in urban areas (10%).
The disparity in the knowledge of HIV/AIDS prevention via condom use increases with years of schooling. Among women with no schooling, only 55% are aware of the preventive benefits of condoms, compared to 68% of men. For those with 12 or more years of schooling, awareness rises to 82% for women and 90% for men.
Currently, married women (70%) and men (82%) show relatively high awareness of HIV/AIDS Prevention through Condom Use. However, the knowledge gap is more significant among never-married individuals, with a 16% difference between women and men.
Women who have been away from home for a month or more in the past year demonstrate better knowledge of condom use in HIV prevention compared to those who have not travelled. Conversely, men who have not been away from home show better knowledge than those who have.
Among Jain women (90%) and men (94%), awareness about HIV/AIDS Prevention through the Use of Condoms is highest, while Muslim women (65%) and men (78%) show the least awareness. The knowledge gap between men and women is notably high among Sikhs and Buddhists (15%). Among Scheduled Tribe (ST) women, awareness is 64%, and 77% for ST men which is least among the all caste groups. In contrast, awareness is higher in advantaged caste groups, with 72% of women and 83% of men acknowledging the preventive benefits of condoms.
Women and men from the lowest wealth quintile show 54% and 72% awareness of HIV/AIDS Prevention through Condom Use, respectively. In the highest wealth quintile, awareness rises to 82% for women and 90% for men. The gender gap in knowledge is approximately 18% in the lowest wealth quintile and decreases as wealth increases.
HIV/AIDS can be effectively prevented by limiting sexual intercourse to one uninfected partner. This practice, known as mutual monogamy, ensures that both partners are only exposed to each other, thereby significantly reducing the risk of HIV transmission. When both individuals are confirmed to be HIV-negative through testing and maintain a monogamous relationship, the likelihood of contracting the virus is minimized. This method of prevention relies on the commitment and honesty of both partners regarding their sexual health and practices.
Fig: 4
Among women aged 15-19 years (63%) and men aged 20-24 years (71%), the lowest percentage of awareness related to HIV/AIDS Prevention by limiting sexual intercourse to one uninfected partner is noted. However, for women aged 20-39 years, awareness is comparatively higher, although it decreases to 69% in the 40-49 age group. In men, the awareness is quite higher in the 25-49 age group. Notably, the gender gap in awareness is most pronounced among individuals aged 15-19 years (12%) and 40-49 years (12%).
Women in urban areas (78%) exhibit a higher awareness of HIV/AIDS Prevention Through Monogamy with an Uninfected Partner compared to their rural counterparts (67%), while men in rural areas demonstrate the highest awareness rate (82%) compared to urban areas (77%). The gender gap in rural areas is also significant at 15% compared to urban areas (-1%).
Among women with no schooling, only 58% have an understanding of HIV/AIDS Risk Reduction by Limiting Sexual Intercourse to One Uninfected Partner, compared to 76% of men. For those with 12 or more years of schooling, awareness increases to 84% for women and 81% for men. The highest gender gap in awareness (18%) is observed among individuals with no schooling and gradually decreases with increasing levels of education, ultimately becoming -3% for individuals with 12 or more years of schooling.
Current married individuals show the highest level of awareness related to Preventing HIV/AIDS by Maintaining a Single Uninfected Sexual Partner, with 72% of women and 79% of men aware of the risk reduction method. Across all marital status categories, women consistently have lower awareness levels compared to men.
Women who have lived away from home for one month or more in the past 12 months are more aware of the risk reduction strategy, whereas the opposite trend is observed in men. The gender gap in awareness among individuals not living away from home for extended periods is higher, at 8%.
Jain women (92%) and men (84%) exhibit the highest level of knowledge regarding preventing HIV/AIDS by Maintaining a Single Uninfected Sexual Partner, whereas Muslim women (65%) and men (73%) show the lowest. The gender gap is highest among the Sikh (13%) and Buddhist (12%) communities. Among the Scheduled Tribes (ST) community, women (64%) and men (73%) have the lowest awareness levels compared to other caste groups. The gender gap in awareness within the Scheduled Caste community (10%) is the highest compared to other caste groups.
In the lowest wealth quintile, 55% of women and 68% of men reported that they have an understanding of HIV/AIDS Risk Reduction by Limiting Sexual Intercourse to One Uninfected Partner. Awareness increases with wealth, reaching 84% of women and 85% of men in the highest wealth quintile. The gender gap decreases from 13% in the lowest quintile to 2% in the highest.
People can contract HIV/AIDS from blood products or blood transfusions if the blood they receive is contaminated with HIV. This can occur if the blood has not been properly screened for HIV, which was a significant risk before rigorous screening procedures were implemented. Today, blood banks and hospitals follow strict protocols to test blood for HIV and other infectious agents, greatly reducing the risk of transmission. However, in regions where screening is not as thorough or resources are limited, the risk remains higher.
Fig: 5
Among women aged 15-19 and men aged 20-24, the awareness that HIV/AIDS can be contracted through blood products or blood transfusions is the lowest, at 70% and 73%, respectively. For women aged 20-39 years, awareness is comparatively higher, although it decreases to 73% in the 40-49 age group. Men in the 25-49 age group exhibit significantly higher awareness levels. Notably, the gender gap in awareness is most pronounced among individuals aged 15-19 years (5%) and 40-49 years (6%).
Women in urban areas exhibit a higher awareness regarding the transmission of HIV/AIDS through blood products or transfusions (82%) compared to their rural counterparts (71%). Conversely, men in rural areas demonstrate the highest awareness rate (80%), compared to 78% in urban areas. The gender gap in rural areas is significant, at 10%.
Among women with no schooling, only 62% have an understanding of the risk of contracting HIV/AIDS from blood products or transfusions differs among different societal cohorts, compared to 76% of men. For those with 12 or more years of schooling, awareness increases to 87% for women and 80% for men. The highest gender gap in awareness (14%) is observed among individuals with no schooling. Interestingly, individuals with more than five years of education surpass men in awareness levels.
Never-married women and currently married men showed the highest awareness, with 75% and 78% respectively. Across all marital status categories, women consistently exhibit lower awareness levels compared to men.
Women who have lived away from home for one month or more in the past 12 months are more aware of this risk reduction strategy, whereas the opposite trend is observed in men. The gender gap in awareness among individuals not living away from home for one month or more in the past 12 months is higher, at 4%, compared to its counterpart.
Religious affiliation and caste significantly affect awareness levels. Jain women (90%) and Christian men (85%) exhibit the highest awareness levels regarding HIV/AIDS transmission through blood products or transfusions vary among distinct population subsets, whereas Muslim women (71%) and men (73%) show the lowest. The gender gap is highest among the Sikh community (13%). Among the Scheduled Tribes (ST) community, women (68%) and men (73%) have the lowest awareness levels, with the highest gender gap also observed within this community at 5%.
In the lowest wealth quintile, 59% of women and 67% of men reported that they know the potential risk of HIV/AIDS transmission through blood products or transfusions among various segments of the population. Awareness increases with wealth, reaching 86% of women and 84% of men in the highest wealth quintile. The gender gap decreases from 8% in the lowest quintile to -3% in the highest.
People can contract HIV/AIDS by injecting drugs if they share needles, syringes, or other drug paraphernalia with someone who is infected with the virus. When injecting drugs, blood can remain in the needle or syringe after use. If an infected person’s blood is present, it can transmit the virus to the next user. This mode of transmission is highly efficient because the virus is directly introduced into the bloodstream. Using sterile needles and never sharing injection equipment are crucial steps in preventing the spread of HIV among individuals who inject drugs.
Fig: 6
Among women aged 15-19 and men aged 20-24, awareness of HIV/AIDS can be transmitted through the reuse of needles or syringes contaminated with the virus is the lowest, at 66% and 73%, respectively. For women aged 20-39 years, awareness is comparatively higher but decreases to 68% in the 40-49 age group. Men in the 25-49 age group exhibit significantly higher awareness levels. Notably, the gender gap in awareness is most pronounced among individuals aged 15-19 years (9%) and 40-49 years (11%).
Women in urban areas demonstrate higher awareness (77%) regarding the risk of HIV/AIDS transmission through sharing drug injection paraphernalia compared to their rural counterparts (67%). Conversely, men in rural areas show the highest awareness rate (81%) compared to 77% in urban areas. The gender gap in rural areas is significant at 15%.
Among women with no schooling, only 58% understand the risks associated with using injection equipment previously used by someone with HIV/AIDS, compared to 75% of men. Interestingly, men with less than five years of education have lower awareness levels than men with no schooling. For those with 12 or more years of schooling, awareness increases to 82% for women and 80% for men. The highest gender gap in awareness (17%) is observed among individuals with no schooling and decreases with higher educational attainment.
Never-married women and currently married men show the highest awareness, with 71% and 78% respectively. Across all marital status categories, women consistently exhibit lower awareness levels compared to men.
Women who have lived away from home for one month or more in the past 12 months are more aware of the risk reduction strategy of avoiding shared needles. In contrast, men show the opposite trend. The gender gap in awareness among individuals not living away from home for one month or more in the past 12 months is higher, at 8%.
Religious affiliation and caste significantly affect awareness levels. Jain women (88%) and men (89%) exhibit the highest awareness levels regarding the dangers of shared or unsterilized needles, whereas Muslim women (65%) and men (73%) show the lowest. The gender gap is highest among the Sikh community (15%). Among the Scheduled Tribes (ST) community, women (64%) and men (73%) have the lowest awareness levels, with the highest gender gap observed within this community at 9%.
In the lowest wealth quintile, 55% of women and 67% of men report awareness that HIV/AIDS transmission can occur through the reuse of contaminated needles or syringes. Awareness increases with wealth, reaching 81% of women and 86% of men in the highest wealth quintile. The gender gap decreases from 12% in the lowest quintile to 4% in the highest.
Strategies and solutions to enhance knowledge and awareness about HIV/AIDS
In India, significant disparities exist in the awareness of HIV prevention methods across various demographic, economic, and geographic factors. The age groups of 15-19 and 40-49 years are particularly vulnerable in terms of knowledge about HIV prevention methods, with men aged 20-24 years also showing vulnerability. This indicates a critical need for targeted educational initiatives aimed at these specific age cohorts to improve their understanding and prevention of HIV transmission.
Geographically, women residing in rural areas and men living in urban areas are identified as vulnerable groups concerning their knowledge of HIV prevention methods. This highlights the necessity for tailored outreach and educational programs that address the unique challenges and informational gaps present in these populations.
Education emerges as a pivotal factor in enhancing awareness of HIV prevention methods. Individuals with higher levels of education exhibit significantly better understanding and knowledge of HIV prevention. This underscores the importance of integrating comprehensive HIV education into the broader educational curriculum and promoting lifelong learning opportunities.
Marriage also appears to play a positive role in increasing awareness of HIV prevention methods. Married individuals tend to have better knowledge, suggesting that partnership and family life may provide additional channels for information dissemination and discussion about HIV prevention.
Religious affiliation significantly influences awareness levels, with the Jain community being one of the most progressive in terms of understanding HIV prevention methods. In contrast, the Muslim community shows comparatively lower levels of awareness, indicating a need for culturally sensitive educational efforts. Additionally, the Scheduled Tribes (ST) community exhibits lower awareness levels, reflecting broader socio-economic and educational disadvantages that need to be addressed through focused public health interventions.
Economic status correlates strongly with knowledge of HIV prevention methods. Awareness increases with rising wealth, suggesting that economic empowerment and improved access to resources can facilitate better health education and prevention measures. This trend indicates that economic development and poverty alleviation are integral to improving public health outcomes.
A concerning trend across all these factors is the persistent gender gap in knowledge of HIV prevention methods. Women, particularly in rural areas and among less educated or economically disadvantaged groups, consistently demonstrate lower levels of awareness compared to men. This gender gap underscores the need for gender-specific strategies and interventions that empower women with the necessary knowledge and resources to protect themselves against HIV.
Addressing the disparities in HIV prevention knowledge requires a multifaceted approach that considers age, geographic location, education, marital status, religious affiliation, caste, and economic status. Public health strategies must be inclusive, culturally sensitive, and targeted to bridge the knowledge gaps and empower all segments of the population, with a particular focus on the most vulnerable groups. Efforts to reduce the gender gap in awareness are crucial for the success of HIV prevention initiatives and for the broader goal of achieving gender equity in health education and outcomes.
References
- Bhagavathula, A. S., Clark, C., Sharma, R., Chhabra, M., Vidyasagar, K., & Chattu, V. K. (2021). Knowledge and attitude towards HIV/AIDS in India: A systematic review and meta-analysis of 47 studies from 2010-2020. Health promotion perspectives, 11(2), 148-160.
- Hazarika, I. (2010). Knowledge, attitude, beliefs and practices in HIV/AIDS in India: identifying the gender and rural–urban differences. Asian Pacific Journal of Tropical Medicine, 3(10), 821-827.
- Banerjee, P., & Mattle, C. (2005). Knowledge, Perceptions and Attitudes of Youths in India Regarding HIV/AIDS: A Review of Current Literature. International Electronic Journal of Health Education, 8, 48-56.
Note: The data is collected from the fifth and fourth rounds of the National Family Health Survey conducted between 2019-21.
About Author: Pankaj Chowdhury is a former Research Assistant at the International Economic Association. He holds a Master’s degree in Demography & Biostatistics from the International Institute for Population Sciences and a Bachelor’s degree in Statistics from Visva-Bharati University. His primary research interests focus on exploring new dimensions of in computational social science and digital demography.
Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the views of 360 Analytika.
Acknowledgement: The author extends his gratitude to the National Family Health Survey for providing data support.
This article is posted by Sahil Shekh, Editor at 360 Analytika.
