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ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 70-74

Association of comprehensive correct HIV/AIDS knowledge among caregivers of children living with HIV and disclosure of HIV status


1 Department of Community Medicine, K S Hegde Medical Academy, Nitte (Deemed to be) University, Deralakatte; Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
2 Department of Community Medicine, K S Hegde Medical Academy, Nitte (Deemed to be) University, Deralakatte; Department of Community Medicine, A. J. Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India

Date of Submission18-Sep-2021
Date of Acceptance07-Jan-2022
Date of Web Publication28-Feb-2022

Correspondence Address:
Dr. Nishanth Krishna Kodyalamoole
Department of Community Medicine, Father Muller Medical College, Father Muller Road, Kankanady, Dakshina Kannada District, Mangalore - 575 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjmsr.mjmsr_40_21

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  Abstract 


Context: Knowledge regarding HIV/AIDS results in better self-care and lesser risk behavior. For children living with HIV (CLHIV) since birth, the caregivers need to disclose the HIV status for them to know regarding HIV. Poor knowledge among caregivers is a barrier to the disclosure of HIV status. Aims: The aim is to assess the knowledge among caregivers of CLHIV regarding HIV/AIDS and to evaluate the association between comprehensive correct HIV/AIDS knowledge (CCAK) among caregivers of CLHIV and disclosure of HIV status. Settings and Design: A cross-sectional study was conducted among 91 caregivers of CLHIV in an antiretroviral therapy center in southern coastal Karnataka between October 2014 and July 2015. Subjects and Methods: The data were collected using a structured questionnaire by interview method. Statistical Analysis Used: Frequencies were calculated for the categorical data. For scoring, the correct answers and wrong answer and “Don't know” options were given one mark and zero marks, respectively. Chi-square test was done to check for the association between knowledge and disclosure of the child's HIV status. Results: The knowledge regarding HIV/AIDS was good in 90% of the cases and moderate in the remaining 10%. However, the CCAK was present in only around 40% of the caregivers. The lowest knowledge was regarding the benefits of condom in preventing transmission of HIV. There was no association between CCAK and disclosure of HIV status to the CLHIV in the present study. Conclusions: Although the overall knowledge regarding HIV/AIDS was good among caregivers, they lacked CCAK. There was no association between CCAK and disclosure of the HIV status to the child.

Keywords: Comprehensive correct HIV/AIDS knowledge, disclosure, HIV/AIDS


How to cite this article:
Kodyalamoole NK, Badiger SB. Association of comprehensive correct HIV/AIDS knowledge among caregivers of children living with HIV and disclosure of HIV status. Muller J Med Sci Res 2021;12:70-4

How to cite this URL:
Kodyalamoole NK, Badiger SB. Association of comprehensive correct HIV/AIDS knowledge among caregivers of children living with HIV and disclosure of HIV status. Muller J Med Sci Res [serial online] 2021 [cited 2022 Jun 25];12:70-4. Available from: https://www.mjmsr.net/text.asp?2021/12/2/70/338502




  Introduction Top


In 2017, there were approximately 87,000 new HIV infections added to the HIV disease burden in India. Karnataka was one of the ten states which contributed to 71% of the new cases.[1] As per the 2016–2017 annual report of the National AIDS Control Organization (NACO), children (<15 years) with around 10.4 thousand new infections and young adults (>15 years) with around 75.9 thousand new infections contributed to all the estimated 86,000 new HIV infections in 2015 in India.[2] Hence, it is of utmost priority to prevent HIV infection in this young population.

Most of these children and young adults, who have not been exposed to HIV, might get exposed to their peers who have been HIV-positive since birth, considering India has a high burden of HIV in pregnant women. Such children may not be aware of their infectivity status, as caregivers would not have disclosed the HIV status to the children living with HIV (CLHIV). Studies were done on barriers to HIV status disclosure to CLHIV showed that a poor knowledge regarding HIV among caregivers was one of the major factors.[3],[4]

Having better HIV knowledge was associated with lesser HIV risk behavior.[5] Children who were disclosed their HIV status had better drug adherence, better knowledge, and better viral suppression.[6] However, the caregivers of such children need to know about HIV to enable them to disclose the correct knowledge to their children. As per the National Family Health Survey-4 (NFHS-4) data, only 9.5% of women[7] and 26.3% of men[8] in Karnataka had a comprehensive knowledge of HIV/AIDS. Hence, this study was done to assess the knowledge of the caregivers of CLHIV regarding HIV and to determine the association between comprehensive correct HIV/AIDS knowledge (CCAK) and the disclosure of HIV status to the CLHIV.


  Subjects and Methods Top


A cross-sectional study was conducted between October 2014 and July 2015 in an antiretroviral therapy (ART) center attached to a district general hospital in southern coastal Karnataka. Caregivers of all the pediatric HIV patients aged 0–18 years visiting the ART center during the study period were considered. The caregivers were excluded if their child was seriously ill. We purposively selected 91 caregivers of 185 CLHIV for the study.

Method of data collection

The data were collected by one of the authors by interview method using a structured questionnaire. The questionnaire for this study was developed based on the previous studies.[9],[10] Seven experts in community medicine validated the content of the questionnaire.

The questionnaire consisted of close-ended questions. It included questions on demographic data, nine questions on transmission routes, and seven basic questions on HIV knowledge. All except one of the questions had a single right answer, and multiple responses were not possible.

Definitions

A caregiver was an adult aged 18 years or older who was involved in the daily care of the CLHIV.

CCAK was considered when the respondent knew that consistent use of condoms every time they have sex could reduce the chance of getting HIV/AIDS, and also knowing that a healthy-looking person can have HIV/AIDS, and rejecting two common misconceptions about transmission or prevention of HIV/AIDS.[9],[11]

Disclosure status was determined as per the information given by the caregiver.

Data Management and analysis

The data collected was entered in MS Excel and was analyzed using the SPSS version 20 (IBM SPSS, Bengaluru). Frequencies were calculated for the categorical data. The correct answers were given one mark and wrong answer and “Don't know” options were given zero marks for the data scoring. There was no negative marking for any questions. The maximum possible score was 15, and the mean score was calculated and categorized into three categories of equal range: score 0–5: poor, 6–10: moderate, and ≥11: good. Chi-square test and Fisher Exact test were done to check for the association between the knowledge of caregivers regarding HIV/AIDS and the disclosure of the HIV status of the child to the CLHIV.

Ethical considerations

The study was undertaken after prior approval from the NACO. Written informed consent was taken from the caregivers before the interview. Ethical clearance was obtained from the Institutional Ethics Committee of the medical college where the study was conducted.


  Results Top


Out of the 91 caregivers of 185 children available for interview, 73 (80.2%) caregivers were biological parents/relatives of the CLHIV, and the remaining 18 (19.8%) were caregivers of CLHIV of HIV care homes. Among caregivers who were biologically related to the CLHIV (n = 73), the biological mother and father had expired in 22 (30.1%) and 46 (63%) cases. Hence, the majority of the children were either single/double orphans. The mother was educated up to the primary level in 37 (50.7%) and secondary level in 21 (28.8%) cases. The education level was the primary level in 29 (40%) of the cases and not available in 29 (40%) of the biological fathers. Among parents/relatives (n = 73), majority of the caregivers were semiskilled workers earning a median income of ₹5000/‒(₹2250–₹9000).

[Table 1] shows the knowledge regarding the various routes of transmission of HIV. The knowledge regarding mother-to-child transmission and the transmission of HIV through breastfeeding by a mother on ART had the least right answer among all the caregivers.
Table 1: Knowledge regarding the routes of transmission of the human immunodeficiency virus (n=91)

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The other questions related to knowledge regarding HIV/AIDS revealed that only around 75% (n = 69) of the participants were aware of the use of condoms to control the spread of HIV. More than 90% of the participants were aware that there was no cure for HIV (83, 91.2%) and that HIV can affect any person, irrespective of caste (85, 93.4%). The other HIV/AIDS knowledge-related frequencies are depicted in [Table 2].
Table 2: Knowledge regarding human immunodeficiency virus/AIDS

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Out of the maximum score of 15, the caregivers' mean score was 13.4 (standard deviation 1.7) with a minimum score of 8 and a maximum of 15. 90% (n = 82) had good knowledge regarding HIV/AIDS, and the remaining 10% (n = 9) had moderate knowledge. The knowledge source was health-care providers and HIV support groups/NGOs in 66 (90%) cases.

Despite the findings in the knowledge scores, CCAK was present only in 36 (39.6%) caregivers. [Table 3] shows the association between knowledge grading and CCAK with caregivers' disclosure of the child's HIV status. There was no association found between knowledge grade and CCAK with disclosure status to the CLHIV in this study.
Table 3: Association between knowledge of the caregiver and disclosure of human immunodeficiency virus status to children (n=91)

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  Discussion Top


Majority of the children had lost either of their parents or both making them single or double orphans. As per the caregiver reports, the mother was HIV-positive in most cases, and the father was positive in more than 80% of the cases. The HIV positivity status of the remaining parent(s) was not available. Although HIV/AIDS knowledge was good in 90% of the respondents, there was no CCAK in 60% of the caregivers. There was no association between CCAK and disclosure of HIV status by the caregivers to the CLHIV in the present study.

Regarding the various routes of transmission, correct knowledge was found concerning most of the routes. The lowest knowledge was found regarding mother-to-child transmission of HIV. Like our study, only around 80% of the respondents had the correct knowledge regarding the transmission of HIV from a breastfeeding mother in a study from Telangana, India,[12] and Uganda.[13] This knowledge is better in our study compared to a study from Cameroon.[14] In another study, nearly half of the caregivers believed that milk substitutes were the best preventive measures for parent-to-child transmission.[15] However, unlike the above study from Telangana,[12] the correct knowledge regarding the transmission of HIV by kissing was higher in our study.

The lowest knowledge was found regarding the role of condoms in preventing the transmission of HIV. The poor knowledge regarding condoms could be due to the stigma associated with condoms and contraceptive devices. The correct knowledge regarding the role of condoms in preventing HIV transmission was similar to the NFHS-4 from India.[11] This knowledge was lower than the findings of a study from South Africa[16] but higher than a study from Iran.[17] The proportion of subjects aware regarding ART's benefits was also higher in the study from South Africa[16] compared to our study. The proportion of caregivers who thought HIV could be diagnosed by looking at a person was higher in Iran's study.[17] However, the proportion of caregivers in our study had the highest misconception in our study was regarding the same question.

The proportion of respondents with good knowledge regarding HIV/AIDS was higher than a study done in Pakistan.[18] This finding of good knowledge score did not translate into CCAK. Most of the caregivers had the wrong knowledge concerning condoms and HIV diagnosis by looking at a person in our study. The proportion of caregivers having CCAK in this study was slightly higher than the finding in India.[11] Compared to other African countries' findings, the findings were better than Ethiopia but worse than Kenya and Burundi[19] and among a fishing community in Uganda.[13] Although the CCAK was higher in a study from Ghana,[20] they have demonstrated a drastic reduction compared to 2008.

Although there was no association between CCAK and HIV status disclosure in our study, a study showed that better HIV care and treatment adherence were found in HIV competent households.[21] Hence, a good HIV/AIDS knowledge is necessary for all aspects of HIV care and treatment, including disclosure.

This study's limitations were the small size of the study population and a hospital-based setting of the study. A larger study was done among caregivers of CLHIV in the community may yield a better picture related to the association between CCAK and disclosure of HIV status to the CLHIV. Furthermore, the disclosure status was assessed only based on the caregiver reports and not confirmed with the CLHIV.


  Conclusions and Recommendations Top


Although the overall knowledge regarding HIV/AIDS was good among caregivers, they lacked CCAK. Health-care workers and non-governmental organizations should consider improving the knowledge of the caregivers regarding the benefits of condoms and that healthy-looking individuals may be HIV-positive. Improvement in the knowledge will improve CCAK among caregivers and will help the caregivers to disclose the child's HIV/AIDS status and impart knowledge to the children, reduce risk behavior, and improve self-care among caregivers and CLHIV.

Acknowledgment

The authors acknowledge the support provided by the antiretroviral therapy center staff at the district hospital of the city while doing the data collection. The authors are grateful to the caregivers of the CLHIV for participating in this study. The authors are also indebted to the KSAPS, NACO, for granting permission to conduct this study. We are thankful to the ICMR for funding this project.

Financial support and sponsorship

This study was financially supported by the ICMR MD/MS Grant vide letter No. 3/2/Nov. 2014/PG-Thesis-HRD (2) dated 1.12.2014.

Conflicts of interest

There are no conflicts of interest.



 
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