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Socio-Economic and Demographic Factors Associated with Knowledge and Attitude of HIV/AIDS among Women Aged 15–49 Years Old in Indonesia

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Women’s susceptibility to HIV/AIDS infection is related to socio-economic and demographic factors. This study sought to analyze socio-economic and demographic factors related to knowledge and attitude of HIV/AIDS among women aged 15–49 years old in Indonesia. We conducted a secondary data analysis using the 2017 Indonesian Demographic and Health Survey (IDHS). Among 49,627 women, our study analyzed 25,895 women aged 15–49 years familiar with HIV terminology. Multiple logistic regression was utilized to analyze associations between socio-economic and demographic factors with knowledge and attitudes toward HIV/AIDS. Women’s age, education level, wealth quintile, residential area and region, access to information, owning cell phones and autonomy were significantly associated with positive knowledge and attitudes toward HIV/AIDS. These findings revealed that several demographical and social factors contribute to knowledge and attitudes toward HIV/AIDS among women aged 15–49 years in Indonesia.
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Citation: Virdausi, F.D.; Efendi, F.;
Kusumaningrum, T.; Adnani, Q.E.S.;
McKenna, L.; Ramadhan, K.; Susanti,
I.A. Socio-Economic and
Demographic Factors Associated
with Knowledge and Attitude of
HIV/AIDS among Women Aged
15–49 Years Old in Indonesia.
Healthcare 2022,10, 1545. https://
doi.org/10.3390/healthcare10081545
Academic Editor: Christian Napoli
Received: 26 June 2022
Accepted: 11 August 2022
Published: 15 August 2022
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Attribution (CC BY) license (https://
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4.0/).
healthcare
Article
Socio-Economic and Demographic Factors Associated with
Knowledge and Attitude of HIV/AIDS among Women Aged
15–49 Years Old in Indonesia
Feny Deya Virdausi 1, Ferry Efendi 1,* , Tiyas Kusumaningrum 1, Qorinah Estiningtyas Sakilah Adnani 2,
Lisa McKenna 3, Kadar Ramadhan 4and Ika Adelia Susanti 1
1Faculty of Nursing, Universitas Airlangga, Surabaya 60115, Indonesia
2Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
3School of Nursing and Midwifery, La Trobe University, Melbourne 3086, Australia
4Department of Midwifery, Poltekkes Kemenkes Palu, Palu 94145, Indonesia
*Correspondence: ferry-e@fkp.unair.ac.id
Abstract:
Women’s susceptibility to HIV/AIDS infection is related to socio-economic and demo-
graphic factors. This study sought to analyze socio-economic and demographic factors related
to knowledge and attitude of HIV/AIDS among women aged 15–49 years old in Indonesia. We
conducted a secondary data analysis using the 2017 Indonesian Demographic and Health Survey
(IDHS). Among 49,627 women, our study analyzed 25,895 women aged 15–49 years familiar with HIV
terminology. Multiple logistic regression was utilized to analyze associations between socio-economic
and demographic factors with knowledge and attitudes toward HIV/AIDS. Women’s age, education
level, wealth quintile, residential area and region, access to information, owning cell phones and
autonomy were significantly associated with positive knowledge and attitudes toward HIV/AIDS.
These findings revealed that several demographical and social factors contribute to knowledge and
attitudes toward HIV/AIDS among women aged 15–49 years in Indonesia.
Keywords:
AIDS; attitude; demographic factors; demographic health; HIV; knowledge; socio-
economic; survey; women
1. Introduction
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS)
is still a significant global burden [
1
,
2
]. Even though substantial efforts have been made to
reduce the HIV/AIDS infection rate and its prevalence, in 2019, more than 35 million people
were living with HIV/AIDS (PLWHA); the majority reside in Sub-Saharan Africa [
1
,
3
,
4
].
The Southeast Asia region ranks second globally, with many PLWHA. Data from the United
Nations (UN) revealed that approximately 19 million people do not know their HIV/AIDS
status [
5
]. The World Health Organization (WHO) stated that 78% of new infections are in
the Pacific region. A total of 5.1 million people in the Asia and Pacific Region are infected
with HIV, including approximately 1.80 million adult women and 1.60 million adult men.
As many as 3.8 million are infected with HIV/AIDS in Southeast Asia [
6
]. In low and
middle-income countries, the prevalence of HIV/AIDS among women is three times higher
than for men [7].
In Indonesia, in 2019, the number of HIV/AIDS cases reported was 50,282 [
8
]. In
Indonesia, women are estimated to be four times more likely to be infected than men.
Women are considered a vulnerable group infected with HIV/AIDS due to reproductive
and genital anatomical structures facilitating the transmission of HIV through sexual inter-
course [
9
]. Women’s vulnerability is formed by several factors, including socio-cultural,
economic and biological factors. The interconnection between gender inequality, migration,
Healthcare 2022,10, 1545. https://doi.org/10.3390/healthcare10081545 https://www.mdpi.com/journal/healthcare
Healthcare 2022,10, 1545 2 of 14
barriers to accessing health services and low levels of education increase women’s vulnera-
bility to contracting HIV/AIDS. In addition, many women contract HIV/AIDS from their
husbands/partners who have unsafe sexual behavior and use drugs [5].
Lack of knowledge may lead to negative attitudes towards PLWHA. It could contribute
to insufficient practice for prevention, treatment, and the risk of transmission among the
community. Knowledge about HIV/AIDS and its transmission can be mainly achieved by
increasing acceptance towards PLWHA and making people more caring [
10
,
11
]. Several
studies have demonstrated that people tend to have negative attitudes and report not
buying vegetables from PLWHA-status sellers [
12
14
]. These PLWHA have physical,
economic, social and psychological consequences as HIV-infected patients are reportedly
rejected by healthcare services [
14
], experience poor quality treatment, are refused when
applying for jobs due to HIV/AIDS status, and experience forced early resignation from
their employment [12,13].
Knowledge and attitudes may affect behaviour toward HIV/AIDS [
15
]. Sufficient
knowledge and positive attitudes concerning HIV/AIDS provide empirical evidence for
policymakers and stakeholders with which to design and implement appropriate pre-
vention mechanisms [
16
,
17
]. Previous studies in East Africa and Vietnam revealed that
lack of knowledge among women can be attributed to the negative attitudes towards
PLWHA [
15
,
18
]. Some previous studies concluded that good knowledge and a positive
attitude are important indicators in the prevention of HIV transmission [
19
21
]. One study
among women of childbearing age in South Sudan showed that women living in urban
areas had better knowledge compared to women living in rural areas [
22
]. Several studies
have been conducted concerning HIV/AIDS prevention [
23
,
24
], while scarce literature
addresses socio-economic and demographic factors associated with knowledge and atti-
tudes toward HIV/AIDS in Indonesia. Knowledge and attitudes concerning HIV/AIDS
among Indonesian women remain critical concerns as some studies revealed insufficient
knowledge and negative attitudes [
25
27
]. Further, recent studies regarding the knowledge
and attitudes of HIV/AIDS in Indonesia reemphasized that behavioral issues remain a
challenge [9,28].
This study can aid in establishing knowledge, provide a basis for further research
in HIV/AIDS and assist the government in strengthening and modifying the program
to approach the HIV/AIDS issue. Possessing good knowledge and a positive attitude
in relation to HIV/AIDS is very important for avoiding HIV transmission and to end
the discrimination among PLWHA. There is increasing concern that some women of
reproductive age lack accurate and complete information on how to prevent HIV/AIDS
transmission. In line with these concerns, the objective of our study was to assess socio-
economic and demographic factors related to knowledge and attitudes toward HIV/AIDS
among women aged 15–49 years in Indonesia.
2. Methods
2.1. Design and Data Source
We conducted a secondary data analysis utilizing the most recent data from the 2017
Indonesia Demographic Health and Survey (IDHS). This study was part of an international
DHS program that ensured ethical standards, including confidentiality, anonymity, and
informed consent. IDHS ethical clearance was obtained from the Inner City Fund (ICF)
International (ethical approval number 45 CFR 46). For this study, permission to use the
data was obtained from ICF International. Additionally, ethical approval was obtained
before the survey was conducted, and all participants provided written informed consent.
All participation in this study was voluntary and subjects were able to withdraw their
participation at anytime from the study.
This study used women’s questionnaire topics which included questions that assessed
women’s knowledge of HIV and other sexually transmitted infections, the sources of
their knowledge about HIV, knowledge about ways to avoid contracting HIV, HIV testing,
stigma and discrimination, and high-risk sexual behaviour [
29
]. A series of questions
Healthcare 2022,10, 1545 3 of 14
on questionnaires about HIV/AIDS was required to be answered by women related to
the (DHS) standard. The Model Questionnaires of the DHS Program emphasize basic
indicators and several modules [
30
]. The data quality issue is a serious concern and
sustained attention from DHS implementers to improve the validity and reliability of
questionnaire is evident [
31
]. Continual improvement of the methodology including the
questions for each questionnaire is performed collaboratively among various stakeholders.
The questionnaire is open and available to the public at the DHS website, which can be
accessed using the following link: https://dhsprogram.com/pubs/pdf/DHSQ8/DHS8
_Womans_QRE_EN_8Apr2022_DHSQ8.pdf (accessed on 9 April 2022).
There were sections on knowledge and attitudes toward HIV/AIDS in the question-
naires. Questions on knowledge of HIV/AIDS included reducing risk, and concerned
aspects such as always using a condom during sexual intercourse, only having one partner,
getting HIV through mosquito bites or by sharing food with PLWHA, that people who
appear healthy can have HIV, can contract HIV through supernatural powers, getting HIV
through unsterilized needles, and that HIV can be transmitted during pregnancy, childbirth
and breastfeeding. Questions on attitudes toward HIV/AIDS included wanting to keep
HIV infection in the family a secret, willingness to care for families with AIDS, whether
children with HIV are allowed to go to school with children who are not HIV positive and
whether they would buy vegetables from a seller who has HIV.
The cross-sectional study represented 1970 census blocks of urban and rural areas
covering 49,250 households across 34 provinces in Indonesia. This survey was conducted
in several steps, including a pretest (July–August 2016), training of field staff (July 2017),
and fieldwork (24 July–30 September 2017). A two-stage stratified cluster sampling method
was employed to recruit the respondents in this study. First, several census blocks were
selected by performing systematic sampling of the proportional size. Second, 25 ordinary
households were chosen from the list via systematic sampling. With these data, the inclu-
sion criteria for our study were as follows: aged 15–49 years, those who were interviewed
during the survey and participants who completed all of the questions including those on
HIV/AIDS issues. We excluded women who did not answered and complete all of the
questions of the survey. Women’s weight was obtained and individual recording of data
during the analysis was applied. Among 49,627 women, our study analyzed
25,895 women
aged 15–49 years based on the inclusion criteria. This study was a representative of national
study involving women over all provinces in Indonesia.
2.2. Variables
The dependent variables were knowledge and attitudes toward HIV/AIDS. In this
study, knowledge on HIV/AIDS was categorized into the following two groups: poor
and good, while attitudes on HIV/AIDS were categorized into positive and negative.
Knowledge was categorized as poor if respondents only answered less than five correctly,
and categorized as good if respondents answered
5 correctly. Attitudes were divided into
positive if respondents answered
3 questions correctly and negative if they only answered
1–2 questions correctly. In this study, the independent variables related to socioeconomic
and demographic factors, including age, education level, occupation, head of household,
wealth quintile, area of residence, region of residence, access to information, mobile phone,
autonomy, and women’s attitudes against wife-beating. The women’s age was divided
into seven categories (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years old). Women’
education levels were grouped into no school, primary, secondary, and higher education.
Women’ employment status was divided into two categories of not working and working.
The head of the household was divided into two categories of women and men. Wealth
quintile was grouped into the following five categories: poorest, poorer, middle, richer,
and richest, and was scored based on wealth criteria on the DHS report [
32
]. Place of
residence was separated into rural and urban areas, while the provinces of Indonesia were
defined as East, Middle and West. Access to information was categorized into never, less
than once, and more than once per week. Mobile phones were divided into yes and no,
Healthcare 2022,10, 1545 4 of 14
while women’s autonomy was grouped into high and low. Women’s attitudes against wife-
beating was divided into two categories of agree and disagree. All categories’ variables
were determined based on the DHS report that adjusted to the minimum sample to meet
the statistical interpretation [33].
2.3. Statistical Analysis
Descriptive statistics were used to describe the characteristics of the respondents. We
used the chi-square test to assess associations between socio-economic and demographic
factors and knowledge and attitudes toward HIV/AIDS. A multiple logistic regression
analysis was performed, which presented an Odds Ratio (OR) and a 95% Confidence Inter-
val (CI) to measure the variables’ associations. The statistical significance was identified if a
p-value was under 0.05, which was considered for results to enter the multivariate analysis.
All statistical analyses were carried out using Stata 16.
3. Results
3.1. Characteristics of the Respondents
Table 1presents the distribution of knowledge and attitudes toward HIV/AIDS
according to sociodemographic and demographic factors among women aged 15–49 years
old in Indonesia. A total of 25,895 women who had complete HIV/AIDS data were included
in the analysis, and 88.74% of women had a high level of knowledge, while 60.28% had
negative attitudes toward PLWHA. Nearly one quarter (20.64%) were 35–39 years old. More
than half (59.15%) of the respondents had received secondary education and were working
(61.27%). Close to all of the respondents’ husbands were heads of the household (93.08%),
while one quarter (25.15%) belonged to the wealthiest families. More than half (54.41%)
resided in urban areas, while more than three quarters (84.51%) of the respondents lived
in the West of Indonesia. More than half reported never accessing the Internet (55.76%),
newspaper (58.93%), and radio (58.64%). More than three-quarters of the respondents’
accessed information more than once per week from television (88.10%), had a mobile
phone (81.89%), had high autonomy (85.97%), and disagreed with wife-beating (82.49%).
Further information about the respondents’ characteristics is presented in Table 1.
Table 1. Characteristics of women aged 15–49 years in Indonesia.
Characteristics N %
Age (Years)
15–19 443 1.71
20–24 2561 9.89
25–29 4372 16.88
30–34 5106 19.72
35–39 5345 20.64
40–44 4425 17.09
45–49 3643 14.07
Education level
No school 112 0.43
Primary 6398 24.71
Secondary 15,316 59.15
Higher 4069 15.71
Occupation
Not working 10,029 38.73
Working 15,866 61.27
Head of household
Men 24,104 93.08
Women 1791 6.92
Healthcare 2022,10, 1545 5 of 14
Table 1. Cont.
Characteristics N %
Wealth index
Poorest 2982 11.52
Poorer 4685 18.09
Middle 5507 21.27
Richer 6209 23.98
Richest 6512 25.15
Resident
Rural 11,806 45.59
Urban 14,089 54.41
Province
West of Indonesia 21,884 84.51
Middle of Indonesia 3485 13.46
East of Indonesia 526 2.03
Access to Internet
Never 14,439 55.76
<1 per week 648 2.50
1 per week 10,808 41.74
Access to television
Never 515 1.99
<1 per week 2567 9.91
1 per week 22,813 88.10
Exposure to newspaper
Never 15,259 58.93
<1 per week 7991 30.86
1 per week 2645 10.21
Access to radio
Never 15,184 58.64
<1 per week 7035 27.17
1 per week 3676 14.20
Mobile phone
No 4690 18.11
Yes 21,205
Autonomy
Low 3632 14.03
High 22,263 85.97
Women’s attitudes towards wife-beating
Agree 4535 17.51
Disagree 21,360 82.49
Knowledge toward HIV/AIDS
Poor 2915 11.26
Good 22,980 88.74
Attitudes toward PLWHA
Negative 15,610 60.28
Positive 10,285 39.72
HIV/AIDS: Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome. PLWHA: People Living
with HIV/AIDS.
3.2. Bivariate Analysis
In the bivariate analysis, an age of 15–19 years, lack of formal education, belonging to
the poorest index, living in rural and West Indonesia, having no access to media, having
no mobile phone, low autonomy and agreeing with wife-beating were associated with
knowledge toward HIV/AIDS (Table 2). Similarly, an age of 15–19 years, having no formal
education, belonging to the poorest index, living in rural and the West of Indonesia, having
Healthcare 2022,10, 1545 6 of 14
no access to the Internet, newspaper, radio, having no mobile phone, and agreeing with
wife-beating were associated with attitudes toward HIV/AIDS (Table 3). No significant
association was detected between an age of 20–49 years, occupation, and head of household.
Table 2.
Socioeconomic and demographic information and knowledge toward HIV/AIDS among
women aged 15–49 years old in Indonesia.
Characteristics
Knowledge
Poor Good
χ2
n(2915) % n(22,980) %
Age (years)
15–19 82 18.55 360 81.45 39.01 ***
20–24 308 12.03 2253 87.97
25–29 489 11.19 3883 88.81
30–34 540 10.57 4566 89.43
35–39 542 10.14 4803 89.86
40–44 490 11.08 3935 88.92
45–49 464 12.72 3180 87.28
Education level
No school 37 33.05 75 66.95 891.11 ***
Primary 1318 20.60 5080 79.40
Secondary 1453 9.49 13,863 90.51
Higher 107 2.63 3962 97.37
Occupation
Not working 1185 11.81 8844 88.19 4.70
Working 1730 10.90 14,136 89.10
Head of household
Men 2726 11.31 21,378 88.69 0.87
Women 189 10.56 1602 89.44
Wealth index
Poorest 596 19.98 2386 80.02 679.12 ***
Poorer 779 16.63 3906 83.37
Middle 715 12.99 4792 87.01
Richer 546 8.79 5663 91.21
Richest 279 4.28 6233 95.72
Resident
Rural 1824 15.45 9983 84.55 353.28 ***
Urban 1091 7.74 12,997 92.26
Province
West of Indonesia 2382 10.89 19,502 89.11 18.00 ***
Middle of Indonesia 464 13.30 3022 86.70
East of Indonesia 69 13.13 456 86.87
Access to internet
Never 2283 15.81 12,156 84.19 651.30 ***
<1 per week 76 11.66 573 88.34
1 per week 556 5.15 10,251 94.85
Access to television
Never 83 16.08 432 83.92 15.81 **
<1 per week 320 12.46 2247 87.54
1 per week 2512 11.01 20,301 88.99
Healthcare 2022,10, 1545 7 of 14
Table 2. Cont.
Characteristics
Knowledge
Poor Good
χ2
n(2915) % n(22,980) %
Exposure to newspaper
Never 2075 13.6 13,184 86.40 236.43 ***
<1 per week 732 9.16 7259 90.84
1 per week 108 4.08 2537 95.92
Access to radio
Never 1937 12.76 13,247 87.24 83.40 ***
<1 per week 684 9.72 6351 90.28
1 per week 294 7.99 3382 92.01
Mobile phone
No 918 19.58 3771 80.42 367.78 ***
Yes 1997 9.42 19,209 90.58
Autonomy
Low 508 13.97 3124 86.03 28.90 ***
High 2407 10.81 19,856 89.19
Women’s attitudes
towards wife-beating
Agree 631 13.90 3905 86.10 35.71 ***
Disagree 2284 10.69 19,075 89.31
** χ2< 0.01. *** χ2< 0.001.
Table 3.
Socioeconomic and demographic information and attitudes toward HIV/AIDS among
women aged 15–49 years old in Indonesia.
Characteristics
Attitudes
Negative Positive χ2
n(15,610) % n(10,285) %
Age (years)
15–19 274 62.00 168 38.00 59.36 ***
20–24 1614 63.01 948 36.99
25–29 2585 59.13 1787 40.87
30–34 2937 57.53 2168 42.47
35–39 3132 58.59 2213 41.41
40–44 2713 61.32 1712 38.68
45–49 2355 64.62 1289 35.38
Education level
No school 87 77.48 25 22.52 294.53 ***
Primary 4326 67.62 2071 32.38
Secondary 9136 59.65 6180 40.35
Higher 2061 50.64 2009 49.36
Occupation
Not working 6112 60.95 3916 39.05 2.81
Working 9498 59.86 6369 40.14
Head of household
Men 14,514 60.21 9590 39.79 0.62
Women 1096 61.19 695 38.81
Healthcare 2022,10, 1545 8 of 14
Table 3. Cont.
Characteristics
Attitudes
Negative Positive χ2
n(15,610) % n(10,285) %
Wealth index
Poorest 2110 70.76 872 29.24 256.14 ***
Poorer 2993 63.87 1693 36.13
Middle 3371 61.22 2135 38.78
Richer 3605 58.06 2604 41.94
Richest 3531 54.22 2981 45.78
Resident
Rural 7579 64.19 4228 35.81 128.11 ***
Urban 8031 57.01 6057 42.99
Province
West of Indonesia 12,846 58.70 9039 41.30 140.80 ***
Middle of Indonesia 2423 69.53 1062 30.47
East of Indonesia 341 64.92 184 35.08
Access to internet
Never 9413 65.19 5026 34.81 317.08 ***
<1 per week 396 61.13 252 38.87
1 per week 5801 53.67 5007 46.33
Access to television
Never 311 60.32 204 39.68 0.07
<1 per week 1541 60.04 1026 39.96
1 per week 13,758 60.31 9054 39.69
Exposure to newspaper
Never 9482 62.14 5777 37.86 84.35 ***
<1 per week 4738 59.29 3253 40.71
1 per week 1390 52.56 1255 47.44
Access to radio
Never 9286 61.16 5898 38.84 28.74 ***
<1 per week 4259 60.55 2776 39.45
1 per week 2065 56.17 1611 43.83
Mobile phone
No 3214 68.55 1475 31.45 151.14 ***
Yes 12,396 58.46 8810 41.54
Autonomy
Low 2207 60.76 1425 39.24 0.37
High 13,403 60.21 8860 39.79
Women’s attitudes
towards wife-beating
Agree 2909 64.15 1626 35.85 31.73 ***
Disagree 12,701 59.46 8659 40.54
*** χ2< 0.001.
3.3. Multiple Logistic Regression Analysis
The final multiple logistic regression models in Table 4were adjusted for association
across variables. People aged 45–49 years old were 181% more likely to have good knowl-
edge of HIV/AIDS compared to women aged 15–19 [1.81(1.26–2.60)]. Women with higher
education levels were 6 times more likely to have good knowledge compared to women
who received no education at all [6.32(3.59–11.11)]. Women in the richest wealth index
were 167% more likely to have good knowledge of HIV/AIDS compared to women with
the poorest wealth index [1.67(1.32–2.10)]. Women who lived in urban areas and East of
Indonesia Province were 137% [1.37(1.22–1.54)] and 128% [1.28(1.00–1.68)] more likely to
Healthcare 2022,10, 1545 9 of 14
have good knowledge compared to those in rural areas and the middle Indonesia Provinces,
respectively. Women who accessed information from the internet
1 per week were 174%
more likely to have good knowledge compared to women who never access the internet
[1.74(1.50–2.03)]. Women who were exposed to a newspaper
1 per week were as much
as 132% more likely to have good knowledge than those never exposed to newspaper
[1.32(1.04–1.67)]. This study found that women who access the information through radio
1 per week have a 131% [1.31(1.11–1.56)] propensity to acquire good knowledge com-
pared to women who never access radio. Women who access information through a mobile
phone were 126% [(1.26 (1.12–1.44)] more likely to have good knowledge compared to those
who do not access from a mobile phone. Women with high autonomy were 123% more
likely to have good knowledge compared to those with low autonomy [1.23(1.05–1.44)].
Table 4.
Multiple logistic regression analysis of socioeconomic and demographic and knowledge-
attitudes toward HIV/AIDS among women aged 15–49 years old in Indonesia.
Variable
Good Knowledge Positive Attitudes
OR
95% CI
OR
95% CI
Lower Upper Lower Upper
Age (years)
15–19 1.00 1.00
20–24 1.40 0.97 2.01 0.87 0.65 1.16
25–29 1.47 * 1.04 2.09 1.00 0.75 1.33
30–34 1.77 ** 1.25 2.51 1.11 0.84 1.46
35–39 2.12 *** 1.49 3.00 1.10 0.83 1.46
40–44 2.04 *** 1.44 2.90 1.02 0.77 1.36
45–49 1.81 ** 1.26 2.60 0.90 0.68 1.20
Education level
No school 1.00 1.00
Primary 1.54 0.92 2.57 1.35 0.75 2.41
Secondary 2.86 *** 1.71 4.78 1.64 0.922 2.93
Higher 6.32 *** 3.59 11.11 2.05 * 1.14 3.68
Wealth index
Poorest 1.00 1.00
Poorer 0.98 0.83 1.16 1.21 ** 1.06 1.38
Middle 1.08 0.91 1.28 1.23 ** 1.08 1.40
Richer 1.29 ** 1.07 1.56 1.26 ** 1.10 1.44
Richest 1.67 *** 1.32 2.10 1.22 ** 1.05 1.41
Resident
Rural 1.00 1.00
Urban 1.37 *** 1.22 1.54 1.11 * 1.03 1.21
Province
West of Indonesia 1.27 *** 1.12 1.45 1.59 *** 1.46 1.73
Middle of Indonesia 1.00 1.00
East of Indonesia 1.28 * 1.00 1.68 1.32 ** 1.12 1.57
Access to Internet
Never 1.00 1.00
<1 per week 1.17 0.87 1.57 1.13 0.92 1.38
1 per week 1.74 *** 1.50 2.03 1.26 ** 1.15 1.37
Access to television
Never 1.00 1.00
<1 per week 0.85 0.59 1.22 0.79 0.61 1.03
1 per week 0.98 0.70 1.37 0.78 0.62 1.00
Healthcare 2022,10, 1545 10 of 14
Table 4. Cont.
Variable
Good Knowledge Positive Attitudes
OR
95% CI
OR
95% CI
Lower Upper Lower Upper
Exposure to newspaper
Never 1.00 1.00
<1 per week 1.07 0.95 1.20 1.02 0.94 1.11
1 per week 1.32 * 1.04 1.67 1.07 0.95 1.20
Access to radio
Never 1.00 1.00
<1 per week 1.10 0.97 1.24 0.96 0.89 1.05
1 per week 1.31 ** 1.11 1.56 1.13 * 1.03 1.24
Mobile phone
No 1.00 1.00
Yes 1.26 *** 1.12 1.44 1.17 ** 1.06 1.29
Autonomy
Low 1.00 1.00
High 1.23 ** 1.05 1.44 0.99 0.89 1.09
Women’s attitudes towards
wife-beating
Agree 1.00 1.00
Disagree 1.08 0.95 1.22 1.10 * 1.00 1.19
*p-value < 0.05. ** p-value < 0.01. *** p-value < 0.001.
There was no association observed in terms of access to television, newspaper and
autonomy with positive attitudes toward HIV/AIDS.
4. Discussion
In this study, we found socio-economic and demographic factors were associated
with knowledge and attitudes of HIV/AIDS among women aged 15–49 years. Among the
representative sample in this study, more than three quarters (88.74%) had a high level
of knowledge, while more than half (60.28%) of women had negative attitudes toward
PLWHA, revealing the tendencies of women in understanding information on HIV/AIDS.
Even though the study population was significantly knowledgeable about HIV/AIDS,
negative attitudes towards PLWHA showed that accepting PLWHA still requires reasonable
efforts and resources. Our study highlights the need for public and/or specific group
awareness about HIV/AIDS, as suggested in previous studies [
34
36
]. Negative attitudes
toward PLWHA may lead to persistent discrimination and their persistent rejection by
community members [
37
39
]. Our study indicated that a high level of knowledge about
HIV/AIDS does not translate to more positive attitudes and revealed the critical social
barrier for PLWHA in Indonesia.
Our findings revealed that women’s age played a vital role in possessing a high level
of knowledge, while age was not associated with attitudes toward HIV/AIDS. Consistent
with previous studies [
20
,
40
,
41
], age was associated with the person’s opportunity to
gather additional and appropriate information considered necessary for daily life. Mature
age can be attributed to greater exposure to sexual health education, such as training
related to sexual health and HIV/AIDS. One explanation why age was not associated with
attitudes might be because age is related to someone’s experience during their lifetime,
while attitude represents a complex processes within human perception that can change
constantly depending on specific situations [42].
Our study confirmed the findings of previous studies indicating that higher educa-
tion was associated with knowledge and attitudes toward HIV/AIDS among women of
reproductive age [
20
,
43
,
44
]. This may be due to educational attainment acts which have
Healthcare 2022,10, 1545 11 of 14
made information more easily accessible and better promoted the reception of such knowl-
edge [
18
]. Further, appropriate resources might foster better knowledge and attitudes
toward PLWHA, which can assist in the problem of HIV/AIDS infection, treatment, and
transmission [18,45,46].
Further, our study found that socio-economic and demographic factors, including
residing in urban areas, living in the West of Indonesia, having access to mass media,
and having mobile phones were associated with knowledge and attitudes on HIV/AIDS.
These results are similar to previous studies conducted in other countries such as India,
Bangladesh, and Pakistan [
34
,
47
,
48
]. Our findings indicate an urgent need to target women
from urban areas and who are exposed to mass media through appropriate campaigns [
49
].
Related to the current context of infectious diseases, the easy availability and accessibil-
ity of health information online can improve patient knowledge and practice related to
HIV/AIDS [
50
,
51
]. A similar study also found that most people have a good level of
knowledge and understand of preventative actions related to infectious disease such as
COVID-19 [
52
]. In the Indonesian setting, robust policies and strategic programs have
utilized the ABCDE (Abstinence, Be faithful, Condom, Do not use drugs, Education) cam-
paigns to reduce the risk of contracting HIV in the East of Indonesia. A series of efforts
has been made through promotional activities, counselling, and voluntary testing and
treatment; however, HIV/AIDS cases remain high in East of Indonesia, especially in the
Papua region [
8
]. Practical policies supplemented with local insights may need to be tested
at the provincial level to understand how to achieve a better outcome.
Moreover, our study revealed that those women who were well-educated and with a
more affluent wealth index were more likely to show good knowledge and positive attitudes
towards HIV/AIDS. This finding aligns with another study conducted in South Sudan
where wealth quintiles had a significant relationship with comprehensive knowledge and
positive attitudes towards people with HIV/AIDS [
22
]. The ability of women to actively
empower themselves with knowledge on HIV/AIDS relates to the personal awareness
and comprehensive understanding of women about HIV/AIDS. These findings are also
consistent with other studies conducted in Ethiopia and Pakistan [
47
,
52
] which suggested
that women’s autonomy is vital to address the effect of HIV/AIDS on women’s health.
Further, our findings showed that women who disagreed with wife-beating were more
likely to have positive attitudes towards HIV/AIDS [47,52,53].
This study has certain strengths that should be highlighted. Our paper is the first
survey report on socio-economic and demographic factors associated with knowledge
and attitudes of HIV/AIDS among women aged 15–49 years old in Indonesia using well-
recommended global tools. All data utilized in the analysis were weighted to reflect the
statistical interpretation with rigorous methodology and techniques. A significant limitation
of our study related to the completeness of data available from the DHS website [
33
], which
intended to capture demographic and health indicators in Indonesia. The limitation of this
study was found to be the study design which was cross-sectional; therefore, we cannot
infer the causality here. Due to the use of secondary data, we also had no control over the
confounding factors and indicators. Despite these limitations, the findings are important
for the formulation of more effective policies concerning knowledge and attitudes toward
HIV/AIDS.
5. Conclusions
This study analyzed socio-economic and demographic factors associated with knowl-
edge and attitudes toward HIV/AIDS among women aged 15–49 years old in Indonesia.
In order to combat HIV/AIDS in Indonesia, issues of knowledge and attitudes toward
HIV/AIDS still must be addressed. In general, women with a higher level of education,
higher wealth status, living in an urban area, residing in West Indonesia and having access
to the Internet, radio, and mobile phones had significantly better levels of knowledge and
positive attitudes towards HIV/AIDS. Our findings indicate that HIV/AIDS knowledge
and attitudes related to personal background, place, and mode of media contributed to a
Healthcare 2022,10, 1545 12 of 14
high level of knowledge and positive attitudes towards HIV/AIDS. Appropriate health
education programs are recommended as the key to increasing the level of comprehensive
knowledge and attitudes related to HIV/AIDS among women. A health education cam-
paign should be launched based on sociodemographic considerations by working with the
local governments and relevant stakeholders.
Author Contributions:
Conceptualization: F.D.V., F.E., T.K., L.M., K.R. Methodology: F.D.V., F.E., T.K.,
Q.E.S.A., L.M., K.R. Formal analysis: F.D.V., F.E., T.K., L.M., K.R. Writing—Original draft preparation:
F.D.V., F.E., T.K., Q.E.S.A., L.M., K.R., I.A.S. Writing—Review and editing: F.E., T.K., Q.E.S.A., L.M.,
K.R., I.A.S. Funding acquisition: F.E. Resources: F.E., T.K., Q.E.S.A., L.M., K.R. Supervision: F.E., T.K.,
Q.E.S.A., L.M., K.R. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement:
The study was conducted in accordance with the Declaration
of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of ICF IRB
(protocol code FWA00000845, 03/11/2015).
Data Availability Statement:
Data are available from https://dhsprogram.com/data/available-
datasets.cfm (accessed on 4 January 2022) by applying through the DHS program via the website.
The authors had no special access privileges to these data.
Conflicts of Interest:
The authors confirm no known conflict of interest associated with this publication.
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Background: Globally Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an ongoing public health issue associated with high morbidity and mortality. Efforts have been made to reduce HIV/AIDS-related morbidity and mortality by delivering antiretroviral therapy. However, the incidence and predictors of mortality in border areas like Metema were not investigated. This study aimed to assess predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy at Metema Hospital. Methods: Retrospective follow-up study was employed among ART patients from January 1, 2013, to December 30, 2018. Data were entered in Epi-data 3.1 and exported to STATA 14 for analysis. Kaplan-Meier and Log-Rank test was used to compare survival differences among categories of different variables. In bi-variable analysis p-values < 0.20 were entered into a multivariable analysis. Multivariate Weibull model was used to measure the risk of death and identify the significant predictors of death. Variables that were statistically significant at p-value < 0.05 were concluded as predictors of mortality. Result: A total of 542 study participants were included. The overall incidence rate was 6.7 (95% CI: 5.4-8.4) deaths per 100 person-years of observation. Being male (HR = 2.4; 95% CI: 1.24-4.62), STAGE IV (HR = 5.64; 95% CI: 2.53-12.56), stage III (HR = 3.31; 95% CI: 1.35-8.10), TB-coinfection (HR = 3.71; 95% CI: 1.59-8.64), low hemoglobin (HR = 4.14; 95% CI: 2.18-7.86), BMI ≤ 15.4 kg/m2 (HR = 2.45; 95% CI: 1.17-5.10) and viral load > 1000 copy/ml (HR = 6.70; 95% CI: 3.4-13.22) were found to be a significant predictor for mortality among HIV patients on ART treatment. Conclusion: The incidence of death was high. Being male, viral load, those with advanced STAGE (III & IV), TB co-infected, low BMI, and low hemoglobin were at a higher risk of mortality. Special attention should be given to male patients and high public interventions needed among HIV patients on ART to reduce the mortality rate.
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Background: India has the third largest HIV epidemic worldwide. There are many studies conducted in various states assessing the knowledge among the key population, general population but there is no systematic study done to assess the overall knowledge and attitudes of people towards HIV//AIDS. The aim of this study is to determine the present status of the knowledge and attitude towards HIV/AIDS by conducting a systematic review. Methods: We identified peer-reviewed literature through PubMed/Medline, Scopus, Embase, and Google scholar databases, published from January 2010 to November 2020. Cross-sectional studies investigating knowledge and attitude towards HIV/AIDS were included, and meta-analyzed accordingly. The data were analyzed using a random-effect model due to the heterogeneity between the studies. Results and discussion: A total of 47 studies were identified through systematic reviewing, and 43 of these were included in the meta-analysis. Overall, the level of knowledge about HIV/AIDS was 75% (95% CI: 69-80%), and studies conducted in female sex workers reported a higher level of knowledge 89% (95% CI: 77-100%) compared to students (77%) and the general population (70%), respectively. However, the studies reported attitude towards HIV/AIDS was suboptimal (60%, 95%CI: 51-69%). Most of the students (58%), people living with HIV/AIDS (57%), general population (71%), and healthcare workers (74%) had a positive attitude towards HIV/AIDS. Conclusions: The overall knowledge about HIV/AIDS in India was found to be reasonable (75%), with about two-thirds (60%) of those indicating a positive attitude. It is necessary to improve the level of knowledge and attitude about HIV/AIDS in India.
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Background Youth in general and young females, in particular, remain at the center of HIV/AIDS epidemic. To avoid and prevent HIV infection, comprehensive knowledge as well as correct understanding of transmission and prevention strategies are crucial. Thus, the aim of this study is to explore the predictors of comprehensive knowledge on HIV/AIDS and accepting attitude towards PLWHIV. Methods A cross-sectional study was conducted using data from the 2016 Uganda Demographic Health Survey. A two-stage probability sampling method was applied and data were collected using a standard questionnaire. Of the total 8674 women aged 15–49 years, 1971 eligible women aged 15–24 years were included in this analysis. Data analysis was done using SPSS version 23. A Chi-square test followed by logistic regression analysis was used to explore the relationship between specific explanatory variables and outcome variables. The results were reported using odds ratios with 95% confidence interval. P value less than 0.05 was considered as statistically significant. Results Overall, 99.3% of the unmarried women aged 15–24 years were aware of HIV/AIDS, but only 51.9% had comprehensive knowledge on HIV/AIDS. Around 70% of the respondents were aware that "using condoms every time when having sex" and "having only one faithful uninfected partner" can prevent HIV transmission. About 68% of the unmarried women rejected at least two common local misconceptions about HIV/AIDS. An alarmingly small (20.6%) proportion of the respondents had a positive acceptance attitude towards PLWHIV. All variables were significantly associated with having comprehensive knowledge on HIV/AIDS in the unadjusted logistic regression analysis. After adjustment, older age (20–24 years), being educated, wealthier, and ever been tested for HIV/AIDS became predictors of adequate comprehensive HIV/AIDS knowledge. Moreover, respondents with adequate comprehensive knowledge of HIV/AIDS were more likely (OR 1.64, 95% CI 1.30–2.08) to have a positive acceptance attitude towards PLWHIV than their counterparts. Conclusion Our study demonstrated a remarkably high level of awareness about HIV/AIDS among study participants, but the knowledge and positive acceptance attitude towards PLWHIV were not encouraging. Thus, endeavors to expand and strengthen educational campaigns on HIV/AIDS in communities, health facilities, and schools are highly recommended. Attention should particularly focus on young-aged and disadvantaged women with low educational level, poor socioeconomic status and those who have never been tested for HIV/AIDS.
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Background HIV-related stigma and discrimination constitute a barrier to different intervention programs. Unlike external stigma, internal stigma is not well explored in in the Middle East and North African countries, while grasping this particular form of stigma is essential to limit its effects. The present study aims to measure internal stigma effects and to identify factors associated with this kind of stigma not yet documented among people living with HIV (PLHIV) in Morocco. Methods The PLHIV Stigma Index questionnaire (adapted and translated into French and Moroccan Arabic dialect “darija”) was used to collect information regarding the stigma and discrimination experienced by PLHIV across 8 cities in Morocco (September–October 2016). A randomly drawn cluster of 10 PLHIV, consisting of 5 men and 5 women, was drawn at each participating medical care center to achieve a nationally representative sample of PLHIV. Fifteen interviewers living with HIV and five supervisors were selected and trained to administer the questionnaire. An internal stigma score (range: 0–7), was calculated based on seven negative feelings/ beliefs. Negative binomial regression was used to identify characteristics associated with the internal stigma score. Results Among 626 PLHIV, internal stigma was reported by 88.2%. The median [IQR] internal stigma score was 4 [2–5]. Regarding internal stigma, 51% avoided going to the local clinic when needed and 44% chose not to attend social gatherings. Belonging to at least one key population (aIRR [95%CI] = 1.15 [1.03; 1.28]), experiencing discriminatory reactions from family following HIV status disclosure (1.28 [1.11; 1.49]), avoiding HIV services for fear of stigmatization by staff (1.16 [1.05; 1.28]) and being denied health services because of HIV status (1.16 [1.03;1.32]) , are among the factors significantly associated with an increase of the internal stigma score. Conclusions Internal stigma is high among Moroccan PLHIV and significantly impacting their life decisions and their healthcare access. Multi-level interventions are needed to address internal stigma experienced by PLHIV in Morocco.
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This study assessed the determinants that shape HIV knowledge and attitudes among South Sudanese women by analysing a Multiple Indicator Cluster Survey collected from 9,061 women in 9,369 households. Generalised linear mixed model regression was performed. Fifty percent of respondents were aware of HIV/AIDS, with 21% and 22% exhibiting good knowledge and positive attitudes towards people with HIV/AIDS, respectively. When controlled for individual and community-level variables, younger women (AOR = 1.28, 95% CI: 1.01-162), women with primary (AOR = 2.19; 95% CI: 1.86-2.58) and secondary (AOR = 4.48; 95% CI: 3.38-5.93) education, and those living in urban areas (AOR = 1.40; 95% CI: 1.12-1.76) had significantly good knowledge. Women in the richer (AOR = 1.60; 95% CI: 1.08-2.36) and the richest (AOR = 2.02; 95% CI: 1.35-3.02) wealth quintiles had significant positive attitudes towards people with HIV/AIDS. Well-designed social and behavioural campaigns targeting uneducated women and those living in rural and remote settings will enhance knowledge of perceived risk, awareness, and ability to carry out preventive behaviours.
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Background: Women are a highly vulnerable population for HIV-infection, influenced by biological, cultural, social and economic factors. Inadequate knowledge about the risk for exposure to HIV will impact the prevention and treatment of HIV. Objectives: The aim of this study was to examine HIV-related knowledge among women in Indonesia and the associated demographic determinants that influence their access to accurate HIV-related information. Methods: This was a secondary analysis of the Indonesia Demographic and Health Survey in 2012. Level of HIV-related knowledge was determined by analyzing nine items on the 2012 IDHS instrument. Results: The percentage of women in Indonesia between the ages of 15 and 49 years of age, more than half (53.6%) had high score of HIV-related knowledge. The results from logistic regression showed that women aged 30-34 years old had 2.2 times higher knowledge level about HIV compared to older women. Married women, living in rural area, with a lower level of education, reported to have limited or no access to HIV related information; thus, had a correspondingly lower knowledge level of HIV. Conclusion: Study findings underscore the lack of knowledge-level among Indonesian women about HIV, especially the prevention, transmission, and prevention mother to child transmission (PMCT).