Sources of AIDS awareness among women in India

Bournemouth University, Bournemouth, England, United Kingdom
AIDS Care (Impact Factor: 1.6). 02/2006; 18(1):44-8. DOI: 10.1080/09540120500100569
Source: PubMed
ABSTRACT
Sources of AIDS awareness among rural and urban Indian women were analysed using data from the National Family and Health Survey (1998-2000). Two measures were developed to study the impact each source had on knowledge. 'Effectiveness' was defined as the proportion of women who had heard of AIDS from only one source, from among women who had heard of AIDS from that particular source and other sources. 'Independent effect' was the proportion who had heard of AIDS from only one source in relation to all women who had heard of AIDS. Television was the most effective medium, and also had the highest independent effect. Radio and print had very low effectiveness and independent effect. Although television and print audiences are growing in India, it is likely a sub-group of women will continue to lack media access. There is an urgent need to disseminate AIDS awareness to this 'media underclass'. Since the media will not reach this group, other sources including health workers, community level activities such as adult education programmes, and networks of friends and relatives need to be explored.

Full-text

Available from: Saseendran Pallikadavath
Sources of AIDS awareness among women in India
S. PALLIKADAVATH
1
, C. SREEDHARAN
2
, & R. W. STONES
1
1
Centre for AIDS Research, University of Southampton, UK and
2
Bournemouth Media School, Bournemouth University,
UK
Abstract
Sources of AIDS awareness among rural and urban Indian women were analysed using data from the National Family and
Health Survey (1998
/2000). Two measures were developed to study the impact each source had on knowledge.
‘Effectiveness’ was defined as the proportion of women who had heard of AIDS from only one source, from among women
who had heard of AIDS from that particular source and other sources. ‘Independent effect’ was the proportion who had
heard of AIDS from only one source in relation to all women who had heard of AIDS. Television was the most effective
medium, and also had the highest independent effect. Radio and print had very low effectiveness and independent effect.
Although television and print audiences are growing in India, it is likely a sub-group of women will continue to lack media
access. There is an urgent need to disseminate AIDS awareness to this ‘media underclass’. Since the media will not reach
this group, other sources including health workers, community level activities such as adult education programmes, and
networks of friends and relatives need to be explored.
Introduction
While not sufficient in itself, awareness of AIDS is
necessary for women to protect themselves from HIV
acquired through sexual relations, and their children
through mother-to-child transmission (Pallikadavath
& Stones, 2003a; Boer & Emons, 2004). India is still
at the early stages of the epidemic in terms of
prevalence but the absolute number of infected
persons is very large and spread through the general
population is now evident in both urban and
rural areas (Gangakhedkar, 1997; Newmann, 2000;
Pallikadavath et al., 2003). Although the Indian
National AIDS Control Organisation (NACO) be-
gan HIV prevention and control work in 1992, nearly
70% of rural and 30% of urban ever-married women
lacked AIDS awareness during 1998
/2000 (IIPS &
ORC Macro, 2000). A more recent survey showed
some improvement in levels of knowledge with 35%
of rural and 15% of urban women indicating a lack of
AIDS awareness (NACO, 2004a), although there
were substantial differences between the states
(NACO, 2004b). A priority for policy in ‘low knowl-
edge, low prevalence’ settings such as north India
would be to increase awareness of AIDS among
women as a means of providing some knowledge for
health protection, rather than waiting for widespread
knowledge of HIV and AIDS to follow rising pre-
valence (Pallikadavath & Stones, 2003a).
Creating awareness of AIDS has been an impor-
tant ‘Information Education Communication’ (IEC)
agenda of NACO (NACO, 2004c). However, there
is lack of research on whether or not these media are
effective as means to generate universal AIDS
awareness in India. The objective of this paper is
to measure the effectiveness of various sources of
AIDS awareness among rural and urban women.
Methods
Data
Data from the 1998
/2000 Indian National Family
Health Survey (NFHS-2) were utilized in the
present study. This was a nationally representative
population-based sample survey of 90,303 ever-
married women aged 15
/49 from 26 states compris-
ing 99% of India’s population. The survey methods
are described in detail in an overview report (IIPS &
ORC Macro, 2000). Data were provided in anon-
ymized form for academic use by ORC MACRO, for
which ethical approval was not required.
During the survey each respondent was asked
whether she had heard of AIDS. To those who
responded ‘yes’ a further question on sources of
information was asked. There were 14 different
sources of AIDS information reported in the survey.
In the present study the main analysis included
Correspondence: R. W. Stones, Senior Lecturer in Obstetrics and Gynaecology, Level F(815), Princess Anne Hospital, Southampton SO16
5YA, UK. Tel:
/44 (0)23 8079 6033. Fax: /44 (0)23 8078 6933. E-mail: r.w.stones@soton.ac.uk
AIDS Care, January 2006; 18(1): 44 /48
ISSN 0954-0121 print/ISSN 1360-0451 online # 2006 Taylor & Francis
DOI: 10.1080/09540120500100569
Page 1
construction of matrix tables for rural and urban
areas for 14 types of sources of AIDS awareness
(data not shown). Matrix tables were used for
obtaining measures of effectiveness and the inde-
pendent effect of each source of AIDS awareness,
defined below with indicative examples.
Measure of ‘effectiveness’
This is the proportion of women who had heard of
AIDS from only one source, from among women
who had heard of AIDS from that particular source
along with all other sources. In the present analysis
there were 950 rural women who had heard of AIDS
from the radio alone, from among 9,073 women who
had heard of AIDS from radio along with all other
sources. Thus, the effectiveness of radio is 10% (950/
9,073)*100. We termed this proportion as a measure
of ‘effectiveness’ because it captures the effect of each
source. For example, 10% effectiveness of radio
indicates that 90% (100-effectiveness) of women
who had heard of AIDS from radio had also heard
it from other sources. In other words, this 90% of
would have heard of AIDS without access to radio.
Measure of ‘independent effect’
This is the proportion of women who had heard of
AIDS from only one source in relation to all women
who had heard of AIDS. In the present analysis there
were 950 rural women who had heard of AIDS from
radio alone and 19,803 women who were aware of
AIDS. Thus, the ‘independent effect’ of radio is
4.8% (950/19803)*100. This proportion is termed
the ‘independent effect’ because it shows the in-
dependent contribution of a particular medium
towards overall awareness of AIDS in the popula-
tion.
Results
Of the total 66,660 ever-married women surveyed in
rural India, 19,803 (29.7%) were aware of AIDS; in
urban areas 23,643 were surveyed, of whom 16,615
(70.3%) were aware of AIDS. The percentages of
urban and rural women who were aware of AIDS are
tabulated by source of information in Table I. As
women who had heard of AIDS from one source
could also have gained knowledge from other
sources, the above percentages do not indicate how
effective each medium was in imparting AIDS
awareness. Table I shows that friends or relatives
emerged as the most effective source of AIDS
awareness in rural India: for 33% of women who
had heard of AIDS from friends or relatives this was
the only source of information. The second most
effective source was television: for 27% of women
who had heard of AIDS from television this was their
only sources of information. Community meetings
were the next most effective source of AIDS aware-
ness: for 26% of women who had heard about AIDS
from community meetings this was the only source
of AIDS information. Although 46% of women had
heard of AIDS from the radio, only 10% had heard
of AIDS from that medium alone.
Table I presents the ‘independent effect’ of each
source of information. The independent effect of all
the 14 sources reported by women in this survey
accounts for 39% of all AIDS awareness. The
independent effects of each source of information
were as follows. In rural areas, television indepen-
dently contributed 18% to AIDS awareness,
followed by friends or relatives (12%) and radio
(5%). The independent effects of the other sources
of information were negligibly low.
The above ‘effectiveness’ and ‘independent effect’
measures do not indicate the number of sources
from which women gained knowledge of AIDS. The
average number of sources was calculated and
presented in the final columns in Table I. On average
rural women had heard of AIDS from 3.6 sources.
Women who had heard of AIDS from the radio,
television, friends or relatives, community meetings,
and in the work place had on average fewer than two
sources of AIDS information. Women who had
heard of AIDS from ‘other sources’ had more than
two sources of information.
Table II shows the percentage of women lacking
AIDS awareness who were exposed to television,
radio, and newspapers. Newspapers were read by 4%
of rural and 8% of urban women. With regard to
television, 41% of women in rural areas and 21%
women in urban areas lacked knowledge of AIDS
even though they had watched television at least
once a week. Similarly 23% of women in rural and
28% in urban areas were radio listeners at least once
a week.
Estimating what would have happened under
different hypothetical scenarios of media penetra-
tion, in the absence of radio, AIDS awareness levels
would have been 28.3% and 69.7% in rural and
urban areas, respectively, compared to the measured
levels of 29.7% and 70.3% in rural and urban areas,
respectively. Absence of newspapers would have
resulted in 29.1% and 70.0% AIDS awareness in
rural and urban areas, respectively. Absence of
television would have resulted in 24.3% and 50.0%
AIDS awareness in rural and urban areas, respec-
tively.
Discussion
Overall there is evidence that AIDS awareness is
rising among Indian women. But knowledge pene-
Sources of AIDS awareness among women in India 45
Page 2
Table I. Sources of AIDS awareness in rural India, 1998 /2000.
% women aware of AIDS Measure of effectiveness Measure of lack of effectiveness (100-effectiveness) Measure of independent effect Average number of sources
Source of AIDS knowledge Rural Urban Rural Urban Rural Urban Rural Urban Rural Urban
Radio 45.8 36.4 10.4 2.3 89.6 97.7 4.8 0.8 1.7 2.1
Television 68.4 91.0 26.7 30.4 73.3 69.6 18.3 27.7 1.5 1.6
Newspaper 20.7 34.0 2.7 0.9 97.3 99.1 0.6 0.3 2.2 2.2
Pamphlet/magazine 9.5 15.9 3.8 2.1 96.2 97.9 0.4 0.3 2.5 2.6
Clinic/health worker 4.4 2.8 16.8 6.1 83.2 93.9 0.7 0.2 2.1 2.8
Place of worship 0.2 0.1 15.9 15.0 84.1 85.0 0.1 0.0 2.3 4.3
School/teacher 1.1 1.0 10.1 4.1 89.9 95.9 0.1 0.0 2.9 3.4
Community meeting 2.9 1.5 26.0 12.9 74.0 87.1 0.8 0.2 1.8 2.7
Friends/relatives 37.3 23.2 33.1 15.9 66.9 84.1 12.3 3.7 1.6 2.0
Work place 3.3 1.8 17.7 6.8 82.3 93.2 0.6 0.1 1.9 3.0
Cinema 5.9 10.6 2.6 0.7 97.4 99.3 0.2 0.1 2.7 2.8
Exhibition 0.6 0.7 11.1 0.0 88.9 100.0 0.1 0.0 2.8 4.0
Adult education programme 0.5 0.5 16.8 8.9 83.2 91.1 0.1 0.0 3.1 3.7
Political leaders 0.1 0.1 18.1 0.0 81.9 100.0 0.0 0.0 2.6 4.5
All
/ / / / / / 38.9 33.6 3.6 4.4
Number of women 19,803 16,615
/ / / / 19,803 16,615 19,803 16,615
46 S. Pallikadavath et al.
Page 3
tration is still unacceptably low in most of the
northern states, especially in rural areas (Pallikada-
vath et al., 2003). The present study has considered
only the crude construct of ‘AIDS awareness’, which
does not reflect the complexity of knowledge acqui-
sition, let alone the response to knowledge in terms
of behaviour change. A study of Indian truck drivers
showed how beliefs and feelings mediated the
relationship between AIDS awareness and condom
use intention (Chaudhuri & Ray, 2004). In the case
of women, there is the additional complexity of
gender relations that limits their capability to ne-
gotiate condom-use even where awareness of AIDS
is substantial.
Among the electronic media, television has played
a vital role in achieving current levels of knowledge
about AIDS, quantified in our analysis using our
novel measures of effectiveness and independent
effect. Increasing access to television could be
anticipated to provide further gains in AIDS aware-
ness among women. However, a study of married
urban women showed how messages obtained from
television are diffused into conversation and discus-
sion within social networks: typically, after seeing
something about AIDS on television discussion with
husbands was mainly in terms of a general social
phenomenon rather than personal perceptions of
risk (Chatterjee, 1999). Thus although necessary,
dissemination of knowledge does not automatically
translate into conversations with the sexual partner
about personal risk. Social relations and gender
dynamics in rural areas provide additional barriers
to any such open discussion.
Our hypothetical consideration of what would
have happened without television indicates that
knowledge levels would have been even lower.
However, our analysis shows that despite watching
television regularly substantial numbers of rural and
urban women had not gained knowledge of AIDS as
a result. Thus, simply increasing women’s access to
television may not in itself guarantee greater levels of
AIDS awareness, particularly in rural areas. In
addition it is necessary to examine the timing of
public information programmes, their design in
relation to actual social conditions and the use of
branded versus generic advertisements (Agha,
2003). According to the National Readership Survey
(NRS-2002) there were 383.6 million television
viewers in 2002, a figure likely to increase in coming
years with every prospect of it becoming the prime
medium in rural India. Clearly, television based
information strategies are of considerable impor-
tance in this context.
We have shown that the contribution of radio to
current levels of AIDS awareness in India is low,
particularly in urban areas. Furthermore, 23% of
rural and 28% of urban women who were not aware
of AIDS claimed to be regular radio listeners.
Although radio transmission in India started as early
as 1927, the number of radio listeners in 2002 was
only 189 million compared to 383.6 million televi-
sion viewers and 180 million print readers (Bunsha,
2002). A number of frequency modulation (FM)
stations in urban areas have been created as a result
of government deregulation in 1999. Despite the
growth in radio stations, the total number of radio
listeners has grown only to a limited extent since this
policy change (Ghosh, no date). If radio is to have an
impact in the future, changes in approach are needed
such as new content in mainstream stations or
specialized stations focusing on women’s issues
(Das, 2003).
The above discussion has considered the impact of
mass media in communicating knowledge. There is a
risk that total reliance on electronic or print media
would exclude vulnerable sub-groups of the popula-
tion, creating a ‘media underclass’ (Johnson, 2001).
National policy has not made systematic use of
person-to-person communication, for example using
opportunistic contacts with health services for pur-
poses of family planning, maternity care or child
health. An existing infrastructure is in place nation-
ally but some reorientation of the service to give due
emphasis to dissemination of knowledge about HIV
and AIDS, underpinned by appropriate training
would be required (Pallikadavath & Stones,
2003a). The Chinese experience has indicated that
such reorientation can be accomplished on a sub-
stantial scale (Wu et al., 2002). Finally, community
level activities by non-governmental organizations
offer the potential to reach otherwise marginalized or
under-served groups who might not make full use of
the existing health service infrastructure, let alone
enjoy full access to the range of information media.
The impact of such efforts necessarily depends on
local capacity, social relations and political condi-
tions but can be encouraged through supportive
policy and programming by official agencies and
donors. Our findings also highlight the importance
of designing interventions that make use of existing
social networks of friends and family, shown to be
effective means of dissemination of AIDS awareness
in this study. Further research is needed to assess
how these networks can be utilized given the con-
Table II. Percentage of women who reported access to media
among those who had not heard of AIDS, rural and urban
India, 1998
/2000.
Percentage of women listeners/readers
Media source Rural (N
/46,850) Urban (N/7,028)
Newspaper 4.1 8.3
Television 41.0 21.2
Radio 22.8 28.0
Sources of AIDS awareness among women in India 47
Page 4
straints of gender relations in discussing sexual
matters, and means of overcoming barriers between
women from different social sub-groups.
Acknowledgements
This work was funded by the UK Government
Department for International Development. The
funder had no role in the design or conduct of the
study and the views expressed are those of the
authors.
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    • "Chatterjee reported that most AIDS-related information obtained by women was acquired through mass media channels [58]. Pallikadavath, Sreedharan and Stones note the value of mass media in educating individuals about HIV/AIDS and suggest that in rural India, radio is most likely to be effective [59]. Similarly, and consistent with the results from our study, research has also shown that mass media is an important source of information for reproductive health awareness among adolescent girls [60]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Rural women in West Bengal have been found to have low rates of formal education, poor health knowledge, high rates of malnutrition and anemia, and low levels of empowerment. Despite these difficult circumstances, some women have positive health outcomes compared to women with similarly disadvantaged backgrounds. The purpose of this study is to identify factors associated with positive health outcomes among women with primary education or less. Methods Multivariable regression models were built for outcomes of positive deviance to better characterize the factors in a woman’s life that most impact her ability to deviate from the status quo. Results Positive deviants in this context are shown to be women who are able to earn an income, who have access to information through media sources, and who, despite little schooling, have marginally higher levels of formal education that lead to improved health outcomes. Conclusions Study findings indicate that positive deviant women in disadvantaged circumstances can achieve positive outcomes amidst a host of contextual barriers that would predict poor health outcomes. Focusing on areas such as enhancing access to media sources, facilitating self-help groups for married women, and promoting prolonged education and delayed marriage for girls may improve health knowledge and behavior among married women with low levels of education.
    Full-text · Article · Apr 2013 · BMC Public Health
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    • "2005 Hamra et al,. , 2006 Takai et al., 1998), self-evaluated perception of risk of HIV infection (Herek et al., 2002; Lew-Ting and Hsu 2002), and knowing someone with HIV or who has died of AIDS (Lau and Tsui 2007; Pallikadavath et al., 2006). A handful of studies have gone beyond assessing the individual-level correlates of accepting attitudes toward PLHIV to examining the potential role of community-level (contextual) factors in an individual's tolerance toward those with HIV (VanLandingham et al., 2005). "
    [Show abstract] [Hide abstract] ABSTRACT: Using the 2003 Kenya Demographic and Health Survey, we investigated the influence of individual- and community-level factors on accepting attitudes toward people living with HIV (PLHIV) using three outcomes: (1) willingness to care for an infected household member, (2) willingness to buy vegetables from an infected vendor, and (3) willingness to allow an infected female teacher to continue teaching. In multilevel logistic regression models, we found that individuals who expressed greater acceptance of PLHIV were more likely to be male, older, more educated, high AIDS knowledge, and exposed to mass media. At the community level, differences in accepting attitudes were associated with community AIDS knowledge, community education, and community AIDS experience, but not for region, or place of residence. The findings suggest the important role of community factors in determining social acceptance of PLHIV. Programmatic strategies aimed at increasing these accepting attitudes should consider both individual- and community-level factors.
    Full-text · Article · Sep 2009 · Health & Place
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