Student Code/ID:
2
7
5
4
Name
Kinley Wangmo
Unit code
Research Project
Submitted to
Mrs. Kesang Dechen
Assignment title
Knowledge of HIV/AIDS among women (15-49 years)
Word count
7,316
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Declaration
I acknowledge that:
This assignment is my own work
This assignment is expressed predominantly in my own words
The words and ideas of others, where used, are properly used and acknowledged No part
of this assignment has been previously submitted for assessment.
I understand that by submitting my work to in both soft and hard copy to Royal Institute of Management
(RIM), it will be maintained within the premises of Institute’s Academic Policy.
Signature
Date: 28/11/2016
Acknowledgement
I would like to firstly express my heartfelt gratitude to my Research Supervisor, Mrs. Kesang
Dechen for her imperative time and endeavor which has immensely added better approach in
completing my research project. She has been an unremitting supply of motivation and support.
Under his advice, the voyage of this research has been exceedingly stimulating. In fact, she has
radiated herself in each and every step throughout the completion of this research.
Secondly, I would like to express my gratitude to Mr. Jamyang Choeda (Sr. Research Lecturer),
Sherubtse College and Mr. Dorji Peljor, National Statistical Bureau for allocating me the data for
the research and advising me with supportive suggestions for the enrichment of my research
project.
I would also like to thank my friends Sangay Choden, Dil Maya, Kuenzang Dorji and Jigme Dorji
for providing me with feedbacks and reviewing my research paper. I would also like to thank the
Royal Institute of Management for giving me the prospect to carry out the research project which
aided me in advancing my research skills. Lastly, I would like to extend my sincere appreciation
to all our referred learned authors, writers and journalists for the accommodating information
endowed in their books and journals.
i
Abbreviations and Acronyms
HIV
Human Immunodeficiency Virus
AIDS
Acquired Immunodeficiency Syndrome
UNAIDS
United Nations Programme on HIV/AIDS
WHO
World health Organization
RGoB
Royal Government of Bhutan
MOH
Ministry of Health
NSB
National Statistical Bureau
UNFPA
United Nations Population Fund
BMIS
Bhutan Multiple Indicator Survey
ii
Abstract
Human Immunodeficiency Virus (HIV) and Acquired Deficiency Syndrome (AIDS) are one of the
complex health problems in this 21st century. Globally there are 35 million people living with
HIV/AIDS, with sub Saharan Africa accounting highest, 24.7 million and Asia and Pacific 4.8
million (UNAIDS, 2014). HIV/AIDS is a serious issue all over the world, without exception to the
small and less populated country like Bhutan. The 6th millennium development goal targeted
combating HIV/AIDS and other hazardous diseases like malaria and tuberculosis, since they are
listed amongst the un-curable diseases. The Royal Government of Bhutan has tried to combat the
HIV/AIDS through awareness programs and encourages researches to prevent it. Despite that, the
HIV cases are increasing over the period of time. Therefore, it is very necessary to test the
knowledge of our vulnerable citizen those who are at the reproductive ages. This study aims to
examine the knowledge level among the women at reproductive ages 15-49 years. The information
on HIV related diseases are mostly determined by the misconception and the mode of transmission
of HIV. The study was descriptive and cross sectional study. It has found out that in general,
women who attain secondary and above educational level has very good knowledge about
HIV/AIDS. 71% of women have answered more than 8 questions correctly on HIV/AIDS out of 13
questions. Nearly 23% of interviewed women age 15-49 have answered 6-7 questions correctly.
About 6% of the women answered less than 5 questions correctly. The knowledge on transmission
of HIV/AIDS virus from mother to child is good, but still there are still misconceptions that HIV
can be transmitted through mosquito bites, sharing food with infected person and through super
natural means.
Keywords: HIV/AIDS, Knowledge, Misconception, Educational Attainment
Level, Wealth Quintile Index
iii
Table of Contents
Acknowledgement ............................................................................................................................ i
Abbreviations and Acronyms ........................................................................................................ ii
Abstract ........................................................................................................................................... iii
CHAPTER ONE ............................................................................................................................. 1
1.1 INTRODUCTION..................................................................................................................... 1
1.2 BACKGROUND ....................................................................................................................... 2
1.3 SIGNIFICANCE OF THE PROBLEM .................................................................................. 2
1.4 PROBLEM STATEMENT ...................................................................................................... 3
1.5 RESEARCH OBJECTIVES .................................................................................................... 3
1.6 RESEARCH HYPOTHESIS ................................................................................................... 3
CHAPTER TWO ............................................................................................................................ 4
2.1 LITERATURE REVIEW ........................................................................................................ 4
CHAPTER THREE ........................................................................................................................ 8
3.1 RESEARCH METHODOLOGY ............................................................................................ 8
3.1.1 Data ...................................................................................................................................... 8
3.1.2 Definition of Variables ......................................................................................................... 8
3.2 CONCEPT AND DEFINITIONS ............................................................................................ 9
3.3 METHOD .................................................................................................................................. 9
3.4 ANALYSIS .............................................................................................................................. 10
3.5 ETHICAL CONSIDERATIONS ........................................................................................... 12
3.6 FUTURE SCOPE FOR STUDY ............................................................................................ 12
CHAPTER FOUR ......................................................................................................................... 13
4.1 RESULTS AND DISCUSSION ............................................................................................. 13
iv
4.1.1 Knowledge on HIV/AIDs................................................................................................... 13
4.1.2 Misconception about HIV/AIDs transmission based on the level of education: ............... 14
4.1.3 Women’s knowledge on some facts about HIV/AIDs ....................................................... 14
4.1.4 Accepting Attitudes toward People Living with HIV/AIDS ............................................. 15
CHAPTER FIVE .......................................................................................................................... 16
5.1 CONCLUSION ....................................................................................................................... 16
5.2 RECOMMENDATIONS........................................................................................................ 17
5.3 LIMITATIONS ....................................................................................................................... 17
References ...................................................................................................................................... 18
ANNEXURE .................................................................................................................................. 20
v
CHAPTER ONE
1.1 INTRODUCTION
HIV/AIDS is an endemic disease which not only affects the health of individuals, households and
communities, but also impacts the development and economic growth of nations. Evidence shows
that HIV endemic is often severe and widespread. According to the Gap report (2014), an estimated
35 million people were living with HIV/AIDS globally; Asia and the Pacific region accounted for
about 4.8 million. HIV/AIDS is recognized as the world’s leading infectious killer.
According to World health Organization (WHO), an estimated 34 million people have died from
AIDS-related causes, including 1.2 million in 2014. The HIV/AIDS epidemic is becoming one of the
rapidly growing health concerns in Bhutan. The first HIV case was detected in 1993, and the
numbers have been rising over the years. In 2011, there were 207 people living with HIV/AIDS.
Since then, there has been much advocacy imparting knowledge on HIV/AIDS and its
misconceptions through awareness campaign, and encouraging use of condoms towards safe sex
practices. Although both men and women are at risk to HIV/AIDS, women seem to be at more risk
than men. As of 2015, there were 199 women living with HIV/AIDS compared to males (Ministry of
Health, 2015).
One of the main causes in the rise of number of spread of HIV/AIDS is the vulnerability of HIV
infection among adolescent girls and women, which is further linked to women's education and
poverty (Gap Report, 2014). Education has been suggested as an 'alternative vaccine' or a ‘social
vaccine’ to prevent, and to mitigate the spread of HIV. As Hargreaves and Glynn (2002) state, “In
the absence of a vaccine and widely available treatment, the primary focus for HIV control programs
must be on reducing transmission…the main method of reducing heterosexual transmission is by
behavior change.” Likewise, a woman living in poor households has been related to higher risk of
HIV/AIDS. Although there are a couple of studies that evaluates the awareness level of HIV/AIDS
among women, research on causal relationship between HIV/AIDS and its risk factors, for example,
education and poverty is scanty.
Therefore, it merits the attention of the researchers for informing policy makers, planners and general
public alike. The aim of this study is to evaluate the casual association between awareness on
HIV/AIDS, education and poverty.
1
1.2 BACKGROUND
A study on ‘The Causes and the Consequences of HIV Evolution’ by Andrew Rambaut et.al in 2004
have revealed that AIDS was first recognized in the United States in 1981, following an increase in
the incidence of usually rare opportunistic infections in homosexual men that were caused by a
general immune deficiency. Later in 1983, Human Immunodeficiency Virus (HIV) was recognized.
Since then, extensive researches have been carried out in understanding the nature of HIV/AIDS by
various international agencies, especially World Health Organization. In an effort to find the cure to
the disease, although no cure have been found so far, various studies have documented that education
plays vital role in mitigating the spreading of HIV/AIDS.
Over the years, researchers have studied levels of educational attainment on sexual behavior such as
condom use, numbers of non-marital sexual relations, and age of first sexual experience. The
evidence from available literatures shows positive correlation between levels of education level and
awareness on HIV/AIDS.
Bhutan has placed high priority on education and therefore, education has been provided free since
the introduction of modern education in Bhutan. Both boys and girls are provided with an equal
opportunity to get enrolled in the school. Nevertheless, women in general are less likely to complete
the higher level of education compared to men (Shahidul & Karim, 2015). Owing to this fact, many
people, especially women and adolescent girls lack knowledge on HIV/AIDS and therefore
contribute in up scaling the number of people living with HIV/AIDS (UNAIDS, 2015). Such
incidence reflects poor knowledge towards HIV/AIDS by women.
1.3 SIGNIFICANCE OF THE PROBLEM
The Royal Government of Bhutan has been demonstrating a strong political commitment to
preventing and controlling the spread of HIV. The government has been introducing HIV/AIDS
prevention and control as one of the most important programs for addressing emerging health issues
and promoting better health for women and adolescents. Despite its strong intervention in this area,
the country still faces serious challenges in its efforts to combat HIV. Keeping this in mind, this
study seeks education as the viable measure to HIV prevention. Understanding the level of
knowledge about HIV transmission, misconceptions and attitude of Bhutanese women age 15-49
2
years would provide a basis to prevent further spread of the disease. In nutshell it would particularly
help our planners and policy makers to understand and implement best policy and make interventions
in the emerging areas.
1.4 PROBLEM STATEMENT
HIV/AIDS has been epidemic around the globe and proportions are more in many developing
countries. For Bhutan the disease is considered as an issue of national concern that demands urgent
attention; and the government places a top priority to tackle this major problem. For example, if the
number of people with HIV positive increases, then Bhutan with an estimated population of about
750 thousands (National Statistics Bureau, 2015) would face extinction, thus testing the sovereignty
of the nation. Therefore, it is a national issue that cannot be ignored or neglected.
1.5 RESEARCH OBJECTIVES
1. To find out whether education has a positive impact on HIV/AIDS prevention;
2. To understand the level of knowledge about HIV transmission, misconceptions and
comprehensive knowledge of HIV transmission by Bhutanese women(15-49 yrs); and
3. To examine the kind of attitude towards people living with HIV by Bhutanese women (15-49
yrs).
1.6 RESEARCH HYPOTHESIS
The paper is aimed at testing the following hypothesis:
1. Education has a positive impact on HIV/AIDS prevention.
2. The more educated the Bhutanese women are, the more likely they are to have
comprehensive knowledge about HIV/AIDS and less likely to have misconception.
3. Women with higher education level provide accepting attitude towards people living with
HIV.
3
CHAPTER TWO
2.1 LITERATURE REVIEW
Human Immunodeficiency Virus (HIV) and Acquired Deficiency Syndrome (AIDS) are one of the
complex health problems in this 21st century. Globally there are 35 million people living with
HIV/AIDS, with sub Saharan Africa accounting highest to 24.7 million and Asia and Pacific 4.8
million (UNAIDS, 2014). HIV/AIDS is a serious issue all over the world, without exceptional to the
small and less populated country like Bhutan. The 6th millennium development goal targeted
towards the combating the HIV/AIDS and other hazardous diseases like malaria and tuberculosis,
since it’s one of the un-curable diseases. The royal government of Bhutan tries to combat the
HIV/AIDS through awareness programs and encourage research to prevent it. Despite that the HIV
cases are increasing over the period of time so for that it’s very necessary to test the knowledge of
our vulnerable citizen those who are at reproductive ages.
The sexual reproductive health issues among young people are of international and national concern
as a result of HIV/AIDs pandemic and also the growing rates of other sexually transmitted infections,
complications of early unplanned or unwanted pregnancy.
It is very important to have
comprehensive sexual education to the younger generation. It’s about giving young people the
information, skills and knowledge they need on contraception human reproduction, pregnancy, safer
sex (prevention of sexually transmitted infections), sexual attitudes and values, sexual anatomy and
physiology, sexual behavior, sexual health and sexual orientation. The issues related to sexual
reproductive also have demographic and social dimensions issues.
Most HIV infections are in African regions that are transmitted through sexual intercourses that
females especially in the reproductive age bear the greater consequences of unsafe sex and STIs
(Djamba, 1997). Particularly in the developing countries, the risk of getting HIV/AIDs and STI are
higher. It significantly contributes to the global population momentum as a result of early sexual
activity and early age child bearing. The social dimension is that reproductive ill health which has
awful consequences on the life or young people, especially for their future and the society they live
in. In developing countries, in 1990, reproductive ill health accounted for 36% of the total disease
burden among women of reproductive age (15-44/49 years), as compared to only 12% in men. For
women, the three groups of conditions included in reproductive ill health are pregnancy-related
deaths and disabilities and sexually transmitted diseases including HIV/AIDS (AbouZahr 1999).The
4
number of HIV cases detected gradually increased from only 38 in 2000 to alarming figure of 246 in
2010 (Bhutan Multiple Indicator Survey, 2010).
According to UNFPA, prevention is key, but many women and adolescent girls do not have the
knowledge or means to prevent HIV infection. “Girls and women are highly susceptible to HIV
infection, both biologically and as a result of gender inequality and discrimination,” states the report
by Zulu and Ciera (2007). “Globally, more than 80% of young women do not have sufficient
knowledge about HIV/AIDS. The silence surrounding issues of sexuality, the realities of gender
inequality and the lack of education about sexual and reproductive health are putting girls and
women at risk,” (Burgoyne, 2008).
Basic knowledge about HIV/AIDS appears to be quite limited in some communities especially in
rural places. Attending school was associated with the lower risk of sexual behaviors and among
young, men lowers HIV prevalence. Secondary school attendance may influence the structure of
sexual networks and reduce HIV risk. Average education level is low in poor countries like sub saran
Africa and HIV/AIDS has been characterized as a disease of poverty and the lack of education.
However the studies carried so far shows the greater level of HIV infection among the more
educated, in both urban and rural areas and among men and women. This was probably because more
educated individuals are engaged in larger, more risky sexual network as a result of their greater
mobility and higher socio-economic status and that poverty is an important driving factor for unsafe
sexual practices, higher proportion of adolescents from poor families to exhibit such behaviors.
(Hargreaves, Morison & Kim et al, 2008).
The reasons for increase in HIV/AIDS infection is due to the limited knowledge about HIV/AIDS
and mainly due to the misconception, lacks the knowledge about correct modes of transmission, their
attitude about the use of condom and lack of control over the sexuality, violence against women. The
methods and findings are based on nations the standardize research done through primary data
collections. The researchers aimed at finding association between the knowledge level and the factors
associated with HIV/AIDS and misconception, attitude towards HIV/AIDS. Available national health
statistic data in the country are also employed (Yerdaw, 2002).
5
HIV/AIDS has a widespread impact on many parts of Africa’s infrastructures. For instance, AIDS is
causing social and economic crisis in Africa. The spread of HIV/AIDS in Africa has severely
affected the size and structure of the populations and the family and social cohesion. Due to
HIV/AIDS millions of African adults are dying at a younger age, leaving behind children struggling
to survive. According to Fredriksson and Kanabus (2004), in many sub-Saharan African countries the
average of life expectancy is now 47 years. Since most of the people who are infected with
HIV/AIDS are productive people between the ages of 15 and 49 years, the death toll is expected to
have a severe impact on the economic growth in the region. In many African countries, the
HIV/AIDS epidemic is bringing additional pressure to bear on the health sector. As the rate of HIV
infection is growing in Africa, the demand for health care for those living with HIV/AIDS rises.
According Hyder &Khan, Kenya expects to be spending 60% of its health budget on the treatment of
HIV/AIDS by 2005 and the World Bank predicts a 15-25% fall in Tanzania's Gross Domestic
Product (GDP) as a result of HIV/AIDS. Additionally, the increased demand for resources in the
African health sector is limiting the resources available for the education sector (1998).
According to Georgetti (2004), a report published jointly by UNFPA, UNAIDS and UNIFEM shows
that currently some 36 million people between the ages of 15 and 49 are living with HIV/AIDS.
Though AIDS cases are rising in Asia, particularly in India and China, it is a national crisis in most
of the countries of sub-Saharan Africa. With only 10% of the world’s population, sub-Saharan Africa
has 70% of all HIV positive people. The majority are women and girls, who comprise just fewer than
60% of the total number of infected people in the region (UNFPA, 2015).
Attending school was associated with the lower risk of sexual behaviors and among young men
lowers HIV prevalence. Secondary school attendance may influence the structure of sexual networks
and reduce HIV risk. Average education levels are low in poor countries like Sub-Saharan Africa and
HIV/AIDS has been characterized as a disease of poverty and the lack of education. However the
studies carried so far shows the greater level of HIV infection among the more educated, in both
urban and rural areas and among men and women. This was probably because more educated
individuals are engaged in larger, more risky sexual network as a result of their greater mobility and
higher socio-economic status (Hargreaves, Morison & Kim et al, 2008).
6
On the other hand, Zulu and Ciera (2007) pointed out that poverty is an important driving factor for
unsafe sexual practices, higher proportion of adolescents from poor families to exhibit such
behaviors. In reality, because the flow of exchange of money and gifts in Africa is predominantly
from males to females, poorer females and wealthier males would exhibit higher sexual behavior.
HIV prevalence among young people has increased steadily in poor nations due to change in sexual
behavior among the adolescent.
Schlegel and Barry argued that the female social role is positively related with sexual permissiveness
and the attitude towards sexual intercourse is related to female contribution to subsistence which the
sexual permissiveness would characterize societies within a high female contribution to subsistence
(n.d.). Welday explains that gender inequalities, inadequate knowledge and negative attitude towards
the disease are the major barriers to prevent spread of HIV/AIDS. Women with no education and
living in rural areas have inadequate knowledge and negative attitude towards people living with
HIV/AIDS in East African Countries (2015).
Women who are married before the age of 18 tend to have more children than those who marry later
in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and
unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There
is evidence to suggest that girls who marry at young ages are more likely to marry older men which
puts them at increased risk of HIV infection. Parents seek to marry off their girls to protect their
honor, and men often seek younger women as wives as a means to avoid choosing a wife who might
already be infected (BMIS, 2010).
7
CHAPTER THREE
3.1 RESEARCH METHODOLOGY
3.1.1 Data
This study uses data collected for the “Bhutan Multiple Indicator Survey”, which was conducted in
2010 in view to monitor the children and women for urban and rural areas in Bhutan. The survey
which was conducted in 2010 has aimed to monitor progress towards the Millennium Development
Goals (MDGs) and other internationally agreed-upon commitments (National Statistics Bureau,
2015). The data included information on various demographic and health indicators with individual
characteristics, marriage and sexual behavior, family planning knowledge and use of condoms, and
also response of HIV/AIDS knowledge, perception and attitude of 14,018 women age 15-49 years.
The BMIS 2010 has used a two-stage stratified sampling.
3.1.2 Definition of Variables
The survey has covered the following modules in the questionnaire:

Education:
The questionnaire administered to women 15-49 years has question on the highest level of
education woman has completed at the time of data collection. The options provided
were;

-
Preschool
-
Primary(PP-6)
-
Lower Secondary (7-8)
-
Middle Secondary (9-10)
-
Higher Secondary(11-12)
-
College/University
HIV/AIDS:
Few questions related to HIV/AIDS were asked as follows:
-
Ever heard of HIV?
-
HIV transmission can be prevented by having one uninfected sexual partner?
-
HIV transmission can be prevented by using condom every time?
-
HIV is transmitted by mosquito bites?
-
HIV is transmitted by sharing food with the person living with HIV?
8
-
Healthy looking person can have HIV?
-
Mother to Child HIV transmission during pregnancy, delivery and breastfeed?
-
Female teacher with HIV should allow continuing teaching in school?
-
Can buy fresh vegetables from a shopkeeper or vendor with HIV?
-
Would reveal if a family member has HIV virus?
-
Willing to care family member with HIV?
3.2 CONCEPT AND DEFINITIONS
Comprehensive Knowledge is the number of women age 15-49 years who knows that HIV can be
prevented by having one faithful uninfected sex partner, using condom every time and also knows
that a healthy looking person can have HIV.
Misconceptions are sharing food with a person having HIV can transmit HIV or mosquito bites can
transmit HIV.
Accepting Attitude are if a woman agrees to believe that a female teacher with AIDS virus and is
not sick should be allowed to continue teaching, would buy fresh vegetables from a shopkeeper or
vendor who has the AIDS virus and is willing to care for a family member infected with the AIDS
virus in own home.
3.3 METHOD
The study is based on 14,018 women age 15-49 years (National Statistics Bureau, 2011) who have
reported having heard of to determine the associations between variables of interest education,
knowledge of HIV transmission, misconceptions and attitude. Logistic regression is used as depicted
below.
Logit(p) = log (p/ (1-p))= β0 + β1X1+ β2X2+ β3X3 +β4X4+ β55 β6X6+β7X7+ β7X8
Where p=probability of having comprehensive knowledge about HIV, probability of having
misconception & probability of having accepting attitude treated individually, X1=Age of women;
9
X2=Eastern; X3=Western; X4=Central; X5= None; X6=Primary; X7=Secondary+ and X8=wealth
quintiles.
All the final results and findings including descriptive and inferential analysis are given separately.
3.4 ANALYSIS
The data set as obtained from BMIS will use composite index method for data analysis procedures.
The study will be based on population of females’ age ranging from 15-49 years. In order to know
the extent of knowledge of HIV/AIDs among female reproductive ages, the knowledge question gave
three options, “yes”, and “no”, “Don’t know/not sure/depends. Accordingly, these three types of
answers were recorded into two categories with correct answer and incorrect answer. Each correct
answers will be recorded as 1and incorrect answers and DK/ not sure/depends category will be
recorded as 0. There will be 13 questions used to determine the HIV/AIDs knowledge of the total
scores ranges from 0-13. The scores will be arbitrarily classified at three levels of knowledge: High
(score of 8 and above), Average (score of 6-7) and Poor (score of 5 and less).
Accordingly, these three types of answers will be recorded into two categories with correct answer
and incorrect answer. Each correct answers will be recorded as 1 and incorrect answers and DK/ not
sure/depends category will be recorded as 0. The study will be a descriptive, cross sectional study on
the knowledge among women ages 15-49 in Bhutan.
The population will consist of women who are non-educated, primary education, secondary and
above and also the wealth index. Both the education level and household wealth will be positively
correlated with the level of comprehensive knowledge. Comprehensive knowledge prevalent among
younger women, unmarried women and women in urban areas versus women in rural areas will also
be determined.
The analysis will be done with the help of software packages for social science (SPSS) to build a
composite index and Microsoft excel, cross tabulation; recording it into different variables and build
composite index with the help of SPSS.
For this study, Statistical Package for the Social Science (SPSS) software will be used to analyze the
data.
10
The analysis will also include the following:
1. Descriptive statistics:
a. relationship between women’s education attainment and women’s awareness on
HIV/AIDS
b. relationship between residence (urban and rural) and women’s awareness on HIV/AIDS
c. relationship between occupational status of women awareness on HIV/AIDS
2. Inferential statistics:
a. Correlation and regression between educational attainment of women and awareness on
HIV/AIDS
b. Correlation and regression between place of residence of women and awareness on
HIV/AIDS
Since, this paper will be employing secondary data; this paper is confident that there are no statistical
biases. Beside, this paper will be requesting secondary data by writing an official to the National
Statistics Bureau, the budget required is very minimal and therefore it has been not reflected in this
proposal.
The analyses are based on the educational attainment level and wealth quintiles. Misconceptions
about HIV are common and can confuse people and hamper prevention efforts. Different peoples are
likely to have different variations in misconceptions although some appear to be universal for
example that sharing food can transmit HIV or mosquito bites can transmit HIV or due to super
natural means. There is still misconception about mode of HIV/AIDS transmission that still some
believe that AIDS virus is transmitted through supernatural means, which indicates that still they are
not aware about the mode of AIDS transmission.
There exists misconception that AIDS virus can be transmitted through mosquito bites. The analysis
can be done on the bases of educational attainment level to know the knowledge extent. One of the
misconceptions among many is that sharing of food with infected person. Still 70% of population
resides in rural places and they are mostly governed by their culture and customs or they strongly
believe in religion. So for that is very difficult to create awareness to them and still believe that AIDS
11
virus can be transmitted through sharing food with infected person. However misconception can be
defined as the false concepts that individual have due to lack of access to awareness and information
and mainly due to their social norms and believe that can be generated from the combination of data,
information and interpretation.
Some facts about HIV/AIDS are employed to see the woman’s knowledge. Knowledge of HIV/AIDS
can be defined as the human false information resulting from interpreted information, understanding
that evolves from combination of data, information, experience and information. Among many facts,
have selected few facts such as is it possible for a healthy looking person to have the AIDS virus?
Can reduce the chances of getting AIDS virus by having one un-infected partner who has no other
sexual partner? Can the virus that causes AIDS be transmitted from a mother to child during
pregnancy? During delivery and through breast feeding? These are the common facts to examine the
knowledge of the women age group 15-49.
3.5 ETHICAL CONSIDERATIONS
Findings of this paper will be purely based on data from BMIS 2010 report and the source will be
cited to show the credibility. The data analysis will be done on software packages for social science
SPSS so that the results do not get manipulated. Personal views will be avoided. The findings will
not be generalized to households beyond Bhutan as the data from only districts from Bhutan has been
used. The findings will be entirely within the scope of my competence and no public statements will
be made as it is involves a highly sensitive social issue.
3.6 FUTURE SCOPE FOR STUDY
While the research projects the essence of education for knowledge on HIV/AIDS, the paper fails to
mention data for those uneducated and poor women residing in urban centers; and the rich and
educated in rural areas. Therefore, for future studies on the same advocacy and researches in urban
centers where there is increasing urban poverty; and women are less exposed to sexual educations
despite living in urban centers and vice versa is essential.
12
CHAPTER FOUR
4.1 RESULTS AND DISCUSSION
Socio-demographic characteristics
Of the 15,400 households selected for the sample, 14,917 were occupied. Of which, 14,676 households were successfully interviewed for a household response rate of 98.4 percent. Within those
interviewed households, there were 16,823 of the eligible women (aged 15-49) were identified. Of
them 14,018 were successfully interviewed, yielding a response rate of 83.3 percent. There are more
respondents from non-educated with 61.2%, primary education 12.0% and secondary education
26.7%. Among 14018 interviewed respondent 17.3% were poorest, 19.0% were middle and 24%
were richest. Most of the respondents are from age group 20-24 and 25-29 which consist of17.9%
and 19.4% respectively. Followed by age groups 15-19, 30-34 and 35-35 which consist of 14.6%,
15.8% and 13.2% respectively and minimum respondent from age group 45-49 which consist only
7.9% of total respondent. However the socio-demographic characteristic or descriptive statistic in
given in annex, Table 1.1
4.1.1 Knowledge on HIV/AIDs
17.5% of Bhutanese women ages ranges from 15-49 have comprehensive knowledge of HIV/AIDS
(BMIS, 2010). 71% of women answered 8-13 answers correctly. Around 23% of interviewed women
answered 6-7 answers correctly and only 6% of women answered less than 5 answers correctly.
Table 1.2
One of the most important pre-requisites for reducing the rate of HIV infection is accurate knowledge
of how HIV is transmitted and strategies for preventing transmission. For that correct information is
the first step toward raising awareness and giving young people the tools to protect them from
infection.
Misconceptions about HIV are common and can confuse people and hamper prevention efforts.
Different peoples are likely to have different variations in misconceptions although some appear to
be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV or
due to super natural means) is depicted in table 1.3 in annex.
13
4.1.2 Misconception about HIV/AIDs transmission based on the level of education:
Of the no educated respondents, 74.3 % believed that HIV/AIDs could be contracted through
witchcraft or other supernatural means, but as the educational attainment rises the misconception
regarding super natural means falls. Those who attained Primary only 20.7% believe that HIV/AIDs
cause by supernatural means and only 5.0% of secondary education level believe that HIV/AIDs is
contracted through super natural means. As depicted in table 1.3. Nearly 70.3% of the non-educated
women respondents believe that HIV is transmitted through mosquito bites. As the educational
attainment level rises, the misconception about HIV transmission falls. Attainment of primary and
secondary education the misconception rate falls to 16.5% and 13.2% respectively. Showed in table
1.4.About 15.6% of women those who are not educated still believe that HIV/AIDs is transmitted
through sharing food with a person who is already having HIV/AIDs. However the knowledge level
or are more aware when educational attainment is higher. Table 1.5
4.1.3 Women’s knowledge on some facts about HIV/AIDs
77.6% of non-educated respondent has heard about the HIV/AIDs and around 98.8%of the secondary
educated respondent heard about HIV/AIDs. Those who have attendant the primary education 87.8%
of they heard about the HIV/AID. Which indicates that higher the education level higher the
awareness about the HIV/AIDs. As showed in table 2.1. 57.07% of non-educated responded that
people can reduce their chances of getting the AIDS virus by having just one uninfected sex partner
who has no other sex partner as depicted in table 2.2, and those who attendant primary and secondary
educational level responds that the people will reduce their chances of getting the AIDS virus by
having just one uninfected sex partner who has no other sex partner.
The analysis based on wealth quintiles, 14.4% of poorest respond that it is possible for a healthylooking person to have the AIDS virus and those who are middle income earners 21.2 % respond that
is possible for healthy person to have AIDS virus. More than 22.9% of richest responds that is
possible for healthy person to have AIDS virus. As the educational attainment and wealth index are
positively coo-related. Higher the income higher will be the educational attainment level and are
more exposed than poor ones and have more knowledge.
14
One of the most important facts about HIV/AIDS is the transmission of AIDS from mother during
pregnancy, delivery, and through breast feeding. The analysis is based on the level of education.
92.57% of non-educated responds that AIDS virus can transmit through mother to child during
pregnancy. It’s good to know that more that most of un-educated knows that AIDS virus can
transmitted through mother to child during pregnancy. The percent increases to 95.1% when
responded attain secondary and above education level. 79.9% of non-educated respond that AIDS
virus can transmit from mother to child and for those who are of secondary and above 78.2% respond
that AIDS virus can be transmitted as showed in table 2.4(b). 84.4% of non-educated women respond
that AIDS virus is transmitted from mother to child through breast feeding. And 80% of the total
respondent of secondary and above educational level assumes that AIDS virus can be transmitted
through breast feeding.
4.1.4 Accepting Attitudes toward People Living with HIV/AIDS
There always remains stigma and discrimination in the community accorded to people living with
HIV/AIDs. Stigma and discrimination were low with respondents showing accepting attitude on
the following four questions asked in the survey: 1) would care for family member sick with AIDS;
2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher
who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status
of a family member a secret.
Around 97.7 percent of women who have heard of AIDS agree with at least one accepting attitude.
The most common accepting attitude is willingness to care for a family member with the AIDS virus
in their own home (86.9 %). Women with higher education (61%) and those from richest households
have more accepting attitudes (72%) than the ones with lower education (41.2%) and a poorer wealth
status (59.3%). Women in the Western region (47%) have more accepting attitudes than women from
the other two regions of central (24.1%) and eastern (19.7%). Also women from urban areas (66.5%)
have more accepting attitudes than women from rural areas (34.9%).
15
CHAPTER FIVE
5.1 CONCLUSION
HIV/AIDS is an endemic disease and often is developing nations widespread and severe. Globally
around 35 million people were living with HIV/AIDS. In Asia and the Pacific region alone about 4.8
million people live with HIV/AIDS. According to World health Organization (WHO), an estimated
34 million people have died from AIDS-related causes, including 1.2 million in 2014.
The HIV/AIDS scourge is becoming one of the speedily mounting health concerns in Bhutan. There
have been advocacies in imparting knowledge on HIV/AIDS and its delusions through awareness
operations, and encouraging use of condoms towards safe sex practice.
The Gap Report suggested that one of the main causes in the rise of number of spread of HIV/AIDS
is the vulnerability of HIV infection among adolescent girls and women, which is further linked to
women's education and poverty (2014). Education has been suggested as an 'alternative vaccine' or a
‘social vaccine’ to prevent, and to mitigate the spread of HIV.
The paper assists the readers to understand the importance of knowledge and awareness on
HIV/AIDs and the status of women knowledge in the same. Further, it will help the policy makers to
understand the short comings in their policies despite their potential effort, understand which field
needs improvement and how they can solve the problems related to HIV/AIDs awareness. The socioeconomic and health conditions of the people can be uplifted by attaining the goals of knowledge on
HIV/AIDs.
The results on the knowledge of HIV/AIDS among 83.7% of women are staggering. 51% women
knew the ways of preventing HIV/AIDS. However, only 17.5% women had comprehensive
knowledge on HIV/AIDS. Further the knowledge of HIV/AIDS is scanty amongst women living in
rural sections, poor quintile and less educated and vice versa. The acceptance level of HIV infected
persons were also higher in educated and wealthy women compared to the rural, poor and
uneducated women.
16
The aim of this study was to assess the casual relationship between awareness on HIV/AIDS,
education and poverty; so to provide health policy makers on developing HIV/AIDS prevention
services, especially in translating policies in to need-based prevention actions.
5.2 RECOMMENDATIONS
After having studied about the knowledge on HIV/AIDS among women aged 18-45, and its causal
relationship with education, wealth and situational settings; we would like to recommend the
following crucial suggestions.
1. An enhanced and thorough advocacy program throughout the country which will perhaps
impart the knowledge and importance of HIV/AIDS amongst all populace, especially women.
2. An improved role of media in advertising a user friendly and captivating reports about the
causes and preventive measures for HIV/AIDS especially to attract rural attraction.
3. Inculcation of sex education in school curriculums (both formal and non-formal) to educate
on safe sex and HIV/AIDS.
4. Dialogues or programs to edify and eradicate misnomers existing in the minds of the rural
women.
5.3 LIMITATIONS
As all studies merit limitations, this paper also has a number of limitations. The data for this research
was collected by the National Statistical Bureau with financial and technical assistance from the
United Nations Children’s Fund and United Nations Population Fund as a part of the fourth global
round of Multiple Indicator Cluster Surveys. The BMIS is required to update information on the
situation of children and women, and measures key indicators to monitor progress towards
Millennium Development Goals and other internationally agreed-upon commitments. However,
sample of respondents selected in the Bhutan Multiple Indicator Survey is only one of the samples
that could have been selected from the same population, using the same design and size; each of
these samples would yield results that differ somewhat from the results of the actual sample selected.
17
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19
ANNEXURE
Table 1.1
Descriptive statistics of women interviewed
N=16,823
Characteristics
Age (Mean) : 30.22
Education:
Non-education
Primary education
Secondary education
Wealth index quintiles:
Poorest
Second
Middle
Fourth
Richest
Frequency
Percent (%)
8585
1687
3746
61.%
12.0%
26.7%
2919
2533
2059
3034
3367
17.3%
18.1%
19.0%
21.7%
24.0%
Table 1.2
Extend of HIV/AIDS knowledge among Bhutanese women.
N=11761
Extend of knowledge
Poor( Able to answer 1-5 correct questions)
Average(Able to answer 6-7 correct questions
Good(Able to answer 8-13correct questions
Number
701
2752
8308
Percent (%)
6%
23%
71%
Women’s misconception on HIV/AIDS transmission
a) Can people get AIDS because of witchcraft or other super natural means?
N=4345
Table1.3
Educational level
Non-educated
Primary education
Secondary education
Total
Number of Responding
"Yes"
3772
899
219
4345
20
(Percent)%
74.3
20.7
5.0
100.0
Fig.1.1
b) Can people get the AIDS from mosquito bites?
N=47450
Table 1.4
Number of responding
“Yes"
3335
782
628
4745
Educational level
Non-education
Primary
Secondary
Total
%
70.3
16.5
13.2
100.0
c) Can people get HIV/AIDS by sharing food with a person who has AIDS?
N=2437
Table 1.5
Education level
Non-education
Primary
Secondary and above
Total
Number of responding
"yes"
1834
311
292
2437
21
%
75.3
12.8
12.0
100.0
Women’s knowledge on some facts about HIV/AIDS
Table 2.1
a) Have you ever heard about HIV/AIDS.
N=25582
Educational level
Non education
Primary
Secondary and above
Total
Number responding
"yes"
6906
10263
8413
25582
%
27.0
40.1
32.9
100.0
Table 2.2
b) People can reduce their chances of getting the AIDS virus by having just one uninfected sex
partner who has no other sex partner.
N=8586
Number of responding
"Yes'
4900
2588
1098
8586
Education level
Non education
Primary
Secondary
Total
%
57.07
30.14
12.79
100.00
Table 2.3
c) People can reduce their chances of getting the AIDS virus by having just one uninfected sex
partner who has no other sex partner
N=8586
Number responding
"Yes"
1240
1538
1817
2026
1965
8586
Wealth index
Poorest
Second
Middle
Fourth
Richest
Total
22
%
14.4
17.9
21.2
23.6
22.9
100.0
Table 2.4
Transmission of AIDS from mother during pregnancy, delivery, and through breast
feeding.
a) During pregnancy
Education level
Non-education
Primary
Secondary
Responding
"Yes"
6393
1399
3194
Responding
"No"
513
108
163
Total
Respondents
6906
1507
3357
11770
Percent responded
"Yes"
92.57
92.83
95.14
b) During delivery
Education level
Yes
Non-education
Primary
Secondary
5517
1206
2624
No
Total
1389
301
733
6906
1507
3357
Percent responding
"yes"
79.9
80.0
78.2
c) Through breast feeding
Educational level
Non-education
Primary
Secondary
Yes
(respondent)
5830
1251
2707
No
(respondent)
1076
256
650
23
Total
(respondent)
6906
1507
3357
% responding
"Yes"
84.4
83.0
80.6