Knowledge, Attitude, and Practices Observed in Seafarers
Concerning HIV Infection and AIDS
Stanislaw Tornaszunas
In the period from March 1 to May 31 1992, a
survey was conducted among Polish seafarers and deep
sea fishermen. The objective was to assess the participant’s knowledge of the methods of HIV virus transmission and methods of AIDS prevention. Additionally, information about attitudes to the problem of
employment of HIV-positive seafarers on ships and
the use of condoms during casual sexual contacts was
sought.
A survey form was prepared and distributed to
the staff of the outpatient department of the Institute
of Maritime and Tropical Medicine and to the surgeries of shipping company doctors. The form had 13
questions, which related to the ways of HIV virus
transmission, methods of AIDS prevention, use of condoms, and the employment of HIV-infected seafarers
on ships.
The anonymous questionnaires, on which the respondent marked age and the type of assignment on
board (e.g., officer, other type of crew member), were
distributed to seamen when they came for their periodic medical examinations or for treatment of diseases
or injuries. The questionnaires were filled in and collected. They were then sent to the Institute for analysis.
Answers were grouped according to the level of
education of respondents (officers and other types of
crew members) and their age in the following four
groups: up to 30 years; 31 to 40 years; 41 to 50 years;
and over 50 years.
One thousand and fifty questionnaires were returned by respondents and were analyzed. In this
number, 980 forms were filled in by merchant seamen
and 70 forms by deep sea fishermen.
Four hundred and sixteen forms were received
from officers, who had a high level of education and
634 forms from AB seamen, motormen, stewards, and
other crew members, who had a lower level of education. The results of the survey are indicated in Table 1.
Regarding the relation between the age and the
level of education and the knowledge of surveyed seafarers on the ways of HIV virus transmission, young
and better educated seafarers (officers) were generally better informed how the virus is, and is not, transmitted.
Young seafarers were more tolerant regarding the
employment of HIV-infected fellow seamen. Out of
Infection with HIV and AIDS is a global problem
with many social, cultural, economic, political, ethical, and legal implications.
The working environment of seafarers plays a
major role in their lives. Currently, there are approximately 1 million seafarers in the world. Consideration of HIV and AIDS in relation to the seafarers
workplace is crucial in dealing effectively with the
problem of infection at the local, national, and international level and also on board ship and at ports of
call.
Considering their way of life and their working
life on board ships, seafarers can be viewed as a group
of “occupational travelers” who could become involved in high-risk activities in relation to HIV infection and AIDS. Relevant factors are their geographic
mobility, longevity of sea voyages, and long separations from their families.
Surveys were conducted on the prevalence HIV
infection and AIDS in seafarers. Results of these surveys were presented on the occasion of the 1989 consultation on AIDS and seafarers, which was held at
the World Health Organization’s headquarters in Geneva.
Studies presented at this event gave little evidence
to suggest high levels of prevalence of AIDS and HIV
among seafarers, although behavioral data pointed
towards high potential risk of infection.
Educational programs on HIV and AIDS exist in
a number of maritime countries. Various activities have
been also initiated by port authorities. These activities include the giving of information on the risk of
infection and free distribution of condoms to crews of
calling ships.
Stanislaw Tomaszunas,MD, DTM&H: Associate Professor, Institute of Maritime and Tropical Medicine,
Gdynia, Poland
Presented at the Third Conference on International
Travel Medicine, Paris, France, April 25-29, 1993.
Reprint requests: S. Tomaszunas, MD, Deputy Director, Institute of Maritime and Tropical Medicine,
Powstania Styczniowego 9B, 81 -51 9, Gdynia, Poland.
169
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J o u r n a l of Travel M e d i c i n e , Volume 1, Number 3
Table 1 Knowledge, Attitude, and Practice in Seafarers Regarding HIV Infection, AIDS Prevention, Use of Condoms, and Employment
of HIV-Positive Fellow Crew Members
Questions
Summary of Answers
Can HIV virus be transmitted
by the following
Responding Seafarers
(No.)
Total Answers
Officers Ratings
1. Handshake
no (92%)
Yes
don’t know
369
0
47
597
0
37
966
0
84
2. Use of glasses and plates
no (72%)
Yes
don’t know
289
31
96
469
113
52
758
144
148
3. Use of toilet
no (63%)
Yes
don’t know
254
62
100
404
123
107
658
185
207
4. Sneezing and coughing
no (61%)
Yes
don’t know
297
49
70
339
183
112
636
232
182
5. Kissing
no (34%)
Yes
don’t know
136
165
120
223
307
99
359
472
219
6. Sexual intercourse
no
yes (98%)
don’t know
1
415
0
3
613
18
4
1028
18
7. Use of syringes and needles
no
yes (98%)
don’t know
0
416
0
4
618
12
4
1034
12
8. Tattooing and acupuncture
no
yes (98%)
don’t know
0
403
13
45
560
29
45
963
42
9. Blood transfusion
no
yes (97%)
don’t know
0
416
0
5
599
30
5
1015
30
10. Use of condoms
no (5%)
yes (900/,)
don’t know (So/)
23
383
15
31
562
36
54
954
51
11. Immunization
no
Yes
don’t know
237
59
122
398
104
130
635
163
252
12. Use of condoms during
casual sexual contacts
no (13%)
yes (54%)
sometimes (19%)
no answer given (14%)
74
208
92
37
61
357
112
109
135
565
204
146
13. Objections to the employment
of a HIV-infected seafarer on a ship
in which you work
no (46%)
yes (29%)
don’t know (25%)
199
139
78
282
162
190
481
301
268
416
634
1050
Can AIDS be prevented by the following:
Total number of seafarers surveyed
171
Brief Communications
670 seamen aged up to 40 years, only 19% declared
that they would object to working with HIV-infected
colleagues. In the older age group (over 40 years, n =
380), the percentage of “objectors” was much higher
at 46%.
These data lead to the following conclusions: a
great majority of surveyed seafarers knew well how
the HIV virus was transmitted. A majority of seafarers knew that HIV was not transmitted by handshake,
use of cutlery, glasses and plates, sneezing, coughing,
and the use of toilet, but many of these respondents
were not sure or considered that these were possible
routes of transmission. Ninety per cent of respondents knew that the use of a condom during sexual intercourse protected them against HIV infection. In spite
of this, only 54 % stated that they had used condoms
during casual sexual contacts.
The remaining 46% had not used condoms or
had used condoms only sometimes or they refrained
from answering this question. Although properly informed about the risk of AIDS, only little more than
50% of the surveyed seafarers regularly used condoms,
the only known and generally successful method of
AIDS prevention. Health education of seafarers about
HIV and AIDS should be a continuous process. Condoms should be available on all ships.
Acknowledgment
The help rendered in the collection of data by the
doctors from the Institute of Maritime and Tropical
Medicine is gratefully appreciated, particularly the help
of Dr. W. Renke and Dr J. Filikowski. As well, the
medical staff of national shipping companies is gratefully acknowledged.
References
1. Van Damme J, Van Damme P. Incidence of HIV infection in a seafarers’ population. Proceedings of the 7th
European Nautical Medical Meeting. Hamburg, Germany, 1989:243-275.
2. World Health Organization. Report of the consultation on AIDS and seafarers. WHO document GPA/IDS/
91.1. Geneva: World Health Organization, 199O:l-13.
A Shaman in Sante Fe, New Mexico lsubmitted by
Charles 0.Ericsson)