HIV/AIDS related knowledge, risk perception, attitude and sexual behavior of working women staying in hostels

Introduction

HIV infection poses a formidable threat to women′s health.[1] They are at higher risk of contract-ing HIV/AIDS infection compared to men. Already, in India, they account for 21.3% of all AIDS cases and data from antenatal clinics indicate a rising HIV prevalence among them.[2] With constantly increas-ing sero-prevalence of HIV in India, men and women are likely to be exposed to a greater risk of the dis-ease. This necessitates the need to quantify the risk and risk perception of the vulnerable women in the society. In metropolitan cities women living alone in hostels and having independent income, may have a liberal life style and chances of practising high risk sexual behaviour is greater. In this regard it may be arguably said that women who are single and inde-pendent are more vulnerable to high risk sexual be-havior. To examine this issue, the present study was conducted among working women staying in hostels in Delhi.

The objectives of this study were: 1. To assess the level of knowledge about different aspects of AIDS. 2. To study the risk perception of working women staying in hostels.3. To examine the attitude of the study group towards sex. 4. To assess the sexual behavior and practices of these women.

Materials and Methods

The study was conducted among the work-ing women staying in two women′s hostels situated in central and west Delhi. At the time of conducting the study there were 340 women staying in the two hostels. The hostel residents were approached through the warden. The women were first collected in groups of 8 to 10. A focus group discussion was held with each such group, in the issue of HIV/ AIDS infection and high risk sexual behavior. This was done in order to increase response to the questionnaire with honesty and confidence. Following this, they were given a pre-tested, semi-structured question-naire to fill up. Participation in the study was volun-tary. Confidentiality and secrecy was assured by not asking any question regarding identity of the respond-ing women. The findings of the survey are discussed below.

Results

Only 121 women could be contacted during the period. Eighty-nine women (73.5%) participated in the study. Their age ranged from 20 to 42 years. Their mean age was 25.36 years, however 80% of them were below 26 years. One fourth of the re-spondents were professionally qualified and 28% were post graduates. Only 5.6% were undergradu-ates. Only 8 (8.9%) respondents were married. Since it was a working women′s hostel, all were employed. The income ranged from Rs.2,000/- to Rs.13,000/- per month and median income was Rs. 5, 000/- per month [Table - 1]. In the majority of cases duration of stay at the hostel was less than 2 years.

Of all the interviewed women, 82 (92.1%) were aware of AIDS as a disease. Sexual route of spread was known to 72% of them. Transmission through materno-foetal route was known to only 16 (17.9%) of them. Only two women knew about all the four methods of transmission [Table - 2].

Regarding methods of prevention, 33(37.1%) responding women knew that safe sex practices should be adhered to in order to prevent transmis-sion of AIDS. Awareness about using sterilized sy-ringes and needles for prevention of AIDS was present in only 15 (16.8%) respondents.66 (74.1%) respondents knew that ELISA test is available for diagnosis, but the place where the test can be per-formed was known to only 37 (41.6%) of them [Table - 3]. About 60% of the women said that condoms are useful for prevention of transmission of AIDS.

Only 19 women (21.3%) considered them-selves at risk for getting AIDS and another 44 (49.4%) were confident of never getting the infection. Thir-teen women (all unmarried) considered pre/extra marital sex to be acceptable but the majority of them were against it. Similarly, majority of the respondents (70.8%) were against having multiple sex partners. 16 (18.0%) of the women were confident that they could assess the risk behavior of their partners. But more than 50% did not reply to this question. Only 4 women had no objection to having sex with persons practicing high risk sexual behavior whereas 61 (68.5%) replied in the negative [Table - 3].

The attitudes of the studied women towards sexual activities are depicted in [Table - 4]. Majority of the women thought that they could refuse to have sex if they were not willing. Only 2 thought that they could not do so. About 38% of the respondents were confident that they could always ask their partners to use condoms and another 24 (27%) thought that sometimes they can could do so. Twenty one (23.6%) women did not reply to this question. The majority of them (74.2%) were confident that they could sug-gest to their partners to have safe sex. Eighteen sexu-ally active women said that they could propose sex to a person of their choice.8 (8.9%) women did not see anything wrong in practicing oral or anal inter-course but 24(27%) considered it to be unhealthy and unhygienic;34 (38.2%) women did not reply to this question.

Out of the 89 par-ticipating women, only 18 (20.2%) admitted to hav-ing experienced sexual in-tercourse [Table - 5]. Among them 8 were married. Thir-teen women had pre or extramarital sexual rela-tionship, of which 3 were married. Eight respondents admitted to having more than one partner for sex of whom 3 were married. Condom was ever used by only 7 (6 unmarried; 1 married) respondents.

Discussion

The data above suggest that the level of awareness about different aspects of AIDS is unsat-isfactory. Though no specific studies on working women residing in hostels could be found, neverthe-less the level of knowledge was better than that reported by other researchers in various women groups across the country.[3],[4],[5],[6] Considering the educa-tional status of the respondents, it was expected that the level of knowledge would be higher. In the study conducted by Porter in Calcutta, 47% women respon-dents had adequate knowledge about various as-pects of AIDS, which is less than our findings, although the present study was conducted on a se-lect highly educated group whereas Porter′s study was on the general population only.[3] Similarly, among the spouses of medical professionals, as studied by Pandit et al, the level of awareness was only 56.2%.[4] In another study conducted in eastern UP, the level of awareness about AIDS among women was ex-tremely poor.[5] However, among female college stu-dents in Bangalore, the awareness level was as high as 82% in some groups.[6] The risk perception also is below satisfactory levels and therefore need to be improved by increasing awareness about risk assess-ment. The attitudes expressed are more towards conservative estimates, this was also corroborated by the low prevalence of sexual activity among the responding women. However considering the nature of subjects being explored, the chances of hiding information cannot be ruled out. Besides, reliability of the responses need to be tested specially in rela-tion to sexual practices. In some of the question-naires contradictory responses had been given by the respondents with respect to sexual behaviour. When directly asked whether they had sex, only 10 answered in the affirmative. But in response to the question, whether they willingly had sex, 13 replied ′yes′. This shows that some respondents did try to conceal facts about their sexual activity. Probably further sensitization to the issue is required and greater confidentiality need to be assured for the respondents to come out with the correct response.