Biology and Medicine

Assessing of HIV Knowledge in Comparison to Urban and Rural in Malaysia: Findings of National Health Morbidity Survey in 2020

Mohamad Hazrin Hasim^1*, Mohamad Shaiful Azlan Kassim¹, Fazila Haryati Ahmad¹, Norhafizah Sahril¹, Chan Ying Ying¹, Chan Yee Mang¹, Nur Liana Majid¹, Syamlina Che Abdul Rahim¹, Mohd Ruhaizie Riyadzi¹, Ahmad Ali Zainuddin¹, Mohamad Aznuddin Abd Razak¹ and Anita Suleiman^{2 1}Department of Pathology, Institute for Public Health, Selangor, Malaysia
²Disease Control Division, Ministry of Health, Putrajaya, Malaysia
^*Correspondence: Mohamad Hazrin Hasim, Department of Pathology, Institute for Public Health, Selangor, Malaysia, Tel: 033362 8709, Email:

Received: 23-Jan-2023, Manuscript No. BLM-22-19472; Editor assigned: 30-Jan-2023, Pre QC No. BLM-22-19472 (PQ); Reviewed: 14-Feb-2023, QC No. BLM-22-19472; Revised: 21-Feb-2023, Manuscript No. BLM-22-19472 (R); Published: 28-Feb-2023, DOI: 10.35248/0974-8369.23.15.531

Abbreviations

HIV: Human Immunodeficiency Virus; AIDS: Acquired Immunodeficiency Syndrome; WHO: World Health Organization

Introduction

Human Immunodeficiency Virus (HIV) is a retrovirus that targets CD4+ T-lymphocyte immune cells. The immune system’s deterioration increases susceptibility to many infectious illnesses and malignancies. Infected individuals develop Acquired Immunodeficiency Syndrome as the disease advances over the years (AIDS). Multiple opportunistic infections (such as Pneumocystis jirovecii, Tuberculosis, generalised Candidiasis, and Cerebral Toxoplasmosis) and AIDS-related malignancies (such as Kaposi’s sarcoma) are defining characteristics of AIDS. HIV is spread through bodily fluids such as blood, sperm, and vaginal secretions, as well as vertical transmission from mother to child during pregnancy or birth. It cannot be transmitted through kissing, shaking hands, sharing personal items, or consuming contaminated food or water [1].

The World Health Organization (WHO) estimated that at the end of 2019, 38 million people worldwide were living with HIV, 1.7 million were newly infected with the disease, and 690,000 died from HIV-related disorders (1). According to the 2019 Malaysian Country Progress Report on HIV/AIDS, the total number of HIV and AIDS cases reported was 118,883 and 25,925, respectively [2]. Health promotion involving HIV/AIDS knowledge has served as a key measure for comparing and assessing national HIV/AIDS preventive programmes [3]. During the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS in June 2001, 189 countries declared their commitment to combating the spread of the pandemic [4].

A person with insufficient HIV/AIDS knowledge and awareness is more susceptible to contracting the disease and may spread the epidemic throughout the population [5]. Numerous global HIV knowledge prevalence studies have been conducted. 67% of Bolivians were observed to have inadequate understanding, compared to less than half (44.7% of South Africans) and 51.9% of unmarried young women in Uganda [6-8]. In 2006, a study of 1,075 young Malaysian adults aged 15 to 24 years revealed intermediate HIV/AIDS awareness, with a mean score of 20,1 out of 32 [9]. Only fifty percent of secondary school students in Malaysia who responded to an online survey utilising the UNGASS indicators correctly identified both methods for preventing the sexual transmission of HIV and rejected main HIV transmission myths [2].

The main objective of this study is to determine the prevalence of adequate HIV knowledge in Malaysia. This study is specific to determinant the knowledge regarding HIV/AIDS and to identify the associated factors of the HIV/AIDS knowledge among the urban and rural Malaysian young people.

Materials and Methods

Study design

Computer-Assisted Telephone Interviewing (CATI) was used to collect data. Using the UNGASS indicators, which comprise five questions on HIV prevention and transmission, an evaluation of HIV knowledge, was conducted. There were two questions concerning the relationship between HIV transmission and sexual behaviour and practise. The remaining questions dealt with insect bites, food sharing, and understanding of the physical appearance of a person infected with HIV. Respondents who answered all five questions correctly were deemed to have sufficient understanding of HIV/AIDS.

Data analysis

Data were cleaned and error-checked before coding using double data input in the Statistical Package for the Social Sciences (SPSS) (v.26) programme. Participants were recruited from multiple states; hence the SPSS survey software was utilised to adjust clustering effects. Data were reported as relative frequencies and 95% Confidence Intervals (CI) for categorical variables, and as means and 95% CI for quantitative variables. Using chi-square tests, the participants of various age groups’ knowledge, attitudes, and behaviours were compared. All P-values were two-sided, and a value of less than 5% was considered statistically significant.

RESULTS

Prevalence of adequate HIV knowledge among espondents aged 13 years and above

Overall, the prevalence of adequate HIV knowledge was 22.6% (95% CI: 19.67-25.85) among general population aged 13 years and above. Respondents living in urban areas had a significantly higher likelihood of adequate HIV knowledge (24.9% (95% CI: 21.40-28.78)) than their rural counterparts (14.8% (95% CI: 11.82- 18.42)). Meanwhile, the prevalence of adequate HIV knowledge was similar among males (22.7% (95% CI: 19.46-26.34)) and females (22.5% (95% CI: 18.9-26.54)). The age group of 40-44 years had the highest prevalence of adequate HIV knowledge (40.3% (95% CI: 32.19-49.05)), while the lowest prevalence was found among younger age group of 13-14 years (12.2% (95% CI: 6.29- 22.31)). By ethnicity, Chinese respondents reported the highest prevalence of adequate HIV knowledge (32.3% (95% CI: 25.99- 39.28)), followed by Malaysia (25.0% (95% CI: 22.47-27.77)) and other Bumiputeras (16.1% (95% CI: 11.39-22.18)). The prevalence of adequate HIV knowledge increased with increasing education level: primary education (12.5% (95% CI: 9.32-16.57)), secondary education (19.8% (95% CI: 17.06-22.96)), and tertiary education (36.5% (95% CI: 29.38-44.29)). Government employees showed a significantly higher prevalence of adequate HIV knowledge (43.2% (95% CI: 34.45-52.39)) compared to other occupational groups (Table 1).

Table 1: Prevalence of adequate HIV knowledge among respondents aged 13 years and above by sociodemographic characteristics.

Proportion of correct response to each item of HIV knowledge among respondents aged 13 years and above

The question on “Can the risk of HIV transmission be reduced by having sex with only one uninfected partner who has no other partners?” (Question 1) had the highest proportion of respondents who answered correctly (74.9% (95% CI: 69.52-79.67)) compared to other items. There was no significant difference across locality and age group (Table 2).

Table 2: Proportion of correct response to question 1: “Can the risk of HIV transmission be reduced by having sex with only one uninfected partner who has no other partners?”.

A total of 69.5% of respondents gave a correct response to the question, “Can a person reduce the risk of getting HIV by using a condom every time they have sex?” (Question 2). There was no significant difference across locality and age group (Table 3).

Table 3: Proportion of correct response to question 2: “Can a person reduce the risk of getting HIV by using a condom every time they have sex?”.

The question on “Can a healthy-looking person have HIV?” (Question 3) was correctly answered by 68.9% of respondents. A significantly higher proportion of respondents from urban areas (71.7% (95% CI: 66.46-76.37)) answered this question correctly compared to respondents from rural areas (59.8% (95% CI: 56.05- 63.41)). However, there was no significant difference observed between age groups (Table 4).

Table 4: Proportion of correct response to question 3: “Can a healthy-looking person have HIV?”.

The question on “Can a person get HIV from mosquito bites?” (Question 4) had the second-highest proportion of being answered correctly by respondents (71.7% (95% CI: 68.79-74.37)). There was no significant difference across locality and age group (Table 5).

Table 5: Proportion of correct response to question 4: “Can a person get HIV from mosquito bites?”.

The proportion of respondents who answered the question “Can a person get HIV by sharing food with someone who is infected?” (Question 5) correctly was 62.0% (95% CI: 58.27-65.65). The proportion of respondents who gave a correct response to this question was significantly higher in urban areas (64.8% (95% CI: 60.46-68.98)) compared to their rural counterparts (52.6% (95% CI: 48.67-56.50)). No significant difference was observed between age groups (Table 6).

Table 6: Proportion of correct response to question 5: “Can a person get HIV by sharing food with someone who is infected?”.

Discussion

In Malaysia, HIV/AIDS knowledge is increasing in rural areas, even though the proportion of HIV/AIDS knowledge in this cluster is much lower than in urban areas. HIV/AIDS is greatly influenced by a variety of socioeconomic and demographic factors. However, it is challenging to increase HIV awareness in rural Malaysia through accurate knowledge because the country needs to improve the educational environment in its underdeveloped rural areas, where HIV knowledge and belief are both lacking. According to the study’s findings, both urban and rural Malaysians have a high level of knowledge about HIV transmission.

Almost all participants in urban and rural areas are aware that HIV transmission can be reduced by having sex with only one uninfected partner and by using a condom every time they engage in sexual activity. They are also knowledgeable regarding the fact that HIV cannot be transmitted through mosquito bites. A significant number of rural participants disagree with the statements can a healthy-looking person have HIV and can someone contract HIV by sharing food with an infected person [10]. Additionally, there are very few prejudices in urban areas. Prior efforts have revealed a significantly higher HIV prevalence among individuals who are unaware of and have inadequate knowledge of the potential routes of HIV transmission [11].

Conclusion

Overall, the prevalence of adequate HIV knowledge in Malaysia was low, especially among young people. Misconceptions about HIV transmission and prevention among young people are still common. The findings from this survey have important implications for the development of primary HIV/AIDS prevention programs and HIV educational campaigns to increase knowledge and dispel misconceptions about HIV. Such education and intervention programs should target rural areas, the young adult population, less educated, and unemployed groups.

Ethical Consideration

The study was conducted after approval had been obtained from The Medical Research & Ethics Committee (MREC), Ministry of Health Malaysia. All participants were informed of the objective of the study and verbal consents were received from the respondents for interview.

Conflict of Interest

None to report.

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