Introduction

Bangladesh is a low HIV prevalence country with several well-documented at-risk groups in women. Experts opined the situation is below (<1%) the level of concentrated epidemic. At least 42 people died of AIDS, 111 others got infected with HIV and 288 found HIV positive this year 2008, as of last year, 123 people died of AIDS, 365 others got infected and 1207 found HIV positive (Rahman, 2008). Bangladesh has been identified as one of the five countries where HIV/AIDS infections are rising in the Asia-Pacific region as it is surrounded by nations with much higher prevalence rates and with its own at-risk population, it was revealed at the 8th International Congress on HIV/AIDS in Asia and the Pacific held in Colombo, 2007. The outbreak of HIV in neighbouring countries, cross borders and steady rise of STIs/STDs make Bangladesh a high-risk zone for HIV/AIDS prevalence (Biswas, 2007). Mondal et al. (2008), showed that among street-based female sex workers (SFSWs) in Rajshahi city of Bangladesh, 56.7% were infected with two or more pathogens of STDs and illiterate and comparatively older SFSWs who spent very little money for their health, had large numbers of children, and used condom inconsistently were observed to be at higher risk of STDs.

AIDS was first identified as a distinct entity in 1981 in the USA (Gottieb et al., 1981) and then the number has increased rapidly all over the world (UNAIDS, 2002). It is one of the five well-established causes of death in the world (Piot et al., 2001; Quinn, 1996). AIDS posing a challenge to the mankind already claimed the lives of more than 23 million, killing about 3 million people every year. According to WHO report 2002, an estimated 42 million people throughout the world currently living with HIV and 70 million men, women and children may die of AIDS in next 20 years and 25 million children will be orphan by 2010. According to the UNAIDS report 2002, approximately 13,000 people (including women and children) are carrying HIV infection in Bangladesh and experts opined the situation is below the level of concentrated epidemic (<1%). However, till December 2004, only 465 cases were officially reported. The sere-surveillance studies have shown an increased HIV prevalence from 1.4% (2002) to 4% (2003) to 8.9% (2004) among injecting drug users (IDU) in central area of Bangladesh indicating rapid evolving of HIV epidemiology in the country (Nasreen, 2005).

Although first AIDS case in Bangladesh was detected in 1989 (DGHS, 2000) little is known about HIV/AIDS awareness in Bangladesh (Khan, 2002). The over populated country is still fortunate because of having low HIV/AIDS prevalence (less than 1 per 1000 adults) as compared to neighboring countries such as India, Nepal, Thailand and Myanmar (PRB, 2002). But presence of many contextual, behavioral and biomedical factors indicated that Bangladesh is at the beginning of HIV/AIDS epidemic threat (Azim et al., 2000; Gibney et al., 1999a; Gibney et al., 1999b). High prevalence of STDs (Khan, 2000; Azim et al., 2000; Gibneyet et al.,1999b; Khan et al., 1997) including limited knowledge of STD/HIV/AIDS (Gibney et al., 1999a; Khan et al., 1997) coupled with high rates of literacy, poverty, and low rate of condom use (Khan, 2002; Gibney et al., 1999a; Islam et al., 1999) may aggravate the HIV/AIDS situation.

As the chair of the Technical Committee of the National AIDS Committee (2007) said a poor country like Bangladesh has to choose for preventive measures rather than depend on costly drugs or future vaccines. Therefore, this study has great importance to examine the awareness of women about HIV/AIDS. Hopefully the findings of the study would be helpful to policy makers, executive agents and health personnel in order to formulate appropriate strategies to improve the HIV/AIDS awareness and preventive activities.

Materials and methods

From November to December 2007, a study on HIV/AIDS was conducted among reproductive aged women (aged 15-49 years) of Natore sadar upazila in Natore district of Bangladesh. All eligible reproductive aged women were requested to participate in the study after being given a brief description of the purpose and procedures of the study. To investigate socio- demographic information on women, 796 women were selected as the study population through using multi-stage sampling design. A structured questionnaire was developed to explore awareness of women about HIV/ AIDS, after a long discussion with an expert group in this area. A personal interview approach was followed for the purpose of data collection. Women were directly interviewed and the information was collected with the questionnaire. The data were analyzed by using Statistical Package for Social Sciences (SPSS), version 10.0. A contingency analysis was used to test for association between the different phenomena on the basis of classification of variables or attributes by applying the Chi-square (ρ²) test, in which ρ² = Σ(O_ij/E_ij - N), follows a ρ² distribution with (r-1)(c-1) degrees of freedom. A logistic regression analysis was performed in order to observe the effects of the independent variables (X) on the dependent variable (Y). The logistic function can be written as:

Figure 1

determined from the data. For the predicted variable

Figure 2

And for the explanatory variables

Figure 3

Results and discussion

A vast section of people don’t know what the impacts of HIV/AIDS disease are and how to avoid this. Different Govt. and non-government organizations (NGOs) are undertaking various awareness raising health programs to make consciousness among the people. Mass media particularly electronic media are contributing to grow awareness. The most recent idea to gain more success in this field is community development in the society. Community development here means demonstration of introducing concept among the people about this disease through religious leaders, teachers, friends and relatives. The study will help to get an idea about the contribution of the above mentioned sources. Table 1 revels the percentage of mother have heard the name of AIDS and it is only 88.4% and 11.6% have not heard the name of AIDS; 76.5% have known about AIDS and 23.5% have not known; 76.4% have known consistent used of Condom prevents AIDS and 23.6% have not known.

Figure 4

Table 1 Percentage of women aged 15-49 according to some selected AIDS awareness based characteristics.

In the light of socio-demographic factors ‘ever heard the name of AIDS’ is significantly associated with mother’s education, father’s education, father’s occupation, monthly income, watches TV and visitation of health worker that has been represented in Table 2. Knowledge about AIDS and Consistent use of condom prevent AIDS are statistically significantly associated with parent’s education and occupation, monthly income, watched TV regularly and visitation of health worker. Especially, parents’ education, occupation, monthly income and having TV are important in building awareness of women about AIDS.

Figure 5

Table 2 Results of contingency analysis according to socio-demographic factors with women awareness based characteristics.

Determinants of knowledge and awareness about AIDS

Logistic regression of Model 1 includes ever heard the name of AIDS as dependent variable and some selected socio-demographic characteristic as the independent variables in Table 3. According to the fitted model as shown in Table 3, only 4 out of 9 independent variables are statistically significant at 1% and 10% level. These significant predicators of ever heard the name of AIDS are place of residence, mother’s education, television and visitation of health worker. It is evident that women in rural area have heard the name of AIDS, 0.715 times lower than the women of urban area. Illiterate women of Bangladesh are in vulnerable condition because of having very poor knowledge on AIDS. We found that regression coefficient and odds ratio for the illiterate mothers are 0.982 and 2.670. Hence it is observed that mother education is positively significant at 5% level and illiterate women have heard the name of AIDS, 2.670 times higher than illiterate women. Model 1 indicates that the women who used to television for watching have heard the name of AIDS, 5.628 times higher than the women who did not use to watch TV. Women to whom health worker used to come irregularly have heard the name of AIDS, 2.479 times higher than the women to whom health worker did not use to come and women to whom health worker used to come regularly have heard the name of AIDS, 4.899 times higher than the women to whom health worker did not use to come.

In Table 3, logistic regression of Model 2 includes knowledge about AIDS is the dependent variable and selected socio-demographic characteristic is the independent variables. According to the fitted model as shown in Table 3, only 5 out of 8 independent variables are statistically significant at 1% and 10% level and these significant predicators are mother’s education, father’s education, father’s occupation, television and visitation of health worker. Model 2 implies that regression coefficient and odds ratio for the illiterate women are 0.787 and 2.197 respectively. It is clear that mother’s education is positively significant at 1% level and literate women have 2.197 times higher knowledge about AIDS than illiterate women. It also reveals that regression coefficient and odds ratio for the illiterate fathers’ are 0.632 and 1.881 respectively and literate fathers have 1.881 times higher knowledge about AIDS than illiterate fathers which has positively significant at 1% level. It is observed that father’s profession is positively significant at 1% level and professional fathers have knowledge about AIDS 1.902 times higher than nonprofessional fathers. Model 2 also shows that the women who watched television regularly they have 10.621 times higher knowledge about AIDS than the women who did not use to watch TV. Visitations of health worker in regular and irregular basis have knowledge about AIDS 5.402 times and 2.984 times respectively higher than the women to whom health worker never come.

Model 3 includes that how condom prevent AIDS as a dependent variable and some selected socio-demographic characteristic as the independent variables which shown in Table 3. The fitted model (Table 3) only 5 out of 8 explanatory variables are statistically significant at 1% and 10% level. These significant predicators are mother’s education, father’s education, father’s occupation, television and visitation of health worker. Regression coefficient and odds ratio for the illiterate mothers are 0.805 and 2.237 respectively which implies mothers’ education is positively significant at 1% level and literate women are 2.237 times more likely to know that condom prevent AIDS than illiterate women. Father’s education is also positively significant at 1% level and literate fathers have 1.897 times more likely to know that condom prevents AIDS than illiterate fathers. Professional fathers have 1.949 times more likely to know that condom prevents AIDS than nonprofessional fathers that mean father’s profession has positive significant effects (at 1% level). The women, who used to watch television, know condom prevent AIDS that are 9.917 times higher than the women who did not use to watch TV. Visitation of health worker has significance impact of women’s AIDS consciousness. Irregular and regular visit of health worker have 2.768 times and 6.307 times more likely to know that condom prevents AIDS than the women to whom health worker did not use to come and it has positive significant effects to acquire knowledge that condom prevents AIDS.

Figure 6

Table 3. Logistic regression estimates for the effects of socio-demographic variables on ever heard the name of AIDS, knowledge about AIDS and know condom prevent AIDS as the dependent variables.

Conclusion and recommendations

HIV/AIDS is no doubt a devastating pandemic in the history of mankind in the world. Though in the recent times, there are some anti retroviral drugs have been innovated but those are not the remedies of this disease. The low level of women awareness on STDs and HIV/AIDS are always upsetting for rapid flow of epidemic within population in Bangladesh. The women of the study areas are deprived of all health assistance since they are illiterate and ignorant about their physical fitness. Awareness and preventive knowledge of HIV/AIDS have seen higher tendency of mothers but they are at high risk of spreading HIV/AIDS.

Recommendations

A lot of work is to be done by the government and non-government institutions as well as the general civilian to come forward for creation awareness about HIV/AIDS among the people. Therefore, the following recommendations should be implemented to overcome this disease from our nation:

The existing awareness level and knowledge about HIV/AIDS as well as prevention of this disease should be improved through mass media such as radio, television, newspaper and widespread observation of AIDS day.

Governmental and non-governmental organizations, social and religious leaders should be brought in effective participation in increasing the awareness about HIV/AIDS to the society.

Special arrangement should be made to spread the knowledge on correct use of condom especially among the couples.

Health personnel need knowledge of HIV/AIDS.

Voluntary counseling and testing of HIV.

Preventing sexually transmitted infections.

More comprehensive qualitative research is needed to the better understanding of the factors relevant to the knowledge and prevention of HIV transmission.