HIV Knowledge, Risky Sexual Behavior & HIV Infection:

An Evaluation Study in Uganda

Rose Apondi (MPH) University of Liverpool

Co-authors: Deborah McGill, Wilford Kirungi, John Ssenkusu, Frank Kaharuza

April 26, 2012Addis Ababa-Ethiopia, 13th World Congress

on Public Health

Background

• Mature, generalized HIV epidemic (prevalence 6.4% 2004/5; 6.7% 2011)

• HIV knowledge may impact risk perception and behavior

• We sought to evaluate the association between HIV knowledge and risk behavior

Context of Study

• Conducted secondary analysis of National Representative HIV Sero-Behavior Survey (UHSBS-2005) with a weighted sample of 18,525 adults

• UHSBS -Cross-sectional descriptive study – Obtain HIV prevalence estimates – Obtain accurate information on behavioral and

care indicators related to HIV/AIDS and other STIs

– Obtain accurate information on other HIV/AIDS program indicators

Study Objectives

• Determine the characteristics of Ugandans who engage in risky sexual behavior

• Identify the possible association of risky sexual behavior with HIV knowledge

• Inform policy on the contribution of HIV knowledge for HIV prevention

Definitions (1)

HIV Knowledge included anyone with knowledge that • Condoms can prevent HIV transmission• Having one uninfected partner who had no partners

AND Anyone with knowledge of any two below • HIV can be transmitted from a mother to her child• Knowledge that a healthy looking person can have

the HIV virus• A man can have AIDS while his partner does not• A woman can have AIDS while her partner does not

Definitions (2)

The study defined risky sexual behavior as any report of unprotected sex with any non-marital or non cohabiting partner in the last 12-months

RESULTS

Population Characteristics by Risky Sex (N=14,044)

Variable Riskyn(%)

Non-riskyn(%)

Total OR- CI 95% Crude P-value

Sex

Female  634 (8) 7053 (92) 7687 Ref.

 

Male  1312 (21) 5045 (79) 6357

2.8

[2.54 3.13]

<0.001

Residence

Urban 382 (17) 1856 (83) 2238 Ref.

 

Rural 1564 (13) 10,242 (87) 11806

0.8

[0.71 0.92]

0.001

Total 14044

Men engaging in risky sex almost 3-fold; People in rural areas less risky than those in urban areas

Odd Ratio of Risky Behavior by AgeReference group: 15-19

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-590

0.050.1

0.150.2

0.250.3

0.350.4

0.450.5

0.45

0.29

0.36

0.28 0.27

0.220.2

0.25

15-19 do not use condoms

Risky Sex by EducationLevel of Education

Riskyn(%)

Non-riskyn(%)

Total OR- CI 95%

Crude P-value

None 178 (6) 2,741(94) 2919 REF  

Primary incomplete

974 (15) 5,397 (85) 6371 2.6

[2.17 3.07]

<0.001

Primary complete

273 (16) 1,484 (84) 1757 2.5

[2.02 3.08]

<0.001

Secondary or higher

521 (17) 2,476 (83) 2997 3.0

[2.45 3.58]

<0.001

Total 1946 12098 14044

There was a 3-fold increase in risky behavior among those with the highest level of education

Risky Sex by Occupation Risky n(%)

Non-risky n(%)

Total OR [CI] P-value (unadjusted)

Unemployed 341 (15) 1975 (85) 2316 REF  

Professional/Services

371 (15) 2117 (85) 2488 1.0

[0.87 1.21]

0.754

Agriculture 826 (12) 6238 (88) 7064 0.8

[0.67 0.89]

<0.001

Manual labor 401 (19) 1736 (81) 2137 1.5

[1.26 1.75]

<0.001

Total 1939 12066 14005

 

There was a 1.5 fold increase in risky behavior among the manual laborers

HIV-Infection & Risky Behavior

Risky Non Risky 0

10

20

30

40

50

60

70

80

90

100

13

87

20

80

Un-infectedInfected

* May not have known their HIV statusPersons who engaged in unprotected sex were more likely to be HIV infected OR (1.6) CI -1.4-2.0]

HIV Knowledge by Risky Behavior

HIV Knowledge Label Risky n(%)

Non-risky n(%)

OR [CI] P-value (unadjusted)

Reduce chances of HIV by Condom

Yes 1606 (17) 8124 (83) REF  

 

  No 330 (8) 3786 (92) 0.45(0.40 0.52) <0.001

Reduce chances of HIV by sex- 1 uninfected partner

Yes 1779 (14) 10606(86) REF  

  No 159 (11) 1315 (89) 0.81(0.68 0.98) <0.001

HIV can be transmitted from mother to a child

Yes 1648 (15) 9647 (85) REF  

  No 298 (11) 2451 (89) 0.73 (0.64 0.84)

<0.001

HIV Knowledge by Risky Behavior

HIV Knowledge Label Risky n(%)

Non-risky n(%)

OR [CI] P-value (unadjusted)

A healthy person can have HIV virus

Yes 246 (3) 246 (3) REF

 

 

  No 1688(41) 1688(41) 0.59 (0.51 0.68) <0.001

A man can have AIDS while his partner doesn’t

Yes 431 (17) 431 (17) REF  

  No 1504 (13) 1504 (13) 0.72(0.64 0.82) <0.001

A woman can have AIDS while her partner doesn’t

Yes 430 (17) 430 (17) REF  

  No 1506 (13) 1506 (13) 0.72 (0.64 0.82) <0.001

HIV Knowledge No 660 (10) 660 (10) REF  

  Yes 1248 (17) 1248 (17) 1.69 [1.52 1.88] <0.001

HIV Knowledge

• After adjusting for age, sex, residence, education, HIV Knowledge was found to be associated with risky sexual behavior

• Odds ratio1.4) 95% CI [1.3-1.6], P-value <0.001

Conclusion

• Factual HIV knowledge does NOT translate in non-risky behavior

• Risk reduction interventions for men and youth are critical

• Specific and targeted interventions for both knowledgeable and non-knowledgeable persons are merited

• 2011 AIS results present an opportunity to examine changes in risky behavior

Acknowledgements

• The Uganda Ministry of Health • University of Liverpool, United

Kingdom• The United States Centers for

Disease Control and Prevention

THANK YOU