AIDS-Related Knowledge, Sexual Behavior, and Condom Use among Men and Women in Kinshasa, Zaire

'4 ..

Jane T. Bertrand, PhD, Bakutuvwidi Makani MS, Susan E. Hassig, DrPH, Kinavwidi Lewu Niwembo, Balowa Djunghu, Mbadu Muanda, L2, and Chiwisa Chirhamolekwa, L2 Acquired immunodeficiency syndrome (AIDS) constitutes a major public health problem in Zaire. It is estimated that 6-8 percent of the adult population of Kinshasa, the capital city of Zaire, are seropositive, based on serosurveys of selected populations.' Six percent of babies delivered in the two major hospitals in Kinshasa in 1987 were bom to seropositive mothers.2 In 1988, 50 percent of the admissions to the intemal medicine ward of the major public hospital, Mama Yemo, were HIV (human immunodeficiency virus) seropositive.3 It is estimated that 80-90 percent of AIDS in Kinshasa is transmitted through sexual contact.' Since homosexuality is rare in Kinshasa, heterosexual relations constitute the major means of AIDS transmission among this population. Until a vaccine or cure is found, public information and education remain an important weapon against AIDS. Since 1987, AIDS messages have been broadcast frequently on radio and television. Luambo, a popular singer in Zaire, further publicized the dangers of AIDS through a widely diffused song. The current study was conducted city-wide in 1988 among the adult population to measure awareness of AIDS, its modes of transmission and means of prevention; coital frequency and extramarital sexual relations; knowledge and use of condoms; perceived risk of getting AIDS; and attitudes toward HIV testing. This module on AIDS formed part of a larger survey on contraceptive prevalence in Kinshasa, conducted by the Projet des Services des Naissances Desirables, the national family planning services project.

Methods The projected sample for this survey consisted of 1,500 men (ages 20-59 years) and 1,500 women (ages 15-49 years), randomly selected from the 24 administrative zones of Kinshasa. The age criterion differed by sex, in an effort to obtain the population at greatest risk of AIDS. Four zones were intentionally oversampled for other research purposes (a field study to test the impact of an AIDS prevention program, not reported herein), bringing the projected sample size to 2,500 per sex. Two-staged sampling was involved: first, 72 of 251 quartiers (the largest administrative unit within an administrative zone) were randomly selected and subse-

quently mapped; second, parcelles (a compound containing one or more households) were systematically selected. Men and women were interviewed in alternate parcelles; thus, the male/female data constitute independent samples, not husbands and wives. Address reprint requests to Jane T. Bertrand, PhD, Associate Professor, Department of Applied Health Sciences, Tulane University, School of Public Health and Tropical Medicine, 1501 Canal Street, New Orleans, LA 70112. About the co-authors: Bakutuvwidi is Consultant, Centre d'Informations Techniques et de Recherches pour le Developpement, Kinshasa, Zaire; Dr. Hassig is Research Assistant Professor, Biostatistics and Epidemiology, Tulane SPHTM, New Orleans; Kinavwidi is Statistician, Institut National de la Statistique, Kinshasa; Balowa is Head of Computer Services, Mbadu is Head of Operations Research, and Chirwisa is Director, all three with Projet des Services des Naissances Desirables (the Family Planning Services Project), Kinshasa. This paper, submitted to the Journal June 19, 1989, was revised and accepted for publication March 21, 1990.

American Journal of Public Health 53

Bertrand, et al.

at the time of the interview. Half of all respondents knew at least one person who had died of AIDS. All respondents who had heard of AIDS were asked whether they had seen or heard something about AIDS via different communication channels. More adults in Kinshasa have been reached via radio than any other medium: 96 percent of men and 83 percent of women. Almost identical percentages of each group reported having heard the Luambo song on AIDS. A slightly lower percentage (86 percent of men, 70 percent of women) had seen something about AIDS on television. The percentages who had seen brochures, newspaper articles, or posters on AIDS were lower, ranging from 38-60 percent for men and 22-34 percent for women. The vast majority of respondents, 95 percent of men and 89 percent of women, wanted to learn more about AIDS.

Multivanate Predictors of Knowledge ofAIDS

Because the average number of eli-

gible respondents per parcelle was higher than expected, the total number of respondents (6,625) exceeded the projected sample. In the tables below, the results have been weighted to adjust for oversampling. The n in each case is based on the unweighted sample (actual number of people who were asked the question), whereas the percentages are based on the weighted

sample. Data collection for this survey took place from January to September 1988. All interviewers underwent a 20-day training course on sampling and data collection procedures prior to the fieldwork. All interviews were conducted in Lingala, the local language, by an interviewer of the same sex, using a pretested, structured questionnaire. Each interview lasted an average of 30-40 minutes. All questionnaires were verified for completeness and logical consistency; where necessary, interviewers were sent back to the field to verify or complete responses. SPSS/PC + and BMDP/PCwere used for the analysis.

Results The total sample included 3,140 men and 3,485 women (Table 1). Over half of 54 American Journal of Public Health

all respondents had at least some level of secondary education; however, significantly more men (20 percent) than women (3 percent) had gone beyond secondary school. The majority of men (59 percent) and women (62 percent) were married or living in consensual union.

Knowledge ofAIDS Awareness ofAIDS is almost universal in Kinshasa (99 percent of men and 96 percent of women). Details of specific AIDS knowledge items are presented in Table 2. Of note, only half the study population knew that mosquitoes do not transmit AIDS and only 70 percent had correct information regarding casual contact. Ninety-four percent of men and 88 percent of women believed that AIDS could be prevented through behavioral changes. Thirty-six percent of men and 45 percent of women at the time of this survey believed that there was a vaccine against HIV. Moreover, 40 percent of men and 21 percent of women believed that a person with AIDS can be cured. An additional 5-12 percent were unsure regarding both of these points. Seventeen percent of men and 31 percent of women knew someone with AIDS

In a multiple regression of the summed knowledge score by demographic and descriptive variables, males and females both had similar results (Table 3). Higher knowledge scores in both groups were associated with higher socioeconomic status (SES), higher educational attainment, length of time and number of messages they had heard about AIDS, personally knowing someone who has AIDS or had died of AIDS, and professing to a non-Christian religion. Being raised in a rural environment was negatively associated with knowledge for women, but not for men. Being older was negatively associated with knowledge for men but not for women. (In both males and females, age was negatively correlated with level of education.) Despite the number of significantly associated variables, the adjusted r square for both the male and female models was only 0.18. Thus, it is apparent that the variability seen in the knowledge scores in this population cannot be truly defined by the available variables.

Sexal Behavior, Knowledge, and Use of Condoms in Mamage The median age at first sex (among those who had initiated sexual relations) was 17 years for men and 16 years for women. One percent of men and 14 percent women had not had sex, while 9 percent men and 4 percent women did not respond to the question. All married respondents (N = 4,008) were asked whether they had had sexual

January 1991, Vol. 81, No. 1

AIDS Knowledge and Behavior in Zaire

Extramanital Relations and Use of Condoms

relations in the previous month; 66 percent of 1,885 men and 60 percent of 2,123 women reported having had relations during this period. Abstinence was associated with the postpartum period or having an absent partner. Among those married respondents who had had relations, the mean number of days of sex during the previous week was 1.3. Over 90 percent of married and single men, 77 percent of married women, and 61 percent of single women had heard of condoms. Despite the high recognition level, relatively few of the respondents in this survey had ever used condoms, with 12 percent of married men reporting ever using them with their spouse.

January 1991, Vol. 81, No. 1

Eight percent of married men and 7 percent of married women reported current condom use with their spouse, although less than 2 percent of either sex reportedly used them "always" or "most of the time." The predominant reason for using condoms with one's spouse was to prevent pregnancy; the second, to prevent sexually transmitted diseases (STDs) in general, and the third to prevent AIDS. Mention of pregnancy prevention was higher among married than single respondents (reporting on condom use with their current partner), whereas singles cited prevention of other STDs and AIDS more often than married respondents.

Twenty-three percent of married men and 1 percent of married women reported having had an extramarital partner or partners in the past six months; 12 percent of men and 1 percent of women reported such relations in the four weeks preceding the interview. Of men having had extramarital activity in the past six months, half reported having only one such partner (Table 4). Among the relatively few women who admitted to extramarital sexual activity, almost all claimed that it was with a single partner. Factors associated with extramarital activity in men included younger age (

AIDS-related knowledge, sexual behavior, and condom use among men and women in Kinshasa, Zaire.

This study was conducted in 1988 among a random sample of 6,625 men and women of reproductive age in all 24 administrative zones of Kinshasa, the capi...
4MB Sizes 0 Downloads 0 Views