Knowledge of condoms as a means of HIV prevention needs to be increased and their use for safe sex must be highlighted. This would be best achieved through culturally sensitive and gender-specific awareness programs.
HIV/AIDS KNOWLEDGE AND ATTITUDES One of the few areas relevant to HIV/AIDS for which there has been ample research in MENA is that of the levels of HIV/AIDS knowledge and attitudes in different population groups. The evidence confirms the variability in the levels of knowledge and nature of attitudes across and within MENA countries, but there are still key features that characterize much of HIV/AIDS knowledge and attitudes in this region.
Levels of HIV/AIDS basic knowledge In the majority of MENA populations, the level of HIV/AIDS basic knowledge is high. In Egypt, 84.4% of ever-married women reported knowing about HIV/AIDS.20 In Pakistan, 86.8% of migrant workers had heard of HIV/AIDS.21 This high basic knowledge level has been seen in the majority of studies (table E.1 in appendix E). In some settings in MENA, however, low levels of basic knowledge have also been documented. In Afghanistan, 50.8% of women were aware of HIV/AIDS in one study and only 20% knew that HIV is sexually transmitted.22 This limited basic knowledge has been observed in a minority of studies (table E.1 in appendix E).
Levels of HIV/AIDS comprehensive knowledge Despite widespread basic knowledge, the level of comprehensiveness of HIV/AIDS knowledge is inadequate.23 In Egypt, only 6.1% of ever-married women had comprehensive knowledge of HIV/AIDS.24 In Somalia, only 4% of young women had comprehensive knowledge of HIV/AIDS.25 20
Measure DHS, “Egypt: Demographic and Health Survey 2005.” Faisel and Cleland, “Study of the Sexual Behaviours.” 22 Todd et al., “Seroprevalence and Correlates of HIV.” 23 Abolfotouh, “The Impact of a Lecture”; Farghaly and Kamal, “Study of the Opinion and Level of Knowledge about AIDS.” 24 Measure DHS, “Egypt: Demographic and Health Survey 2005.” 25 Somaliland Ministry of Health and Labour, Somaliland 2007 HIV/ Syphilis Seroprevalence Survey. 21
Many people may have heard of HIV/AIDS, but are unaware of its different transmission modes and clinical manifestations of infection and disease.26 Knowledge of transmission modes is biased by the sociocultural context, where some transmission modes, such as sharing of injections, can be widely known, but other transmission modes, such as sexual relations within marriage, are not thought of as a transmission mode.27 This pattern of low comprehensive knowledge has been seen in many studies (table E.2 in appendix E). A few studies, however, have identified fairly good levels of comprehensive knowledge in specific populations, including a general population group in the Islamic Republic of Iran28 and prisoners, FSWs, MSM, and injecting drug users (IDUs) in Lebanon.29 Comparing knowledge, attitudes, and practices (KAP) surveys in Sudan from 2002 and 2005 found a substantial improvement in HIV/AIDS knowledge.30 The level of HIV/AIDS knowledge appears to be steadily improving.
Levels of HIV/AIDS misinformation There is a high level of misinformation and many misconceptions about HIV/AIDS in MENA.31 In the Islamic Republic of Iran, one-third of high school students believed that HIV can be transmitted by mosquitoes.32 In Saudi Arabia, 49% of health care workers (HCWs) identified casual kissing as a transmission mode.33 In Sudan, onefifth of antenatal clinic (ANC) attendees believed they could acquire HIV by sharing a meal with an HIV-positive person.34 This high level of misinformation has been seen in many other studies (table E.3 in appendix E).
Perception of risk of HIV infection Most people in MENA do not consider themselves at risk of HIV infection. In Djibouti, 80% 26
Genc et al., “AIDS Awareness and Knowledge.” UNAIDS, “Key Findings.” 28 Montazeri, “AIDS Knowledge and Attitudes.” 29 Mishwar, “An Integrated Bio-Behavioral Surveillance Study”; Rady, “Knowledge, Attitudes and Prevalence.” 30 SNAP, UNICEF, and UNAIDS, “Baseline Study on Knowledge.” 31 Abolfotouh, “The Impact of a Lecture”; Farghaly and Kamal, “Study of the Opinion and Level of Knowledge about AIDS.” 32 Tavoosi et al., “Knowledge and Attitude.” 33 Mahfouz et al., “Knowledge and Attitudes.” 34 Ahmed, Antenatal. 27
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