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Endline HIV/AIDS Survey among Youth in Bangladesh, 2008 An assessment of HIV/AIDS related knowledge and attitudes among youth, gatekeepers, community leaders and policy makers

National AIDS/STD Programme Directorate General of Health Services Ministry of Health and Family Welfare


Endline HIV/AIDS Survey among Youth in Bangladesh, 2008 An assessment of HIV/AIDS related knowledge and attitudes among youth, gatekeepers, community leaders and policy makers

Project on ‘Prevention of HIV/AIDS among Young People in Bangladesh’


Strategic Direction:  Dr. Mohd. Ali Belal, Former Line Director, National AIDS/STD Programme & SBTP  Dr. Mohd. Abdur Rahman, Former Programme Manager, National AIDS/STD Programme  Dr. Md. Hanif Uddin, Former Deputy Programme Manager, National AIDS/STD Programme  Dr. Hasan Mahmud, Former Deputy Programme Manager, National AIDS/STD Programme  Dr. Shamsul Hoq Gazi, Former Deputy Programme Manager, National AIDS/STD Programme  Dr. Nizam Uddin Ahmed, Director, HIV/AIDS Sector and South Asia Program Advisor, Save the Children- USA  Dr. Tasnim Azim, Scientist and Head, Virology Laboratory and HIV/AIDS Program, ICDDR,B Prepared by: ACPR  Prof. M. Sekandar Hayat Khan, Advisor  Mr. APM Shafiur Rahman, Director  Prof. Nitai Chakraborty, Consultant  Ms. Tauhida Nasrin, Deputy Director (Research) ICDDR,B  Dr. Quamrun Nahar, Senior Operations Researcher, HSID  Dr. Md. Shah Alam, Project Research Manager, LSD  Dr. Elizabeth Oliveras, Research Scientist, HSID, and Project Director, GFATM 905 Consortium  Dr. Fariha Haseen, Assistant Scientist, HSID  Mr. A. H. Nowsher Uddin, Assistant Scientist, HSID, and Project Coordinator, GFATM 905 Consortium  Dr. Tasnim Azim, Scientist and Head, HIV/AIDS Programme, LSD, ICDDR,B Population Council  Ms. Ismat Bhuiya, Senior Programme Officer  Dr. Ubaidur Rob, Country Director Reviewed by: Save the Children- USA (currently unified under Save the Children)  Dr. Amzad Ali, Deputy Director, Management & Implementation  Dr. Kazi Belayet Ali, Deputy Director, Performance Measurement  Dr. Lima Rahman, Program Manager, Young People Prevention  Dr. Saima Khan, Manager, Monitoring & Evaluation  Dr. Fadia Sultana, Manager, Response and Coordination  Mr. Tahseen Hasan Qadeer, Deputy Program Manager

First Print: October 2011 Design and printing: Printcraft Company Limited Published by: Save the Children Disclaimer: The baseline figures in this report do not match with those in the published report of the baseline survey because of weighting


Acknowledgment This National Endline Survey among Young People was conducted in 2008 with the grant supports from the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). The Government of Bangladesh acknowledges with gratitude the commitment of the Global Fund to pave the way towards effective programming by facilitating the application of evidences. This report is a clear reflection of this effort. The Endline Survey was initiated by the Ministry of Health and Family Welfare (MOHFW), Government of Bangladesh, through the National AIDS/STD Programme (NASP), the coordinating arm of the Directorate General of Health Services (DGHS). The stewardship role of the NASP in supporting the facilitation of all activities under this survey deserves special appreciation that NASP officials were able to support the survey.

Save the Children, the Management Agency for the Global Fund supported project “Prevention of HIV/AIDS among Young People in Bangladesh” deserves sincere thanks and gratitude. A true recognition is due to them for the accomplishment of this mammoth task which has contributed significantly to Bangladesh’s evidence-based knowledge for improvement of quality HIV/AIDS program implementation and strategy in Bangladesh especially among young people. Dr. Mohd. Abdul Waheed Line Director National AIDS/STD Programme (NASP) Directorate General of Health Services (DGHS) Ministry of Health & Family Welfare (MoHFW)

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

ACPR, Population Council and ICDDR,B, as implementing partners of the package-905 took hard effort to conduct this Endline Survey and they deserve sincere thanks. The household enlisters, interviewers and all staff involved in the data processing and report preparation process deserve special gratitude for their hard work in completing field and next level activities. The reviewers of this report have provided valuable inputs to preparing this informative report and they deserve special acknowledgement. Finally all credits and thanks go to the millions of young people in Bangladesh who are directly and indirectly reached through this program.

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Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table of Contents

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Acronyms VIII Executive Summery IX Chapter 1 Introduction........................................................................................................................................................... 2 1.1 Background............................................................ ............................................................................ 2 1.2 Organization of the assessment ......................................................................................................... 3 1.3 Organization of the report................................................................................................................10 Chapter 2 Characteristics of Youth Participants ...................................................................................................................12 2.1 General characteristics of respondents in the behavioral survey .....................................................12 2.2 Exposure to media............................................................................................ ................................16 2.3 General characteristics of serological sample ...................................................................................17 Chapter 3 Sexual and Reproductive Health Knowledge and Behaviors of Youth ............................ ...................................19 3.1 Knowledge about safe sex and condoms .........................................................................................19 3.2 Awareness and knowledge of HIV...................................................................................................26 3.3. Awareness and knowledge of STIs and care seeking for STIs.........................................................44 3.4 Sexual behavior and condom use .....................................................................................................53 3.5 Perceived HIV risk, barriers and self-efficacy ..................................................................................57 3.6 Use of illicit substances.....................................................................................................................61 Chapter 4 Young People’s Exposure to GFATM Activities.................................................................................................63 4.1 Exposure to the slogan Bachte Holey Jante Hobe.................................................................................63 4.2 Exposure to the TV serial Heeraphul .................................................................................................64 4.3 Exposure to the radio series Jholmolia ...............................................................................................65 4.4 Exposure to HIV-related class in school..........................................................................................65 4.5 Exposure to other GFATM activities............................ ...................................................................66 Chapter 5 Gatekeepers’ Interview Results.............................................................................................................................68 5.1 Profile of gatekeepers .......................................................................................................................68 5.2 Knowledge about HIV/AIDS related issues....................................................................................69 5.3 Attitude towards providing SRH and HIV/AIDS information............................ ...........................74 5.4 Suggested SRH and HIV/AIDS education and intervention options.............................................76 5.5 Attitudes towards condom use and supply.......................................................................................76 5.6 Awareness and exposure to GFATM activities................................................................................77 Chapter 6 Health Service Providers’ Interview Results.........................................................................................................79 6.1 Profile of service providers...............................................................................................................79 6.2 Quality characteristics of existing services........................................................................................80 6.3 Provision of services to adolescents and youth............................................................ ....................81 6.4 Perception about peoples’ attitude towards condom supply and STI services for young people ... 83 6.5 Perception about the HIV/AIDS epidemic and its prevention............................ ...........................85 6.6 Involvement and attitudes towards HIV/AIDS intervention programs .........................................86 Chapter 7 Policy Planners Interview Results.........................................................................................................................88 7.1 Profile of policy planners interviewed..............................................................................................88 7.2 Policy planners’ perceptions about HIV as a problem for Bangladesh ...........................................88 7.3 Awareness towards HIV prevention programs in Bangladesh ........................................................89 7.4 Preferred source of HIV/AIDS information...................................................................................90 7.5 Attitude towards the use of condoms ..............................................................................................92 7.6 Role as an individual .........................................................................................................................93 Chapter 8 Assessment of Community Readiness ...................................................................................................................95 Chapter 9 Conclusion and Recommendations ....................................................................................................................100 Chapter 10 104 Appendix 112 References


List of Tables Table 1.1 Table 1.2 Table 2.1a Table 2.1b Table 2.1c Table 2.1d Table 2.1e Table 2.1f Table 3.1a Table 3.1b Table 3.2a Table 3.2b Table 3.3a Table 3.3b Table 3.4a Table 3.4b Table 3.5a Table 3.5b Table 3.6a Table 3.6b Table 3.7a Table 3.7b Table 3.8a Table 3.8b Table 3.9a Table 3.9b Table 3.10a Table 3.10b Table 3.11a Table 3.11b Table 3.12a Table 3.12b Table 3.12c Table 3.12d Table 3.13a Table 3.13b Table 3.14a Table 3.14b Table 3.15a Table 3.15b Table 3.16 Table 3.17a Table 3.17b Table 3.18 Table 3.19 Table 3.20 Table 3.21 Table 3.22a Table 3.22b Table 3.23a Table 3.23b Table 3.24a Table 3.24b Table 3.25 Table 4.1a Table 4.1b Table 4.2a Table 4.2b Table 4.3a

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Response rate in behavioral survey .......................................................................................................... 8 Participation rate in serological survey..................................................................................................... 8 Characteristics of males...........................................................................................................................13 Characteristics of females........................................................................................................................13 Characteristics of males...........................................................................................................................14 Characteristics of females........................................................................................................................15 Exposure to media: males .......................................................................................................................16 Exposure to media: females ....................................................................................................................17 Knowledge about safe sex: males............................................................................................................19 Knowledge about safe sex: females.........................................................................................................20 Correct knowledge of safe sex by background characteristics: males.....................................................21 Correct knowledge of safe sex by background characteristics: females..................................................22 Knowledge about condoms: males .........................................................................................................23 Knowledge about condoms: females ......................................................................................................23 Knowledge of different uses of condoms: males....................................................................................24 Knowledge of different uses of condoms: females.................................................................................25 Knowledge of HIV/AIDS and source of AIDS information: males.....................................................27 Knowledge of HIV/AIDS and source of AIDS information: females..................................................28 Knowledge of routes of HIV transmission: male...................................................................................29 Knowledge of routes of HIV transmission: female................................................................................30 Knowledge of routes of HIV transmission by background characteristics: males.................................31 Knowledge of routes of HIV transmission by background characteristics: females..............................32 Knowledge of ways to prevent HIV: males............................................................................................33 Knowledge of ways to prevent HIV: female ..........................................................................................34 Knowledge of HIV prevention by background characteristics: males ...................................................35 Knowledge of HIV prevention by background characteristics: females ................................................36 Comprehensive knowledge of HIV by residence and marital status: male ............................................37 Comprehensive knowledge of HIV by residence and marital status: female .........................................37 Comprehensive knowledge of HIV by background characteristics: male..............................................38 Comprehensive knowledge of HIV by background characteristics: female...........................................39 Misconceptions related to HIV transmission: males ..............................................................................41 Misconceptions related to HIV transmission: females ...........................................................................42 Misconceptions related to HIV prevention: males .................................................................................43 Misconceptions related to HIV prevention: females ..............................................................................43 Knowledge about STIs: males.................................................................................................................45 Knowledge about STIs: females..............................................................................................................46 Knowledge about STIs symptoms: males...............................................................................................49 Knowledge about STIs symptoms: females............................................................................................49 Reported signs/symptoms of STIs in men.............................................................................................50 Reported signs/symptoms of STIs in women........................................................................................50 STI treatment……………………………………………………………………….…………….….51 STI treatment by background characteristics: males...............................................................................51 STI treatment by background characteristics: females............................................................................52 Prevalence of syphilis by background characteristics………………………………... ………...…….52 Prevalence of HCV by background characteristics………….………………………………...……..53 History of premarital sex………………………………………………................ …………………54 History of extramarital sex……………………………………………………................. ………….54 Sex before the age of 15: males...............................................................................................................55 Sex before the age of 15: females............................................................................................................56 Perceived barriers in accessing STI services and condoms: male...........................................................59 Perceived barriers in accessing STI services and condoms: female........................................................59 Self-efficacy for overcoming barriers: male ............................................................................................60 Self-efficacy for overcoming barriers: female .........................................................................................60 Use of illicit substances…………………………………………………………................. ……..…61 Exposure to the slogan Bachte Holey Jante Hobe: male........................................................................63 Exposure to the slogan Bachte Holey Jante Hobe: female.....................................................................63 Exposure to the TV serial Heeraphul: male............................................................................................64 Exposure to the TV serial Heeraphul: female.........................................................................................64 Exposure to the radio serial Jholmolia: male ..........................................................................................65

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

List of Tables

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Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 4.3b Table 4.4a Table 4.4b Table 4.5a Table 4.5b Table 5.1a Table 5.1b Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 6.10

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Exposure to the radio serial Jholmolia: female .......................................................................................65 Exposure to HIV-related class in school: male.......................................................................................65 Exposure to HIV-related class in school: female....................................................................................66 Exposure to other GFATM activities: male ...........................................................................................66 Exposure to other GFATM activities: female ........................................................................................66 Profile of gatekeepers..............................................................................................................................68 Profile of gatekeepers..............................................................................................................................69 Gatekeepers’ knowledge and awareness about key HIV/AIDS issues ..................................................70 Knowledge of routes of HIV transmission.............................................................................................70 Knowledge of HIV prevention...............................................................................................................71 Awareness about HIV prevention programs ..........................................................................................72 Awareness and participation in HIV and SRH related youth programs in the community...................73 Attitudes towards providing SRH and HIV/AIDS information to youth and adolescents...................74 Attitudes towards discussing SRH issues with youth and adolescents ...................................................75 Support in selective interventions in schools, colleges, technical colleges or madrasas.........................76 Attitudes towards condom use and supply .............................................................................................77 Awareness about GFATM activities.......................................................................................................77 Profile of service providers .....................................................................................................................79 Providers’ training and characteristics of existing service provision ......................................................80 Type of services provided to young people ............................................................................................82 Type of services provided to young people ............................................................................................83 Access to services ....................................................................................................................................84 Privacy in the health facilities..................................................................................................................84 Knowledge about condom use................................................................................................................85 Perception about social barriers to condom supply & STI treatment ....................................................85 Perception about HIV/AIDS epidemic and HIV/AIDS programs in Bangladesh...............................86 Involvement and willingness to participate in HIV/AIDS activities......................................................86


List of Figures : : : :

Figure 3.2a : Figure 3.2b : Figure 3.3a : Figure 3.3b : Figure 3.4a : Figure 3.4b : Figure 3.5a : Figure 3.5b : Figure 3.6a Figure 3.6b Figure 3.7a Figure 3.7b Figure 3.8a

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Figure 3.8b : Figure 3.9a : Figure 3.9b : Figure 3.10 : Figure 3.10a : Figure 3.11 Figure 5.1 Figure 5.2 Figure 5.3

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Figure 6.1 : Figure 6.2 : Figure 6.3 : Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4 Figure 8.5 Figure 8.6

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Youth response rate in behavioral survey by type of sample, 2005 and 2008 .................................................. Youth participation rate in serological survey by type of sample, 2005 and 2008 ........................................... Percentage of male youth & who mentioned use of condom as & safe sex, baseline and endline surveys ... Percentage of female youth & who mentioned use of condom as & safe sex, baseline and endline surveys……………………………………………………………..................................................... Percentage of male youth who could mention dual use of condom, baseline and endline surveys ............... Percentage of female youth who could mention dual use of condom, baseline and endline surveys ............ Percentage of male youth who could correctly identify two or more routes of HIV transmission, baseline and endline surveys…………………….……….................................................................................... Percentage of female youth who could correctly identify two or more routes of HIV transmission, baseline and endline surveys……………………………..................................................................................... Percentage of male youth who could correctly identify two or more ways of HIV prevention, baseline and endline surveys……………………………………....................................................................... Percentage of female youth who could correctly identify two or more ways of HIV prevention, baseline and endline surveys………………………………................................................................................ Percentage of male youth who both correctly identify ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission, baseline and endline surveys ........ Percentage of male youth who both correctly identify ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission, baseline and endline surveys ........ Misconceptions relating to HIV transmission among male youth baseline and endline surveys ................... Misconceptions relating to HIV transmission among female youth baseline and endline surveys ................ Misconceptions relating to HIV prevention among male youth baseline and endline surveys ...................... Misconceptions relating to HIV prevention among female youth baseline and endline surveys ................... Percentage of male youth who could correctly identify two or more ways of transmission of STIs, baseline and endline surveys ………………………………............................................................................... Percentage of female youth who could correctly identify two or more ways of transmission of STIs, baseline and endline surveys ………………………………............................................................................... Percentage of male youth who could correctly identify two or more ways of prevention of STIs, baseline and endline surveys ………………………………............................................................................... Percentage of female youth who could correctly identify two or more ways of prevention of STIs, baseline and endline surveys ………………………………............................................................................... Percentage of male youth using condom in premarital, extramarital and higher risk sex, baseline and endline surveys ................................................................................................................................................... Percentage of male youth using condom in last premarital and higher risk sex by comprehensive HIV knowledge, endline survey .............................................................................................................................. Percentage of young people who perceived risk of becoming infected by HIV, baseline and endline surveys ...... Knowledge of routes of HIV transmission, baseline and endline surveys ........................................................ Knowledge of ways to prevent HIV, baseline and endline surveys .................................................................... Percentage of gatekeepers supportive of condom education in schools, colleges, technical colleges and madrasas .............................................................................................................................................................. Percentage of providers who received orientation training about providing services to youth clients, baseline and endline surveys .................................................................................................................................... Percentage of providers who mentioned that services and clinic hours are listed on a signboard in their facility, baseline and endline surveys ............................................................................................................. Percentage of providers who distribute contraceptives to all youth clients irrespective of marital status, baseline and endline surveys ........................................................................................................................ Stage 1—Level of vulnerability by participant type .............................................................................................. Stage 2— Knowledge of HIV transmission by participant type ......................................................................... Stage 3—Knowledge of HIV prevention by participant type ............................................................................. Stage 4—Planning by participant type .................................................................................................................... Stage 5—Preparation by participant type ............................................................................................................... Stage 6—Initiation of HIV prevention activities by participant type .................................................................

9 10 20 21 25 25 30 31 34 35 40 41 42 42 43 44 47 47 48 48 57 57 58 71 72 76 81 81 83 95 96 96 97 98 98

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 1.1 Figure 1.2 Figure 3.1a Figure 3.1b

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Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Acronyms

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ACPR AIDS ANC BBS BDHS CD CSW DG DK DVD ELISA FCPS FWA FWC GFATM GOB HASAB HH HIV HSV2 ICDDR,B IgG IgM IMPS LMF LSE MBBS MCWC MoHFW MPH NASP NGO PC PIACT PPS PSU RMP RPR SACMO SMA SPSS SRH STD STI TPHA TPPA TT TTPA TV UNAIDS UNFPA UNGASS USA YFHS

Associates for Community and Population Research Acquired Immune Deficiency Syndrome Antenatal care Bangladesh Bureau of Statistics Bangladesh Demographic and Health Survey Compact Disc Commercial sex worker Director General Don’t know Digital Versatile Disc Enzyme linked immunosorbent assay Fellow of College of Physicians and Surgeons Family Welfare Assistant Family Welfare Center Global Fund to Fight AIDS, Tuberculosis and Malaria Government of Bangladesh HIV/AIDS and STI Alliance of Bangladesh Household Human Immunodeficiency Virus Herpes Simplex Virus 2 International Centre for Diarrhoeal Disease Research, Bangladesh Immunoglobulin G Immunogobulin M Integrated multipurpose survey Licentiate of the Medical Faculty Life skills education Bachelor in Medicine and Bachelor in Surgery Maternal and Child Welfare Centre Ministry of Health and Family Welfare Masters of Public Health The National AIDS/STD Programme Non-Government Organization Population Council Program for the Introduction and Adaption of Contraceptive Technology Probability proportional to size Primary sampling unit Rural Medical Practitioner Rapid plasma reagin Sub-Assistant Community Medical Officer Statistical Metropolitan Area Statistical Package for Social Science Sexual and reproductive health Sexually Transmitted Disease Sexually Transmitted Infection Treponema Pallidum Haemagglutination Test Treponema Pallidum Particle Agglutination Tetanus Toxoid Treponema Pallidum particle agglutination Television Joint United Nations Program on AIDS United Nations Population Fund United Nations General Assembly Special Session United States of America Youth Friendly Health Services


Executive Summary Introduction The AIDS epidemic claims over two million lives worldwide each year. Of particular concern are high rates of HIV infections among young people; 45% of all new infections among adults in 2007 occurred to those under the age of 25.Youth are particularly susceptible to HIV and other STIs for several reasons, including a lack of knowledge about sexual health, risky behavior, and low condom use. Youth in Bangladesh are no exception. In 2003, the Ministry of Health & Family Welfare (MOHFW) and Save the Children, USA initiated a collaborative project, ‘Prevention of HIV/AIDS among Young People in Bangladesh’ funded by Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). The aim of this project was to prevent HIV infection among young people aged 15–24 in order to avert a generalized HIV epidemic in the country. As part of the project, baseline and endline surveys were conducted to analyze changes over time in key indicators of knowledge, attitude, behavior and access to services among youth in Bangladesh. Baseline and endline surveys were also done to compare HIV/AIDS knowledge and attitude of key stakeholders over time. In 2008, an additional component was added to assess the community readiness to HIV/AIDS. This report presents all these findings together and presented as an assessment which includes the results from the 2008 endline survey of HIV/AIDS knowledge, attitude and behaviors among youth and other key stakeholders and compares selected findings from the 2005 Baseline survey conducted in a similar population and the findings from the community readiness to HIV/AIDS. Objectives The objectives of the endline survey were to document young people’s HIV/AIDS knowledge, attitude and behavior and their access to information, service, and condoms, to assess attitudes of gatekeepers towards HIV/AIDS and STI intervention programs, and to measure any changes over the three year period since the baseline and during which the prevention intervention continued.

As in the 2005 baseline survey, the 2008 endline survey used a nationally representative sample of youth aged 15–24 (by sex and marital status) selected using a two-stage cluster sampling method. In both surveys, the representative sample for behavioral component was drawn from 360 clusters randomly selected from urban, rural and statistical metropolitan areas (SMA). To ensure maximum precision and minimum bias in estimating the change between the 2005 and 2008 surveys, all the 2005 sample clusters were retained. The sample size was also kept the same as that in baseline. Similar to the baseline survey, the endline had a serological component where 142 clusters were randomly selected. In addition to the youth sample, the survey also included interviews with gatekeepers consisting of parents, teachers, religious and community leaders and service providers. Qualitative data about HIV prevention issues and programmatic views were obtained from policy planners working in relevant key government ministries. In addition, to understand community readiness included interviews with trained teachers, imam, drug vendors, business or agricultural association members with national representative data. A total of 11,188 of youth, 1,435 parents, 354 teachers, 366 religious/community leaders, 719 service providers, and five policy planners were interviewed. For the serological part of the assessment, 2,591 samples were collected. For the community readiness part, 100 imams, 93 headmasters/teachers, 94 drug vendors, and 95 business leaders were interviewed.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Methodology

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Youth Interview Results Background characteristics: The mean age of unmarried male and female youth respondents was 18.8 and 17.0, respectively. The mean age of married male and female youth respondents was 22.5 and 20.5, respectively. The majority of respondents had secondary education, either complete or incomplete. A large proportion of respondents had no education. Overall educational attainment was higher among females than males and higher for unmarried than married youth. The primary occupations of male youth were student, agricultural, or skilled worker whereas female youth were primarily housewives and students. Exposure to any of the three media – watching television, listening to radio or reading newspaper was high (97% males and 82% females). For both males and females, exposure to television was higher than exposure to radio or newspapers. Knowledge about safe sex: The majority of respondents was aware and could define what they meant by “safe sex”. However, a sharp difference was observed between the responses given by males and females. Almost 90% of male youth mentioned using condom during sex as safe sex whereas only 37% of female respondents mentioned using condoms as safe sex. The majority (65%) of female mentioned having sex with one’s spouse as safe sex. When compared with baseline findings, correct knowledge about safe sex for both males and females increased over time. Whereas only 69% of male youth and adolescents had correct knowledge about safe sex at the time of the baseline survey, 78% has this knowledge at the time of the endline (p <=0.001). Knowledge about condoms: The majority of respondents had heard of condoms. When asked about different uses of condoms prevention of pregnancy or contraception was the most cited response by the majority of respondents. A significant proportion of males (56% of unmarried and 42% of married males) and a smaller proportion of females (27% of unmarried and 18% of married females) mentioned that condoms are used for prevention of HIV. Irrespective of residence or marital status, knowledge on dual protection was very low, i.e. compared to 96% general awareness about condoms among males, less than 40% of males were aware of the dual use of condoms. This knowledge was even lower among females. Comparing findings with the baseline survey, knowledge about dual use of condom for both males and females increased over time. However, more increase was marked among males compared to females.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Awareness about HIV: Study results showed high awareness of HIV among young people. Awareness, however, appeared to be higher among males, married youth, and those who lived in urban areas. In terms of sources of information about HIV, television was most commonly mentioned (91% for males and 82% for females).

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Knowledge about routes of HIV transmission: The most common route of HIV transmission as cited by male youth and adolescents was having sex with sex workers followed by not using a condom during sex, using non-sterile needles/syringes, receiving HIV/AIDS infected blood, and unprotected sex with a HIV infected person. The most commonly cited responses for females were using non-sterile needles/syringes, receiving HIV/AIDS infected blood, sex with multiple partners and unprotected sex with an HIV infected person. Overall, females had better knowledge about two or more routes of HIV transmission. More specifically, thirty six percent of males could mention two or more correct ways of HIV transmission whereas the same figure for females was 40%. When compared with baseline findings, there was significant increase in correct HIV transmission knowledge during the last three years. Knowledge about ways of HIV prevention: The most frequently cited ways to prevent HIV was to use condoms, cited by 54% of married and 53% of unmarried males. The other cited ways to


prevent HIV by male youth were avoid sex with sex workers, avoid HIV infected/unscreened blood transfusion, avoid sex with multiple partners and use of sterile syringes/needles. On the other hand, use of sterile syringes/needles, avoid sex with multiple partner, use of condom, and avoid sex with HIV infected persons were the most cited responses by females to prevent HIV infection. Males have better prevention knowledge compared to females; 44% of males and 38% of females could mention two or more correct ways of HIV prevention. While the HIV prevention knowledge for males had increased over time (from 36% of male youth surveyed in 2005 were able to correctly identify two or more ways of prevention compared to 44% in 2008 (p <=0.001) irrespective of residence and marital status, the findings for females were not consistent. There was slight increase in HIV prevention knowledge among unmarried females (from 46% to 50%, p <=0.01) and among rural married females (from 23 to 26%, p <=0.01), but no change among urban married females (from 44 to 42%, p=0.32). Comprehensive knowledge about HIV: Comprehensive knowledge of HIV as defined by â&#x20AC;&#x153;percentage of youth who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmissionâ&#x20AC;? was found to be 15% for males and nine percent for females. Education and household economic status were the two key determinants of comprehensive HIV knowledge among youth. For instance, comprehensive knowledge was much higher among males (38%) and females (27%) with secondary or higher level of education compared to those with no education (4% of males and 1% of females). Similarly, comprehensive knowledge was significantly higher among youth of households with the highest wealth quintile (24% of males and 16% of females) compared to those of the lowest quintile (8% percent of males and 3% of females).

Knowledge of STI: Overall, knowledge of STIs was poor among youth. Urban males were more aware than rural males; however, there was no significant difference in awareness between urban and rural females. According to the survey results, the most reported modes of STI transmission were having sex with sex workers and not using condoms during sex. Knowledge of routes of STI transmission was lower among females than males. However, there was significant improvement in the correct knowledge of two or more modes of STI transmission for both males and females between baseline and endline surveys. Among males the percentage that could correctly identify two or more ways of transmission of STIs increased from 28.0 to 44.3 between the baseline and endline survey (p <=0.001), while for females it increased from 10.4 to 15.2 (p <=0.001). Similarly, there was significant improvement in the correct knowledge about two or more modes of STI prevention for both males and females. Prevalence of STI symptoms: About 19% of males and 26% of females reported experiencing one or more signs or symptoms of STIs in the last 12 months preceding the survey. The most commonly cited symptoms among males were burning sensation during urination (11% for unmarried and 13% for married males) followed by ulcer in genital region (8% percent for unmarried and seven percent for married males). For females, the most commonly cited symptoms were increased vaginal discharge for both married and unmarried females (19 and 15% respectively) and pain during coitus for married women (16%). When compared with

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Comparable figures from the baseline and endline surveys showed that the comprehensive knowledge about HIV has increased significantly over time for males (10% in baseline compared to 15% in endline, p <=0.001); however, the comprehensive knowledge among females has decreased slightly (10% in baseline and 9% in endline, p <=0.05). When comprehensive knowledge is assessed using United Nations General Assembly Special Session (UNGASS) indicator #13, which includes a slightly different range of questions than the questions used in this report, 22% of males and 13% of females had correct knowledge at endline. This indicator could not be calculated based on the baseline data.

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baseline data, there was significant decrease in the proportion of young men reporting one or more STI symptoms (28% in baseline and 19%, p <=0.001). On the contrary, reporting of one or more STI symptoms increased significantly among young females (22% in baseline versus 26% in endline, p <=0.001). Among those who experienced one or more STI symptoms in the last 12 months preceding the survey, 57% (62% of males and 53% of females) reported to have sought care from someone. When compared with the baseline findings, percentage of youth who sought care from any source decrease significantly for both males and females (66% versus 62% for males and 56% versus 53% for females, p <=0.001). Prevalence of selected STIs: Among the 2,591 specimens tested for syphilis, 1.3% and 0.3% of specimens were found to be positive using RPR and TPHA respectively; 0.3% of specimens were positive for both tests indicating current infection of syphilis. Out of all specimens tested, 4.5% were HSV2 IgG positive, indicating either a current or past exposure to Herpes Simplex Virus2. This prevalence was higher among the older age group and among married youth.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Sexual behavior and condom use: Survey results showed that about 23% of males (both urban and rural) and less than one percent (0.5% of urban and one percent of rural) of females had a history of premarital sex. The prevalence of extramarital sex among males was nine percent. Thirty percent of males who had premarital or extra marital sex had sex with sex workers and 35% of them had paid sex. Out of the male youth who reported ever having sex, about two percent of them reported having sex with more than one partner (higher risk sex). Practice of higher risk sex was significantly higher among unmarried (10%) youth compared to married youth (0.3%). Among those who had ever experienced sex, 12% of males and 31% of females experienced first sex before the age of 15. Among those who ever experienced premarital sex, 12% of male and 2% of females experienced first sex before the age of 15. Among those who ever had premarital sex, only 37% of males reported using a condom during last sex and 46% males who had extra marital sex used condoms at last extra marital sex. However, 55% of respondents who had engaged in high-risk sex used condoms during their last sex.

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Perceived barriers in condom use: While the majority of married males perceived that the community would not like it if a young person purchased a condom (58%), the same perception was much lower among unmarried males (24%). Unmarried males also identified unwillingness of sellers to sell condoms to youth (23%) and lack of confidentiality about condom sales (26%) as common barriers, whereas married males perceived these barriers less compared to them. The pattern was found to be similar for female respondents. Exposure to GFATM activities: The results showed young peopleâ&#x20AC;&#x2122;s exposure to different GFATM activities targeted at that particular age group. Almost all respondents had heard of the slogan Bachte Holey Jante Hobe; exposure to the TV serial Heeraphul and the radio series Jholmolia was also noted. Out of respondents who were currently enrolled in school at the time of the interview, 43% of males and 41% of females reported to have attended classes related to HIV issues. Gatekeepersâ&#x20AC;&#x2122; Interview Results The study results show that gatekeepers were well aware of the key issues related to HIV/AIDS. About 80% of parents and almost all teachers and religious/community leaders had heard of HIV/AIDS. Almost all gatekeepers had positive attitudes towards providing SRH information


to youth. More than 97% of parents, teachers, and religious/community leaders were supportive of HIV/AIDS education in schools. About 80% were supportive of condom education in schools, which is a significant increase from the baseline survey at which time only 56% were supportive of condom education in schools. A large majority of gatekeepers agreed that condoms must be used to prevent the spread of HIV; however, almost three-fourth of all gatekeepers opposed selling condoms to unmarried adolescents. Health Service Providers’ Interview Results Over 90% of all service providers reported that they provided SRH services to youth. Although half of the providers mentioned providing family planning services to married youth; only a quarter reported providing those services to everyone, irrespective of marital status. Knowledge of condom use as a preventive method for STIs and HIV/AIDS was very high among service providers; however, only 60% of providers agreed that condoms should be sold to youth. Almost all service providers were aware of the global HIV/AIDS epidemic, and the likelihood of the epidemic to spread to young people. Almost all service providers stated their willingness to support and contribute HIV/AIDS prevention activities in the form of counseling youth, regardless of marital status, on HIV/AIDS prevention and condom use. Policy Planners’ Interview Results All policy planners believed that HIV/AIDS is a problem for Bangladesh. Although not all policy planners believed that Bangladeshi youth were particularly vulnerable to the AIDS epidemic, all of them agreed that urban youth were more vulnerable than rural youth. All policy planners participated in the study mentioned that media should continue to play a vital role in providing information on HIV prevention and awareness. They also agreed that condoms can prevent HIV transmission, but most of them were not in favor of providing condom messages directly to a general audience because they believed this to be culturally insensitive.

Community readiness for HIV prevention is low. In general, among the groups interviewed, the community leaders in 70% communities related HIV to “bad people”. No communities thought that anyone in their community could be infected and some (20%) believed that HIV was a global problem, but not in Bangladesh. An additional 10% felt that it was a problem in Bangladesh, but not in their community. Knowledge of prevention and transmission varied, with better knowledge of prevention reported. Drug vendors were the most aware of the four groups of community leaders included while Imams were the least aware. At the same time, few groups had moved beyond these initial stages of readiness. Planning, preparation and initiation had only begun among teachers and Imams and those groups that had begun any of these stages tended at low levels of readiness meaning that they had few concrete ideas or actions. Conclusions and Recommendations The results of the 2008 endline assessment provide a current picture of the situation with regard to HIV knowledge and behaviors among youth in Bangladesh. The findings highlight that while youth continue to be at risk because of their behaviors, knowledge is improving and misconceptions are decreasing. There is also an increase in condom use. Continued efforts can further the improvements that have already been seen and can move youth from a state at which they know the correct information to one at which they can implement it in order to prevent HIV.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

National Assessment of Community Readiness

xiii


Chapter 1 Introduction


Chapter 1: Introduction 1.1

Background

Human Immuno-Deficiency Virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS) result in more than two million deaths globally each year. In addition, it is estimated that 2.7 million new HIV infections occurred in 2007 alone and 32.9 million people were living with HIV [1]. Of particular concern are high rates of HIV infections among young people; 45% of all new infections among adults in 2007 occurred to those under the age of 25. Youth and adolescents are especially vulnerable to HIV and other sexually transmitted infections (STIs) due to lack of knowledge about sexual health and HIV/AIDS, risky sexual behavior, injecting drugs, lack of access to preventive tools such as condoms, low condom use, poor negotiating skills, high prevalence of STIs, low economic status, fewer protective antibodies and a lower immunity of the cervix in young women. Thus, prevention of HIV among youth is a priority strategy.. In Asia, some countries have experienced declining HIV prevalence (Thailand, Cambodia and Myanmar), others have experienced an increase (Indonesia, Pakistan and Viet Nam) [2]. Injecting drug use is the main mode of transmission in some countries, including India, but heterosexual transmission is increasing, particularly from men who become infected through injecting drug use or unprotected sex with other partners and then infect their wives.

Prior to this program, HIV risk among youth in Bangladesh was documented, although not nationally. The proportion of youth becoming sexually active at the age of 18 ranges from 6% among unmarried females in rural areas to 88% of unmarried males in urban areas [3]. Documented risk behaviors include sex with sex workers, drug use and working as a sex worker [4]. Studies from the 1990s showed that knowledge about sexual and reproductive health among youth was poor [5, 6]. At the same time, studies conducted prior to the GoB program showed that the environment in Bangladesh is unsupportive for HIV prevention efforts. Sharing information regarding sex and sexuality is culturally unacceptable [5-7]. In addition, existing reproductive health services are generally inaccessible to young people and access to condoms is very limited [6]. Finally, social stigmatization and discrimination form barriers for young people to access information and services [6]. These findings were confirmed by the first national HIV/AIDS survey among youth, conducted under the global fund HIV/AIDS project in 2005. Although 85% of youth have heard of HIV, knowledge is limited; only 29% of males and 38% of females have correct knowledge of two or more routes of transmission and 36% of males and females have correct knowledge on two or

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

In Bangladesh, where one-fifth of the 150 million population are youth, the Ministry of Health & Family Welfare (MoHFW) of the Government of Bangladesh (GoB) and Save the Children, USA launched a collaborative program, ‘Prevention of HIV/AIDS among young people of Bangladesh’ in 2003 with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). The aim of this program was to prevent HIV infection in young people aged 15–24 in order to avert a generalized HIV epidemic in the country. The adopted strategies included providing HIV prevention information to young people through mass and print media, life skills education through youth organizations and clubs, making health services more youthfriendly, reviewing and updating the social marketing strategy for accessibility of condoms targeted to young people, integrating HIV prevention education and information into secondary and higher secondary school curriculum, and advocacy and sensitization programs targeting various levels such as policy makers, religious and community leaders and parents.

2


more means of prevention. The survey also documented risk behaviors. 25% percent of males and 2% of females reported premarital sex and seven percent of married male youth reported extramarital sex. 30% of the males who had premarital or extramarital sex had sex with sex workers. Condom use was low with just 35% of unmarried males reporting condom use at last sex. The data highlight the barriers to condom use, particularly stigma associated with it; 80% of unmarried youth reported that buying condoms is not socially acceptable. The baseline survey shows high levels of acceptance of HIV prevention programs by the gatekeepers, with 94% being in favor of introducing HIV/AIDS and sexual health in secondary schools but limited acceptance of condom education (56%). From the outset, baseline and endline surveys were incorporated as part of the program activities to assess changes over time in key indicators of knowledge and access. While the changes observed cannot be attributed solely to the program interventions, there is also potential problem of assessing visible impact of the program because of short time frame and insufficient coverage of different components of the interventions. Yet, given the range of HIV prevention activities that have taken place in Bangladesh during the program period and because of its focus on youth, the results are likely to be indicative of the program’s effect. This report presents the main results from the 2008 Endline HIV/AIDS survey among youth in Bangladesh and compares selected indicators with the findings from the 2005 Baseline survey conducted in a similar population. The endline survey had an additional component – a national assessment of community readiness—that is also presented in this report. This new national assessment provides insight into the readiness of different groups within Bangladesh for HIV prevention among youth.

1.2

Organization of the assessment1

1.2.1 Objectives of the assessment The objectives of the endline assessment were to document young people’s knowledge about HIV/AIDS and their access to information, services and condoms, assess attitudes of parents/guardians, teachers, and community leaders towards HIV/AIDS and STI intervention programs, and measure any changes over the three years period since the baseline survey . The specific objectives were:

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

3

  

 

1

To document baseline and endline knowledge about HIV/AIDS and STIs among youth; To determine the current status of access to sexual and reproductive health (SRH) information and services, and condoms; To estimate the existing pattern of risk behavior and prevalence of Syphilis and Herpes Simplex Virus 2 (HSV2); To assess beliefs and attitudes of parents/guardians, teachers, community and religious leaders, health services providers and policy makers that influence the dissemination of information on HIV/AIDS and STIs to youth; To assess changes in the above indicators three years after the baseline survey, which was conducted in 2005, and To assess community readiness for HIV prevention.

The term assessment is used to refer the endline survey of youth, gatekeepers and service providers and assessment of community readiness to HIV/AIDS.


1.2.2

Implementation

The assessment was conducted by Associates for Community and Population Research (ACPR) and ICDDR,B in collaboration with Population Council (PC) under the collaborative project “Prevention of HIV/AIDS among Young People in Bangladesh” between Ministry of Health and family Welfare and Save the Children, USA; with support from National AIDS and STD Program . The assessment consisted of five parts, a behavioral survey of youth, a serological survey of selected STIs among youth, knowledge and attitudes survey of gatekeepers, interviews with policy makers and a national assessment of community readiness for HIV prevention among youth. The youth behavioral survey and gatekeepers survey were implemented by ACPR; the serological survey, policy maker’s interviews and national assessment of community readiness were implemented by ICDDR,B. The two organizations worked closely throughout the process to ensure coordination of the multiple components. 1.2.3

Sample design

Behavioral survey

The survey was designed to provide separate estimates for urban and rural youth and married and unmarried youth. Bangladesh is divided into six administrative divisions, and each division is divided into rural and urban areas. The six divisional headquarters comprise SMAs that have different characteristics from other urban and rural areas. The survey selected samples from the master sample, the integrated multipurpose sample (IMPS), maintained by the Bureau of Statistics (BBS) for the implementation of surveys. The IMPS consists of 1000 primary sampling units (PSUs). In rural areas, a PSU is a Mauza or a segment of a Mauza, while in urban areas it is a Mahalla. The PSUs in the IMPS were selected with probability proportional to size (PPS) from the 2001 census frame. The PSUs for the endline (the same as in the baseline) survey were subselected from the IMPS PSUs with equal probability. A PSU is in fact a cluster of households. A total of 360 clusters were used in the survey. These were 30 clusters from each of the 6 rural divisions, 25 clusters from each of the urban divisions of Barisal, Chittagong, Khulna, and Rajshahi, 27 clusters from urban Dhaka, 21 clusters from urban Sylhet, and 32 clusters from SMAs. Since the sample was not self-weighting, weights were applied to derive population estimates for urban and rural areas. For the behavioral survey, ACPR conducted a household listing operation in all 360 PSUs from February 21, 2008 to April 05, 2008. Approximately 200 households in each cluster/PSU were listed. Using household listing data, four separate frames for youth aged 15–24 years by sex and marital status were prepared. Then, approximately 10 youth of each type (with some margin for non-response) were selected for interview from each selected cluster. Ultimately, 11,188 youth (2,440 married male, 2,879 unmarried male, 2,964 married female, 2,905 unmarried female) age 15–24 years were interviewed.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

As in the 2005 baseline survey, the ‘2008 Endline HIV/AIDS survey’ used a representative sample of youth aged 15–24 (by sex and marital status) selected using a two-stage cluster sampling method. In both surveys, the representative sample was drawn from 360 clusters randomly selected from urban, rural and statistical metropolitan areas (SMA). To ensure maximum precision and minimum bias in estimating the change between the 2005 and 2008 surveys, all the 2005 sample clusters were retained. The sample size was also kept the same as that in baseline.

4


Serological survey The serological survey was conducted in 142 randomly selected clusters; 57 clusters were from urban areas, 73 from rural areas, and 12 from SMAs. All youth participating in the behavioral survey in the selected clusters were also approached for the serological survey. Ultimately, blood specimens were collected from 605 married males, 701 unmarried males, 613 married females and 672 unmarried females. Gatekeepers’ survey A survey was also conducted among gatekeepers, including parents/guardians of youth, teachers of secondary schools, and religious and community leaders. Also, information was collected from health service providers. The study was designed to randomly select and interview four parents from each selected cluster, taking an equal number of fathers and mothers, as well as one secondary school teacher, one religious or community leader, and two health service providers from government, NGO or from the private sector. Ultimately, 1,435 parents, 354 teachers, 366 religious/community leaders and 719 service providers were interviewed. Interviews with policymakers There are a total of 19 Focal persons of HIV/AIDS in 19 different ministries under the People’s Republic of Bangladesh. Of them five ministries are directly involved in implementation of GFATM activities and four other ministries are likely to be involved with future GFATM activities. Focal persons of these nine ministries were purposively selected for interview, and of them five were interviewed.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Nationwide assessment of community readiness

5

Community readiness was assessed in 100 randomly selected PSUs from the 360 PSUs selected for the youth survey. In each community four participants were selected to take part: a lead or knowledgeable teacher, an imam, a drug vendor, and a business or agricultural association member. These leaders were identified mainly by the general public in busy areas in the community, such as markets, shops, and tea stalls. Individuals were asked which mosques in the area performed Jummah prayer, to find the most influential religious leader, and where the community school or madrasa was located, to find the headmaster. The local vendors, if they were members of business associations, were asked about presidents of such associations, while drug vendors were identified by other store vendors. 1.2.4 Instruments used Six instruments were used for the 2008 endline HIV/AIDS assessment:  Household listing schedule  Questionnaire for interviewing youth  Questionnaire for gatekeepers (parents/teachers/community teachers)  Questionnaire for service providers  Interview guideline for community readiness assessment  Interview guideline for policy planners These survey instruments were similar to those used in the baseline survey. The questionnaires were modified by the researchers of the consortium partners: ICDDR,B, ACPR and Population


Council. They were then reviewed by Save the Children, USA and the NASP. The questionnaires were developed in English and then translated into Bangla. They were pre-tested prior to finalization. Based on pretest results and the suggestions and comments received from interested groups, the questionnaires were finalized. Household listing The household listing schedule was used to conduct the household listing operation in each PSU/cluster in order to facilitate systematic selection of the required number of respondents. The household schedule was used to list all usual members of the households. Some basic information was collected on the characteristics of each person including age, sex, education, and marital status. The main purpose was to identify married-unmarried and male-female youth aged 15–24 years who were eligible for an interview. Youth survey A questionnaire was used to interview youth. Youth were asked questions about the following topics:      

Socio-economic characteristics (age, religion, education, exposure to mass media, occupation, employment, household characteristics, etc.); Knowledge about SRH, and condoms; Marriage and sexual history; Knowledge and attitudes towards HIV/AIDS and other STIs; Barriers in accessing SRH information and services, self-efficacy to overcome these barriers, related social norms and risk behaviors, and Awareness of GFATM components and activities. Gatekeeper survey

The service provider questionnaire was used to interview local level health service providers responsible for providing SRH-related services at government, NGO and private health facilities, including upazilla health complexes, union health centers, municipality hospitals, NGO clinics and private practices. The questionnaire had three sections: socio-economic characteristics, quality of SRH services provided to youth, and knowledge and attitudes towards the HIV/AIDS epidemic in Bangladesh. Interview with policy planners The in-depth interview guideline for policy planners focused on HIV/AIDS prevention activities namely knowledge and attitudes towards HIV/AIDS, awareness about HIV prevention programs and suggested ways to design programs targeting youth in Bangladesh. Nationwide assessment of community readiness A targeted interview guideline was used with selected community leaders to elicit the knowledge and experience of the group they represented with regard to HIV prevention (i.e., imams were asked to talk about the knowledge and experience of imams in their community rather than their

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

The gate keeper questionnaire was used to interview parents, teachers, and religious and other community leaders about their socio-economic information, knowledge and attitudes towards HIV/AIDS and other STIs, and attitudes towards SRH information and education for youth and adolescents.

6


own knowledge and experience). Readiness was independently assessed for each of the six stages of community readiness. Their responses were scored on a 5-point scale, where 0 was given to a statement indicating a lack of willingness or activity, and 4 indicating a high level of achievement of that stage. 1.2.5

Laboratory methods for serological survey sample

Tests were done for antibodies to syphilis and HSV2. Syphilis was tested by Rapid Plasma Reagin (RPR) test (Nostion II, Biomerieux BV, Boxtel, The Netherlands) and Treponema Pallidum Particle Agglutination (TPPA) test (Serodia TPPA, Fujirebio Inc., Japan). All samples were initially tested for RPR. TPPA test was carried out only when RPR was positive. Samples positive for both TPPA and RPR were considered to reflect positive syphilis infection. For antibodies to HSV2, sera were initially tested using an Enzyme Linked Immunosorbent Assay (ELISA) kit2 specific for HSV2 IgG (Euroimmun AG, Germany) and all positive samples were re-tested with a second ELISA kit (Euroimmun AG, Germany) specific for IgM. Samples positive for both IgG and IgM were considered to reflect current HSV2 infection. 1.2.6

Data collection, processing and analysis

The behavioral component of the survey was conducted by ACPR whereas the serological and the community readiness components were done by ICDDR,B. The details of training, data collection, data processing and data analysis are attached as Appendix 3. 1.2.9

Response rates

Behavioral survey

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 1.1 shows response rates for the behavioral survey. A total of 17,077 unmarried/ married male and female youth aged 15â&#x20AC;&#x201C;24 years were randomly selected from 360 clusters for the sample. Of this sample, 11,188 married/unmarried male and female youth were successfully interviewed. The main reasons for the shortfall were non-availability of youth at home at the time they were visited by the interviewing teams (because of work, studies, etc.), misclassification of age (eligibility criteria) during listing, incapacity or sickness. The overall response rate for youth was 66%. The response rates for unmarried male, married male, unmarried female, and married female youth were 67%, 58%, 71%, and 67%, respectively.

7

2

Test kits used for testing HSV2 in baseline survey was Dia Sorin, Italy. During the endline survey, Euroimmun AG, Germany was used since Dia Sorin, Italy was out of production and was not available in the market. Therefore, the test results for HSV2 between baseline and endline surveys is not strictly comparable. However, similar test kits were used for testing Syphilis between baseline and endline surveys.


8

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Number of youth sampled who participated and participation rate Type of youth respondents Urban Rural Sampled Participated Participation Sampled Participated rate Unmarried male 525 353 67.2 542 348 Married male 455 312 68.6 472 293 Unmarried female 534 343 64.2 554 329 Married female 520 307 59.0 572 306 Overall 2,034 1,315 64.7 2,140 1,276

Table 1.2: Participation rate in serological survey

Participation rate 64.2 62.1 59.4 53.5 59.6

1067 927 1088 1092 4,174

All Sampled

701 605 672 613 2,591

Participated

Participation rate 65.7 65.3 61.8 56.1 62.1

Number of youth, gatekeepers, and service providers sampled and interviewed and response rates according to residence Type of respondent Urban Rural All Sampled Interviewed Response Sampled Interviewed Response Sampled Interviewed Response rate rate rate Youth Unmarried male 2,137 1,450 67.9 2,161 1,429 66.1 4,298 2,879 67.0 Married male 2,094 1,216 58.1 2,106 1,224 58.1 4,200 2,440 58.1 Unmarried female 2,047 1,456 71.1 2,073 1,449 69.9 4,120 2,905 70.5 Married female 2,235 1,467 65.6 2,224 1,497 67.3 4,459 2,964 66.5 All 8,513 5,589 65.7 8,564 5,599 65.4 17,077 11,188 65.5 Gatekeepers Parents 717 712 99.3 725 723 99.7 1,442 1,435 99.5 Teachers 173 172 99.4 182 182 100.0 355 354 99.7 Religious/community leaders 185 184 99.5 182 182 100.0 367 366 99.7 All 1,075 1,068 99.3 1,089 1,087 99.8 2,164 2,155 99.6 Service providers 369 368 99.7 354 351 99.2 723 719 99.4

Table 1.1: Response rate in behavioral survey


Figure 1.1: Youth response rate in behavioral survey by type of sample, 2005 and 2008

*** p <=0.001

Comparison of youth response rates between baseline3 and endline surveys shows that overall response rate in the endline survey was lower than in the baseline survey (71% versus 65.5%, respectively). Response rates for all categories of samples in the endline survey were lower than in the baseline survey. The response rates for gatekeepers and service providers were almost 100%. Out of 1,442 selected parents 1,435 were successfully interviewed; 354 of 355 teachers and 366 of 367 religious and other community leaders were successfully interviewed as well. A total of 723 service provider interviews were attempted of which 719 were successfully completed The response rates for different types of gatekeepers and service providers were similar between the baseline and endline surveys.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Serological survey

9

As shown in Table 1.2, a total of 4,174 respondents who were interviewed in the behavioral survey were approached for serological survey, out of whom 2,591 agreed to provide a blood sample, resulting in a 62% overall participation rate. Participation rates for all four samples in the endline serology survey were much higher than the participation rates in the Baseline survey. Policy planner interviews Of the nine ministries who were directly involved in implementation of GFATM activities, five were interviewed. Representatives of the four other ministries were not available because of the national election and changes in the government at the time of the study.

3

Baseline response rate was calculated excluding special male sample


Figure 1.2: Youth participation rate in serological survey by sample type, 2005 and 2008

*** p <=0.001

Community readiness assessment The study aimed to interview four types of participant in each of 100 PSUs. Although an imam was interviewed in every community visited, there were 93 successful interviews with headmasters/teachers, 94 with drug vendors, and 95 with business leaders. The chief reason why headmasters were not interviewed was the lack of a high schools or Alia madrasas within the community. Drug vendors were not interviewed because either the lead drug vendor could not be found or there were no pharmacies in the community. Lastly, business leaders were not interviewed mainly because there were no agricultural or business associations in those PSUs.

Organization of the report

This report has nine chapters. The next three chapters present findings from behavioral and serological surveys of youth. While Chapter 2 presents basic profiles of youth taking part in the assessment, Chapter 3 presents SRH knowledge and behavior of youth. Chapter 4 presents information on young peopleâ&#x20AC;&#x2122;s exposure to GFATM activities. Chapters 5 and 6 present findings from the gatekeepersâ&#x20AC;&#x2122; and health service providersâ&#x20AC;&#x2122; surveys. Findings from interviews with policy planners are presented in Chapter 7. Chapter 8 contains findings from the community readiness assessment. Chapter 9, the final chapter, highlights the major findings of this assessment, discusses them and draws conclusion based on the findings.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

1.3

10


Chapter 2 Characteristics of Youth Participants


Chapter 2: Characteristics of Youth Participants This chapter begins by presenting information on the background characteristics of youth included in the behavioral survey. It presents information on the distribution of respondents by key demographic characteristics such as age, educational attainment, occupation, employment status and monthly income. It also provides information on media exposure of respondents. At the end of this chapter, the background characteristics of the serological sample are presented.

2.1

General characteristics of respondents in the behavioral survey 2.1.1

Age

Tables 2.1a and 2.1b show the distribution of youth respondents by selected background characteristics. As shown in the tables, age distribution varied by gender and marital status. Overall, married respondents were older compared to unmarried respondents. For instance, about 60% of unmarried males were 15-19 years old, but only 6% of married males were in this age group. Similarly, 87% of unmarried females were 15-19 years old, compared to 35% among the married females. The mean age for unmarried males was 18.8 year, while that for married males was 22.5 years. The mean ages of unmarried and married females were 17.0 and 20.5 years, respectively. There was no significant difference in the age distribution of respondents by residence, except for unmarried females, where the proportion of those who were aged 20-24 years was significantly higher in urban areas (18%) compared to rural areas (10%). The age distribution of youth was similar to that found in the 2005 baseline survey. Also the mean ages of unmarried and married males and females were found to be similar to the baseline estimates. Education

Tables 2.1a and 2.1b show educational attainment of the respondents. The majority of respondents had secondary education, either complete or incomplete. A significant proportion of respondents had no education. Overall educational attainment was higher among females than males and higher for unmarried than married youth. For example, only 4% of unmarried and 14% of married females had no formal education, while the same figures for unmarried and married males were 10% and 29%, respectively. Similarly, 77% of unmarried and 52% of married females had secondary or higher education compared to 62 and 32% of unmarried and married males, respectively. Educational attainment among urban youth was higher compared to rural youth especially for females. Some improvement was noted in the educational attainment among youth in 2008 compared to the 2005 baseline time. The proportion of those with no formal education had dropped, particularly among rural unmarried females. 2.1.3

Religion

As expected, the majority of the respondents were Muslims with only 10% from other religions such as Hinduism or Christianity. 2.1.4

Division

Over half of the respondents were from Dhaka and Rajshahi divisions. Overall there was no difference in the relative share of respondents by division between unmarried and married respondents, however, about half of the urban respondents were drawn from Dhaka division and this pattern was consistent for both males and females. Distribution of respondents by division was similar in the 2005 baseline survey.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

2.1.2

12


Table 2.1a: Characteristics of males Percentage of male youth by age, education, religion, and residence Characteristics Urban Rural Unmarried Married Unmarried Married Age 15-19 59.3 6.1 60.6 5.6 20-24 40.7 93.9 39.4 94.4 Mean 18.9 22.5 18.8 22.5 Education No education 9.3 24.4 10.9 30.5 Primary incomplete 13.6 19.8 13.8 22.6 Primary complete 13.0 20.1 14.5 16.7 Secondary incomplete 55.2 33.4 54.5 28.6 Secondary and above 9.0 2.3 6.3 1.7 Religion Islam 90.3 95.3 87.8 90.1 Hinduism 8.8 4.1 12.0 9.3 Others 0.9 0.6 0.2 0.6 Division Barishal 2.4 2.0 9.3 11.8 Chittagong 16.0 12.8 10.2 7.8 Dhaka 52.3 50.7 26.2 19.9 Khulna 10.5 12.2 15.0 16.5 Rajshahi 16.0 20.0 28.6 35.4 Sylhet 2.8 2.3 10.8 8.6 N 1,350 345 2,906 718

Total Unmarried Married 60.2 39.8 18.8

5.7 94.3 22.5

10.4 13.7 14.0 54.8 7.1

28.5 21.6 17.8 30.1 2.0

88.6 11.0 0.4

91.8 7.6 0.6

7.1 12.0 34.5 13.6 24.6 8.3 4,256

8.6 9.4 29.9 15.1 30.4 6.6 1,063

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 2.1b: Characteristics of females

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Percentage of female youth by age, education, religion, and residence Characteristics Urban Rural Unmarried Married Unmarried Married Age 15-19 81.6 34.0 89.8 36.0 20-24 18.4 66.0 10.2 64.0 Mean 17.4 20.6 16.8 20.4 Education No education 4.3 12.1 3.8 15.2 Primary incomplete 7.7 18.0 9.0 18.0 Primary complete 8.8 16.5 11.0 15.0 Secondary incomplete 69.2 50.1 70.7 49.9 Secondary and above 10.0 3.2 5.6 1.9 Religion Islam 89.0 93.6 86.7 89.9 Hinduism 9.8 5.4 13.1 9.8 Others 1.1 0.9 0.3 0.2 Division Barishal 2.4 2.2 11.0 9.6 Chittagong 18.6 16.1 13.6 7.2 Dhaka 52.6 51.5 23.5 24.9 Khulna 9.6 11.6 13.6 16.5 Rajshahi 13.5 16.7 26.6 34.4 Sylhet 3.3 1.9 11.7 7.5 N 784 1,179 1,386 2,521

Total Unmarried Married 86.8 13.2 17.0

35.4 64.6 20.5

4.0 8.5 10.2 70.2 7.1

14.3 18.0 15.5 50.0 2.3

87.5 11.9 0.6

91.1 8.4 0.5

7.9 15.5 34.0 12.1 21.9 8.7 2,170

7.2 10.0 33.3 14.9 28.8 5.7 3,699


2.1.5

Occupation

Tables 2.1c and 2.1d show occupation, employment status and monthly income of the respondents. There was a major difference in type of occupation between married and unmarried respondents. The primary occupation of married males was business 4, followed by skilled work5, agriculture, and services6, while unmarried males were mostly students followed by farmers and skilled workers. On the other hand, most of the married females were housewives, whereas a significant proportion of unmarried females was students. Urban youth were more skilled than rural youth. Similar findings were also reported in the 2005 baseline report. 2.1.6

Employment and income

Among the respondents who were involved in some form of employment, about 85% of males and 62% of females were working fulltime. For males, there was not much difference in the proportion of youth who worked fulltime by their marital status or urban-rural residence; but for females, a significantly higher proportion of urban females worked fulltime compared to rural females, and married females more often worked fulltime compared to unmarried females.

Percentage of male youth by occupation, employment and monthly income, according to residence and marital status Characteristics Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Primary occupation Student 33.7 0.9 34.3 1.0 34.1 0.8 Business 14.4 20.1 9.9 12.5 11.4 15.0 Agriculture 6.3 8.7 18.7 32.4 14.7 24.9 Skilled workers 21.9 34.1 13.1 17.5 15.9 22.9 Service 8.3 12.0 3.9 3.8 5.3 6.4 Unemployed 6.0 1.5 6.4 1.8 6.2 1.7 Others7 9.3 22.7 13.8 31.0 12.4 28.3 N 1,350 345 2,906 718 4,256 1,063 8 Employment Full time 91.0 92.6 82.5 81.2 85.2 84.8 Part time 4.9 4.8 5.4 7.4 5.2 6.6 Occasionally 4.1 2.7 12.1 11.3 9.5 8.6 N 814 336 1725 698 2539 1035 Monthly income9 No income 31.7 3.1 36.2 7.2 34.8 5.8 â&#x2030;¤ 1,000 7.8 1.3 10.4 4.0 9.6 3.1 1,001-2,500 19.1 11.9 19.7 24.7 19.5 20.5 2,501-5,000 32.3 62.1 27.7 52.5 29.1 55.6 5,000+ 9.0 21.6 6.0 11.6 7.0 14.8 Mean 2563 4308 2038 3444 2204 3725 Median 2000 4000 1500 3000 1500 3000 N 1,350 345 2,906 7,18 4,256 1,063

Includes small trading, home-based manufacturing and cattle/poultry raising. Includes garment and construction workers, bus/truck/launch/taxi driver, transport/restaurant/garage workers, and small shopkeepers . 6 Includes work in an office and professions like teacher, doctor, lawyer, and engineer. 7 Includes apprentice, private tuition 8 Information was collected from all except students, housewives, and unemployed. 9 Information was collected from all including students, housewives and unemployed. 4 5

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 2.1c: Characteristics of males

14


Wealth index Lowest Second Middle Fourth Highest N

14.8 16.6 21.2 22.9 24.5 1,350

26.7 22.6 24.1 17.1 9.6 345

14.0 19.2 20.9 21.7 24.2 2,906

28.6 23.5 19.4 14.3 14.2 718

14.3 18.3 21.0 22.1 24.3 4,256

27.9 23.2 20.9 15.2 12.7 1,063

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 2.1d: Characteristics of females

15

Percentage of female youth by occupation, employment, and income, according to residence and marital status Characteristics Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Primary occupation Student 56.1 2.6 55.7 2.6 55.8 2.6 Housewife/home based 8.0 85.5 7.7 92.1 7.8 90.1 Business10 1.7 1.4 1.5 1.0 1.6 1.1 Agriculture 0.1 0.0 0.0 Skilled workers11 8.4 6.2 2.2 1.1 4.5 2.7 Service12 2.0 1.4 1.6 0.6 1.7 0.9 Unemployed 20.8 1.0 29.2 1.5 26.1 1.4 Others13 2.9 1.8 2.2 1.0 2.5 1.2 N 784 1,179 1,386 2,521 2,170 3,699 Employment14 Full time 68.9 76.6 50.0 48.4 60.4 64.7 Part time 20.2 17.2 33.7 31.2 26.6 23.1 Occasionally 10.9 6.3 16.3 20.4 13.1 12.2 N 119 128 104 93 222 221 Monthly income15 No income 71.9 83.2 83.6 89.2 79.4 87.3 â&#x2030;¤ 1,000 17.1 8.5 13.3 8.0 14.7 8.2 1,001-2,500 6.7 4.6 2.3 2.0 3.9 2.8 2,501-5,000 3.1 3.3 0.6 0.7 1.5 1.6 5,000+ 1.3 0.3 0.1 0.1 0.2 0.2 Mean 395 273 125 98 223 154 Median 0 0 0 0 0 0 N 784 1,179 1,386 2,521 2,170 3,699 Wealth Index Lowest 11.1 20.1 14.0 23.1 13.0 22.1 Second 17.6 22.7 18.0 24.3 17.9 23.8 Middle 20.2 20.1 20.6 19.2 20.4 19.5 Fourth 22.6 19.4 24.0 17.5 23.5 18.1 Highest 28.6 17.6 23.4 15.8 25.3 16.4 N 784 1,179 1,386 2,521 2,170 3,699

While 79% of unmarried and 87% of married females did not have any monthly income, the same figure was six percent for married and 35% for unmarried males. The mean monthly income was significantly higher for males than females. Married males earned almost twice as much as unmarried males. On the other hand, unmarried females earned more than married females. In general, urban youth earned more than rural youth. Includes small trading, home-based manufacturing and cattle/poultry raising. Includes garment and construction workers, bus/truck/launch/taxi driver, transport/restaurant/garage workers, and small shopkeepers. 12 Includes work in an office and professions like teacher, doctor, lawyer, and engineer. 13 Includes apprentice, private tuition 14 Information was collected from all except students, housewives, and unemployed. 15 Information was collected from all including students, housewives and unemployed. 10 11


2.1.7

Wealth index 16

Overall, more married respondents belonged to households in the lowest and second lowest economic status quintiles compared to unmarried respondents. The pattern was similar for males and females and urban and rural residents.

2.2

Exposure to media

In the survey exposure to media was assessed by asking respondents how frequently they read a newspaper, watched television, or listened to the radio. Tables 2.1e and 2.1f show the extent male and female respondents were exposed to different types of mass media, by background characteristics. Exposure to any media was significantly higher amongst males (96%) than females (82%). For both males and females, exposure to television was higher than exposure to radio or newspapers. 84% of males and 60% of females watched TV every week; this was higher among urban youth (for both males and females) than among their rural counterparts. Watching TV was also associated with division of residence, and it was positively associated with educational status of youth. Table 2.1e: Exposure to media: males

Primary complete Secondary incomplete Secondary and above All

16

2.9 1.1 0.0 3.4

23.8 50.2 83.5 34.7

83.8 90.1 92.6 83.9

37.1 38.2 38.4 37.7

23.5 39.5 49.0 27.9

N

2,623 2,696 1,695 3,624 395 612 1,785 737 1,370 421 4,256 1,063 746 814 783 2,651 325 5,319

Wealth index was created using asset scores. Each asset was assigned a weight generated through principal component analysis and the resulting asset scores were standardized in relation to a normal distribution with a mean score of zero and standard deviation one. Each household was then assigned a score for each asset and the scores were summed for each household; individuals were ranked to the total score of the household in which they resided.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Percentage of male youth of exposure to media by background characteristics Type of Mass media No Read Watch Listen to Weekly Background characteristics exposure newspaper TV radio exposure to all to media weekly weekly weekly three media Age 15-19 3.5 37.0 84.2 39.2 29.9 20-24 3.2 32.5 83.5 36.1 26.0 Residence Urban 2.1 42.7 92.5 31.8 27.0 Rural 4.0 30.9 79.8 40.4 28.3 Division: Barishal 5.6 27.0 69.5 36.9 28.9 Chittagong 1.3 36.3 88.2 37.7 30.0 Dhaka 3.4 37.0 87.6 38.7 27.2 Khulna 1.0 37.1 89.8 39.9 31.2 Rajshahi 3.9 34.6 80.6 39.4 27.9 Sylhet 6.4 25.7 75.8 24.2 21.2 Marital status Unmarried 3.0 38.4 85.4 37.9 30.6 Ever married 4.8 19.8 77.8 36.8 17.0 Education No education 10.1 0.8 69.1 33.9 0.8 Primary incomplete 6.5 6.1 73.6 39.7 10.7

16


Table 2.1f: Exposure to media: females Percentage of female youth of exposure to media by background characteristics Background characteristics Age 15-19 20-24 Residence Urban Rural Division Barishal Chittagong Dhaka Khulna Rajshahi Sylhet Marital status Unmarried Married Education No education Primary incomplete Primary complete Secondary incomplete Secondary and above All

No exposure to media

Type of Mass media Read Watch Listen to newspaper TV radio weekly weekly weekly

Weekly exposure to all three media

N

15.5 20.5

8.3 5.6

62.6 56.9

21.7 17.1

11.9 6.4

3,192 2,677

7.1 23.2

11.1 5.0

80.5 49.7

15.3 21.8

10.0 9.1

1,963 3,906

25.7 15.2 15.1 17.1 16.4 33.8

6.0 11.6 7.4 8.8 4.5 4.7

43.9 67.1 66.3 61.6 56.5 44.5

24.4 16.3 18.1 21.5 23.1 11.0

9.5 11.6 9.4 8.9 8.6 9.1

439 707 1,970 814 1,540 398

10.1 22.4

14.2 2.9

71.6 53.2

25.1 16.4

17.8 4.4

2,170 3,699

40.3 32.0 22.2 10.2 2.8 17.8

0.2 0.4 0.8 9.3 37.8 7.1

34.7 44.6 53.3 68.5 82.1 60.0

12.5 13.2 18.2 22.3 27.7 19.6

0.2 1.0 2.1 13.2 33.2 9.4

614 851 793 3,371 240 5,869

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Weekly listening to radio was considerably lower than weekly television watching among male and female youth, both in urban and rural areas. About 32% of urban and 40% of rural males, and 15% of urban and 22% of rural females listened to radio weekly. Overall, the proportion of youth who read the newspaper weekly was low. Only 35% of males and seven percent of females read the newspaper weekly.

17

Only 28% of male youth and 9% of female youth were exposed to all three media on a weekly basis. Both male and female youth with higher levels of education were more likely to be exposed to all three media. Similarly, unmarried youth were more likely to be exposed to all three media compared to married youth. There was no significant difference in exposure to all three media by urban or rural residence or division of residence. 2.3

General characteristics of serological sample

The serological samples were drawn equally from two age groups 15-19 and 20-24, males and females, married and unmarried, and urban and rural residents. About 14% of sampled respondents had no education, 30% had primary or less than primary education, and the rest had more than primary education. Slightly higher proportions of the sample were drawn from residents of Dhaka and Rajshahi divisions compared to those drawn from respondents living in other divisions.


Chapter 3 Sexual and Reproductive Health Knowledge and Behaviors of Youth


Chapter 3: Sexual and Reproductive Health Knowledge and Behaviors of Youth This chapter presents information on young people’s knowledge and behaviors relating to sexual and reproductive health matters. In particular, it provides information on knowledge about safe sex and condoms. It presents information on awareness and knowledge about HIV and other STIs, prevalence of selected STIs, reported symptoms of STIs and health seeking behavior related to STIs. In addition, it gives information on sexual behavior, especially those behaviors which are considered risky for contracting HIV and other STIs.

3.1

Knowledge about safe sex and condoms 3.1.1

Safe sex

Condom use is the single most important component of HIV prevention programs. In the survey, youth respondents were asked about their understanding about ‘safe sex’. The majority of them was aware about safe sex and could define what they meant by it. As shown in Tables 3.1a and 3.1.b, there was a sharp difference between the responses given by males and females. While the majority of male respondents mentioned using condoms during sex as safe sex, most of the female respondents said that sex with husband or wife was safe sex. Among males, the proportion that identified use of condoms during sex as safe sex was higher among urban males compared to rural males and higher among unmarried compared to married males. The opposite was seen for females. The proportion of females who identified using condoms during sex as safe sex was higher among married females compared to unmarried females. Table 3.1a: Knowledge about safe sex: males Percentage of male youth by knowledge about safe sex, according to residence and marital status Urban Unmarried

Rural

Total

Married

Unmarried

Married

Unmarried

Married

78.6 21.4

88.4 11.6

71.2 28.8

80.8 19.2

73.5 26.5

83.2 16.8

What is safe sex? Use of condom during sex

69.0

73.3

53.6

56.4

58.5

61.8

Sex with husband/wife Sex after marriage Sex with a faithful partner Don’t know Not aware of safe sex

23.9 7.0 3.5 0.2 21.4

47.4 4.9 2.0 0.3 11.6

30.2 7.0 3.4 0.7 28.8

38.9 5.0 2.4 0.4 19.2

28.2 7.0 3.4 0.5 26.5

41.6 5.1 2.3 0.4 16.8

1,350

344

2906

718

4,256

1,063

Aware of safe sex

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Yes No

19

N

Figures 3.1a and 3.1b present the comparative picture of correct knowledge17 about ‘safe sex’ between baseline and endline surveys among males and females, respectively. As shown in these figures, correct knowledge about safe sex for both males and females increased significantly over time. However, the increase was more marked among males compared to females.


Table 3.1b: Knowledge about safe sex: females Percentage of female youth by knowledge about safe sex, according to residence and marital status Urban

Rural

Total

Unmarried

Married

Unmarried

Married

Unmarried

Married

Aware of safe sex Yes No

71.3 28.7

86.9 13.1

66.2 33.8

83.0 17.0

68.0 32.0

84.2 15.8

What is safe sex? Use of condom during sex Sex with husband/wife Sex after marriage Sex with a faithful partner

26.3 45.8 24.6 2.0

40.5 62.3 21.1 0.8

19.4 44.9 24.2 2.9

26.4 63.1 24.6 1.4

21.9 45.3 24.4 2.6

30.9 62.8 23.5 1.2

1.3 28.7

0.4 13.1

2.1 33.8

1.4 17.0

1.8 32.0

1.1 15.8

783

1,179

1,386

2,520

2,170

3,699

Don’t know Not aware of safe sex N

***p =<0.001

Knowledge about safe sex by selected background characteristics is presented in Tables 3.2a and 3.2b. Correct knowledge of safe sex was positively associated with educational attainment. There were variations in the knowledge of safe sex by division. Male youth and adolescents of Dhaka and Khulna divisions were more knowledgeable than those of other divisions. However, there was no such pattern for females. For males knowledge of safe sex was lowest in Chittagong division; for females, knowledge was lowest in Sylhet division. It is seen that urban youth, both male and female, were more knowledgeable about safe sex than their rural counterparts. Married youth, both male and female, were more knowledgeable about safe sex than unmarried youth. 17

Correct knowledge is defined as use of condom during sex

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 3.1a: Percentage of male youth who mentioned use of condom as ‘safe sex’, baseline and endline surveys

20


Figure 3.1b: Percentage of female youth who mentioned use of condom as â&#x20AC;&#x2DC;safe sexâ&#x20AC;&#x2122;, baseline and endline surveys

* p <=0.05; ** p <=0.01; *** p <=0.001

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.2a: Correct knowledge of safe sex by background characteristics: males

21

Percentage of male youth who had correct knowledge about safe sex by selected background characteristics Background Urban Rural Total characteristics Unmarried Married Unmarried Married Unmarried Married N Age 15-19 64.3 55.0 48.7 65.0 53.6 62.3 2,623 20-24 75.8 74.1 61.2 55.9 65.9 61.8 2,696 Education No education 50.0 59.5 24.8 43.8 31.8 48.2 746 Primary incomplete 50.0 64.7 33.8 54.3 38.8 57.1 814 Primary complete 62.6 82.6 44.9 61.3 50.1 69.3 783 Secondary incomplete 73.7 80.9 62.7 67.3 66.2 72.2 2,651 Secondary and above 97.5 87.5 88.6 76.9 92.1 81.0 325 Division Barishal 66.7 66.7 53.1 56.5 54.8 57.1 395 Chittagong 40.7 52.3 35.9 42.9 38.1 47.0 612 Dhaka 77.9 80.0 57.3 64.3 67.2 73.0 1,785 Khulna 70.2 76.2 65.7 74.8 66.8 75.0 737 Rajshahi 70.4 69.6 55.7 48.2 58.7 52.9 1,370 Sylhet 50.0 50.0 39.3 47.5 40.6 48.6 421 Wealth index Lowest 43.5 56.5 24.8 43.4 30.9 47.5 905 Second 54.3 71.8 44.6 50.9 47.3 57.1 1,027 Middle 75.5 78.3 51.3 59.0 59.0 66.1 1,115 Fourth 78.6 84.7 62.3 68.9 67.7 74.7 1,103 Highest 79.5 87.9 71.7 76.5 74.2 79.3 1,169 All 69.0 73.0 53.6 56.4 58.5 61.8 5,319


Table 3.2b: Correct knowledge of safe sex by background characteristics: females Percentage of female youth who had correct knowledge about safe sex by selected background characteristics Background characteristics Urban Rural Total Unmarried Married Unmarried Married Unmarried Married N Age 15-19 23.6 37.4 18.0 23.2 20.0 27.5 3,192 20-24 38.2 42.2 31.7 28.2 35.0 32.7 2,677 Education No education 8.8 28.5 11.5 10.9 10.5 15.6 614 Primary incomplete 6.7 30.0 7.2 13.7 7.0 18.9 851 Primary complete 7.2 34.9 7.2 21.2 7.7 25.7 793 Secondary incomplete 27.1 47.2 21.1 36.2 23.3 39.7 3,371 Secondary and above 60.3 71.1 46.8 56.3 53.5 62.4 240 Division Barishal 31.6 38.5 18.3 25.2 19.8 26.5 439 Chittagong 30.1 44.7 20.6 35.4 24.8 40.3 707 Dhaka 24.8 40.3 21.2 26.3 23.2 33.2 1,970 Khulna 33.3 35.8 18.6 23.4 22.5 26.4 814 Rajshahi 22.6 42.9 21.4 29.6 21.7 32.0 1,540 Sylhet 19.2 18.2 12.3 11.2 13.3 12.4 398 Wealth index Lowest 10.5 24.9 10.8 13.9 11.0 17.1 1,100 Second 15.1 28.4 11.6 22.0 12.9 24.0 1,269 Middle 32.3 44.7 18.5 24.1 23.4 30.9 1,166 Fourth 25.0 48.9 24.4 37.2 24.7 41.1 1,180 Highest 36.2 59.9 26.2 42.1 30.3 48.2 1,154 All 26.3 40.5 19.4 26.4 22.0 30.9 5,869

Knowledge of condoms

As shown in Tables 3.3a and 3.3b, about 96% of males and 90% of females had heard about condoms. For males, there was no significant difference between the proportions who heard about condoms by background characteristics. However, for females, the proportion of respondents who heard about condoms was higher among those who were older, married and those who had secondary or higher education. When asked about a formal source of condoms18, almost all respondents who heard about condoms could mention at least one source. The most commonly cited formal sources of condoms were shops and pharmacies. For males, less than 20% of respondents mentioned hospitals, clinics, family planning centers and health care providers as formal sources for getting condoms.

18

A formal source includes shop, pharmacy, hospital/clinic/FP center or health service provider

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

3.1.2

22


Table 3.3a: Knowledge about condoms: males Percentage of male youth having knowledge about formal source of condoms by background characteristics N19 Heard Know a formal source of condom Know at least Background about one formal Shop Pharmacy Hospital/ Health characteristics condoms source of clinic/ FP service condoms center provider Age 15-19 93.3 80.8 78.0 14.5 8.8 98.6 2,448 20-24 98.3 82.6 83.5 13.8 11.1 99.3 2,649 Residence Urban 96.9 78.1 85.8 13.1 8.3 99.5 1,643 Rural 95.3 83.5 78.5 14.6 10.8 98.7 3,453 Division Barishal 95.4 85.2 72.0 17.5 16.0 99.2 376 Chittagong 93.3 63.1 84.5 13.1 7.9 98.8 571 Dhaka 96.6 80.7 85.9 12.5 7.4 99.2 1,724 Khulna 96.7 91.1 78.7 15.8 15.6 99.7 713 Rajshahi 95.9 84.5 77.3 17.4 11.5 98.6 1,313 Sylhet 94.5 84.2 78.0 5.9 3.8 98.2 398 Marital status Unmarried 95.1 81.5 80.9 14.8 9.5 98.9 4,046 Ever Married 98.8 82.7 80.7 11.7 11.9 99.0 1,050 Education No education 89.3 83.6 71.3 6.6 5.2 99.1 666 Primary incomplete 93.7 82.4 71.7 10.5 7.2 97.8 763 Primary complete 96.8 83.3 80.8 11.2 6.0 98.4 759 Secondary incomplete 97.5 81.4 84.4 15.9 11.8 99.3 2,585 Secondary and above 100.0 75.8 93.8 10.7 21.3 100.0 325 Wealth index Lowest 89.9 83.6 71.8 8.2 7.1 98.2 814 Second 95.5 85.3 76.5 11.4 7.7 99.1 981 Middle 96.6 82.9 78.3 14.0 8.6 99.1 1,077 Fourth 97.8 81.5 85.2 15.5 11.2 99.0 1,079 Highest 97.9 76.6 89.4 19.6 14.3 99.4 1,145 95.8 81.8 80.9 14.1 10.0 99.0 5,096 All

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.3b: Knowledge about condoms: females

23

Percentage of female youth having knowledge about formal source of condoms by background characteristics Background characterizes Heard Know a formal source of condom Know at least N20 about one formal Shop Pharmacy Hospital/ Health condoms source of clinic/ FP service condoms center provider Age 15-19 83.8 64.3 56.0 25.1 15.2 95.6 2,675 20-24 96.6 69.7 58.6 26.6 21.3 98.6 2,587 Residence Urban 91.8 59.0 67.7 28.7 17.9 97.3 1,802 Rural 88.6 70.8 51.8 24.3 18.4 96.9 3,461 Division Barishal 87.0 62.9 62.1 27.3 12.6 95.0 382 Chittagong 87.3 57.3 65.5 32.4 20.2 96.8 617 Dhaka 88.5 65.7 60.2 23.7 16.5 97.9 1,744 Khulna 93.7 81.7 55.8 29.3 28.6 98.3 763 Rajshahi 92.7 65.5 50.8 24.1 16.2 96.3 1,427 Sylhet 82.5 68.5 51.5 22.5 15.0 96.4 329 19 20

Represents number of respondents who heard about condoms Represents number of respondents who heard about condoms


Marital status Unmarried Married Education No education Primary incomplete Primary complete Secondary incomplete Secondary and above Wealth index Lowest Second Middle Fourth Highest All

78.7 96.1

60.4 70.1

57.5 57.1

25.1 26.2

14.1 20.2

93.8 98.6

1,708 3,555

87.5 83.4 85.5 91.9 99.6

71.7 72.1 67.0 65.8 56.4

46.6 50.1 48.8 60.8 80.1

18.2 20.0 22.2 28.4 37.2

17.0 17.5 16.5 18.4 26.2

97.0 97.2 97.3 96.9 98.7

537 710 679 3,099 238

83.9 88.9 89.3 92.1 93.9 89.7

72.3 68.0 67.7 64.5 63.1 67.0

46.6 46.6 55.5 66.8 69.5 57.2

21.0 22.0 27.3 28.2 30.0 25.8

16.7 18.3 17.4 19.4 19.0 18.2

96.3 96.2 97.0 98.0 97.8 97.1

923 1,128 1,041 1,088 1,084 5,263

When asked about different uses of condoms, prevention of pregnancy or contraception was the most cited response by the majority of respondents (Tables 3.4a and 3.4b). A significant proportion of males (56% of unmarried and 42% of married males) and a smaller proportion of females (27% of unmarried and 18% of married females) mentioned that condoms are used for prevention of HIV. Use of condom as a means to prevent STI was low; about 15% of males mentioned that condoms can prevent STIs and the same figure was 5% only for females. Irrespective of residence or marital status, knowledge of youth about dual use of condoms, that is, contraception and prevention of HIV, was very low. Compared to 96% general awareness about condoms among males, less than 40% of males were aware of the dual use of condoms (34% of married and 39% of unmarried males). This knowledge was even lower among females (16% of married and 18% of unmarried females). In general, the knowledge of dual use of condoms was higher for urban youth compared to rural youth. There was no difference in this knowledge between married and unmarried urban youth; however, for rural youth the knowledge of dual use was higher among unmarried compared to married youth.

Percentage of male youth having knowledge about different uses of condoms by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Contraception/ prevent pregnancy 68.5 83.9 77.4 88.3 74.5 86.8 Prevent HIV 65.6 53.5 51.2 36.5 55.9 42.1 Prevent STI 14.6 17.1 15.7 17.5 15.3 17.4 Contraception and prevent HIV 40.9 41.0 38.4 29.9 39.2 33.6 Others 0.0 0.2 0.0 0.1 Donâ&#x20AC;&#x2122;t know 5.3 1.3 6.7 2.2 6.3 1.9 N 1,299 344 2,747 706 4,046 1,050

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.4a: Knowledge of different uses of condoms: males

24


Table 3.4b: Knowledge of different uses of condoms: females Percentage of female youth having knowledge about different uses of condom by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Contraception/prevent pregnancy 73.1 95.8 73.7 95.7 73.4 95.7 Prevent HIV 31.9 23.1 23.7 14.9 26.8 17.6 Prevent STI 6.2 4.1 4.9 4.6 5.3 4.5 Contraception and prevent HIV 22.2 20.6 15.4 13.6 18.0 15.9 Donâ&#x20AC;&#x2122;t know 16.1 1.3 17.7 2.5 17.1 2.1 N 649 1,153 1,059 2,402 1,708 3,555

Figures 3.2a and 3.2b present a comparative picture of knowledge about dual use of condoms between baseline and endline surveys among males and females respectively. As shown in these figures, knowledge about dual use of condoms for both males and females increased over time. While the proportion of males who mentioned dual use of condoms doubled during the three year time, despite a slight increase, the proportion of females having knowledge about dual use of condoms was at the same level as it was for males in 2005. Figure 3.2a: Percentage of male youth who could mention dual use of condom, baseline and endline surveys

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

* p <=0.05; ** p <=0.01; *** p <=0.001

25

Figure 3.2b: Percentage of female youth who could mention dual use of condom, baseline and endline surveys


3.2

Awareness and knowledge of HIV

One of the principal objectives of the 2008 endline survey was to measure the level of awareness and knowledge of HIV among youth and compare this with data collected in the 2005 baseline survey in order to see whether knowledge improved over time. The baseline and endline surveys asked the same set of questions related to awareness of HIV, sources of HIV/ information, knowledge of routes of HIV transmission, and ways to prevent its spread. This section presents findings related to these topics. 3.2.1

Awareness about HIV

Tables 3.5a and 3.5b show high awareness about HIV among young people. About 94% of males and 87% of females had heard about HIV. Awareness appeared to be higher among males, married youth, and those who lived in urban areas. Awareness was positively associated educational attainment and household economic status. Awareness appeared to be slightly higher in 2008 than in the baseline conducted in 2005; in 2005, 92% of males had heard about HIV compared to 94% in 2008 (p <=0.001). Similarly, in 2005, 83% of females had heard about HIV compared to 87% in 2008 (p <=0.001). Table 3.5a and 3.5b show the proportion of respondents who had heard of HIV by sources of information. Television was by far the most important source of information about HIV, especially among urban youth and males. About 91% of males and 82% of females had heard of HIV from television. Other significant sources of HIV information for both males and females were radio (38% of males and 21% of females), peer group (57% of males and 11% of females), and print media (21% of males and 14% of females). A certain proportion learned about HIV from billboards or signboards (14% of males and 7% of females) or school (15% of males and 19% of females). 3.2.2

Knowledge of routes of HIV transmission

For females, the most commonly cited responses were using non-sterile needles/syringes (35% of married and 57% of unmarried), receiving HIV/AIDS infected blood (29% of married and 48% of unmarried), sex with multiple partners (41% of married and 38% of unmarried) and unprotected sex with a HIV infected person (10% of married and 12% of unmarried). As shown in Table 3.6a, only 14% of unmarried males could mention three or more correct ways of HIV transmission and an additional 25% could mention two ways of HIV transmission giving rise to 39% of unmarried males who could mention two or more ways of HIV transmission. On the other hand, among the married males, only 6% could mention three or more ways and another 18% could mention two ways of transmission and thus only 24% of married males could mention two or more ways of HIV transmission. Urban males knew more than rural males. The mean number of known correct modes of HIV transmission was 0.8 for married males and 1.2 for unmarried males; these figures did not change much compared to the findings of the baseline survey conducted in 2005 (0.7 for married and 1.0 for unmarried males).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Tables 3.6a and 3.6b present knowledge of youth about routes of HIV transmission. The most common route of transmission of HIV as mentioned by male youth was having sex with sex workers (61% of married and 51% unmarried males), followed by not using a condom during sex (40% of married and 39% of unmarried), using non-sterile needles/syringes (29% of married and 46% of unmarried), receiving HIV/AIDS infected blood (23% of married and 36% of unmarried), and unprotected sex with an HIV infected person (14% of married and 15% of unmarried).

26


27

Percentage of male youth who have ever heard of AIDS, and source of information about AIDS by background characteristics Background Ever heard of Source of HIV/AIDS information characteristics HIV/ AIDS % N Radio TV Book/newspaper/ Bill Board/ Health Religious School magazine/leaflet Sign Board worker leader Age 15-19 93.2 2623 38.9 89.5 23.0 13.6 10.3 0.5 25.2 20-24 95.8 2696 38.0 92.1 19.0 14.8 17.2 0.4 5.3 Residence Urban 96.6 1695 30.2 94.1 22.6 14.9 15.1 0.5 16.1 Rural 93.5 3625 42.4 89.3 20.1 13.9 13.2 0.4 14.4 Division Barishal 93.4 395 41.0 84.4 20.0 18.3 16.6 0.4 13.5 Chittagong 94.4 612 24.7 91.4 21.2 10.5 9.3 0.8 13.8 Dhaka 95.5 1785 37.0 90.2 19.3 14.4 14.3 0.2 14.2 Khulna 97.8 737 45.9 94.6 25.8 24.9 10.2 1.1 20.3 Rajshahi 93.4 1370 46.8 91.3 22.1 10.0 15.5 0.2 16.5 Sylhet 88.8 421 21.1 90.6 15.1 8.8 16.9 0.7 6.4 Marital status Unmarried 94.8 4256 38.4 91.2 23.3 15.1 12.5 0.5 18.0 Married 93.2 1062 38.8 89.4 11.0 10.7 19.1 0.4 2.5 Education No education 83.8 746 35.5 83.3 0.7 1.6 8.0 0.1 0.2 Primary incomplete 88.3 814 35.5 87.9 3.3 8.3 8.2 0.4 0.6 Primary complete 94.8 783 37.7 92.0 11.5 12.6 15.2 0.1 0.8 Secondary incomplete 98.6 2651 39.1 92.3 29.1 17.5 14.9 0.6 24.3 Secondary and above 100.0 325 46.7 97.1 54.3 28.9 25.4 1.0 32.4 Wealth index Lowest 86.3 905 34.2 83.1 6.0 6.1 11.2 0.2 3.7 Second 92.1 1027 39.0 88.0 13.1 12.4 11.1 0.4 8.8 Middle 96.5 1115 38.7 90.1 16.9 14.6 13.4 0.4 13.3 Fourth 97.5 1103 43.8 94.9 25.8 16.2 15.4 0.6 18.6 Highest 98.1 1169 35.6 95.4 36.6 19.1 16.7 0.7 25.9 94.5 5319 38.4 90.8 20.9 14.2 13.8 0.5 15.0 All

Table 3.5a: Knowledge of HIV/AIDS and source of AIDS information: males

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Family 13.2 16.8 13.3 15.9 10.9 19.7 11.5 24.9 11.5 21.2 14.2 18.7 20.2 22.4 19.2 11.7 6.6 22.5 17.9 14.1 11.7 11.7 15.0

Community meeting 0.6 0.5 0.7 0.5 0.8 0.2 0.6 1.6 0.0 0.6 0.6 0.4 0.3 0.2 0.6 0.7 0.4 0.7 0.6 0.3 0.9 0.4 0.5

60.3 55.7 58.5 57.0 54.7 57.0

65.2 58.9 57.5 55.4 49.9

57.0 57.2

48.8 38.1 64.0 60.0 54.7 64.9

59.3 55.9

56.0 58.0

Peer group

12.5 11.0 13.5 10.8 10.7 11.7

11.4 11.6 8.5 12.0 16.6

11.5 12.3

12.8 6.3 12.0 17.8 10.0 11.2

10.4 12.3

10.8 12.5

Other source

781 946 1,076 1,075 1,147 5,026

625 719 742 2,615 325

4,035 990

369 578 1,705 721 1,279 374

1,638 3,388

2,444 2,582

N


28

3191 2677 1963 3906 439 707 1970 814 1540 398 2170 3699 613 851 794 3371 240 1100 1269 1166 1180 1154 5869

87.6 86.0

94.5 83.0

83.8 91.5 91.0 91.0 81.8 71.9

91.2 84.3

62.3 70.6 80.1 96.0 100.0

68.5 81.7 90.3 94.8 98.3 86.8

N

17.2 21.5 22.5 22.0 19.0 20.6

15.1 13.0 16.5 22.3 36.8

21.3 20.2

26.2 15.1 22.5 24.9 18.5 12.5

15.7 23.4

19.9 21.5

Radio

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Age 15-19 20-24 Residence Urban Rural Division Barishal Chittagong Dhaka Khulna Rajshahi Sylhet Marital status Unmarried Married Education No education Primary incomplete Primary complete Secondary incomplete Secondary and above Wealth index Lowest Second Middle Fourth Highest All

%

61.9 76.2 82.3 89.3 95.1 82.4

66.9 75.7 75.8 85.8 95.6

84.8 80.9

69.4 84.4 86.1 80.7 82.1 77.4

91.2 77.4

81.9 83.0

TV

3.7 9.9 14.2 17.1 22.5 14.2

1.5 3.8 5.3 17.0 47.2

20.9 10.0

14.5 13.7 15.7 12.8 12.7 16.2

16.2 13.1

16.3 11.8

Book/newspaper / magazine/leaflet

3.4 4.2 5.6 6.9 11.7 6.6

1.3 1.2 3.2 7.8 22.3

9.9 4.6

7.3 8.5 6.3 6.9 5.8 7.0

8.0 5.9

7.0 6.2

Bill Board/ Sign Board

17.2 13.4 13.6 17.3 12.8 14.7

11.7 12.8 14.9 15.3 17.1

11.2 17.0

12.5 23.6 13.3 18.7 10.1 16.6

15.8 14.1

11.2 19.0

Health worker

0.0 0.1 0.1 0.0 0.1 0.1

0.0 0.0 0.2 0.1 0.1

0.1 0.0

0.3 0.0 0.1 0.1 0.0 0.0

0.0 0.1

0.1 0.0

Religious leader

6.6 12.9 17.5 23.0 29.6 18.9

0.4 0.7 2.7 25.9 41.3

37.4 7.1

22.0 23.1 18.0 20.9 16.6 15.1

19.7 18.4

27.1 8.8

School

Percentage of female youth who have ever heard of AIDS, and source of information about AIDS by background characteristics Background Ever heard of Source of HIV/AIDS information characteristics HIV/ AIDS

Table 3.5b: Knowledge of HIV/AIDS and source of AIDS information: females

0.0 0.1 0.1 0.3 0.4 0.2

0.0 0.0 0.1 0.2 0.9

0.4 0.1

0.1 1.2 0.1 0.0 0.0 0.2

0.2 0.2

0.2 0.2

Community meeting

47.2 41.0 35.9 34.1 27.9 36.4

48.2 48.7 45.4 32.3 18.8

23.8 44.5

38.0 37.4 37.3 38.5 34.2 30.9

33.2 38.3

32.4 41.3

Family

11.1 10.4 10.3 11.6 13.0 11.3

9.1 11.6 11.2 11.1 17.2

16.4 8.1

11.3 19.9 8.3 13.2 7.3 23.5

9.9 12.1

13.6 8.6

Peer group

3.4 4.6 4.8 2.5 4.2 3.9

2.3 3.3 2.8 4.2 6.4

4.4 3.6

3.2 2.0 2.5 8.3 4.7 3.0

4.2 3.8

3.6 4.2

Other source

754 1,037 1,053 1,119 1,134 5,096

382 601 636 3,237 240

1,979 3,117

368 647 1,793 741 1,260 286

1,855 3,241

2,795 2,301

N


Table 3.6b presents similar findings for females and shows that females knew significantly more about different ways HIV can be transmitted compared to males. As shown in Table 3.6b, about 23% of unmarried females could mention three or more ways of HIV transmission and an additional 30% could mention two ways of HIV transmission giving rise to 53% of unmarried females who could mention two or more ways of HIV transmission. Among the married females, only 11% could mention three or more ways and another 21% could mention two ways of transmission and thus only 32% of married females could mention two or more ways of HIV transmission. Urban females knew more than rural females. The mean number of known correct routes of HIV transmission was 1.0 for married females and 1.5 for unmarried females. When compared with the baseline findings, there is not much change in the mean number of correct routes of transmission known by married and unmarried females (0.9 and 1.4 respectively) Table 3.6a: Knowledge of routes of HIV transmission: male Percentage of male youth by knowledge of routes of HIV transmission by type of residence Routes of transmission of HIV

Urban

Rural

Total

Unmarried

Married

Unmarried

Married

Unmarried

Married

Unprotected sex with HIV infected person

13.3

13.1

16.2

14.2

15.3

13.8

Receiving HIV infected blood Using non-sterile needles/ syringes Through HIV/AIDS infected mother during pregnancy/ delivery

46.1 55.6

33.1 38.1

31.6 40.8

18.5 24.1

36.2 45.5

23.3 28.6

3.9

0.6

2.5

0.6

3.0

0.6

Sex with HIV infected person Through breast feeding by a HIV infected mother

14.8 3.3

14.5 1.5

15.5 3.1

13.6 1.4

15.3 3.2

13.9 1.4

Not using condoms during sex Sex with sex workers Sex with multiple partners

42.3 57.7 21.2

47.2 57.7 19.4

37.7 48.0 24.8

37.0 56.5 26.1

39.2 51.1 23.7

40.3 61.0 23.9

28.8 24.4 31.0 15.8

40.0 27.5 25.2 7.2

40.0 25.4 21.8 12.9

52.8 27.4 14.8 5.0

36.4 25.0 24.7 13.8

48.6 27.5 18.2 5.7

1.4

1.0

1.1

0.7

1.2

0.8

1,351

345

2,906

718

4,257

1,062

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

No. of correct21 ways known

29

0 1 2 3 or more Mean N

21

First six responses listed in Table 3.6a were considered as correct ways of HIV transmission as these responses were very specific


Figure 3.3a: Percentage of male youth who could correctly identify two or more routes of HIV transmission, baseline and endline surveys

* p <=0.05; ** p <=0.01; *** p <=0.001

Percentage of female youth by knowledge of routes of HIV transmission, by type of residence Routes of transmission of HIV Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Unprotected sex with HIV 11.9 9.7 11.4 9.4 11.6 9.5 infected person Receiving HIV infected blood 57.1 39.9 42.6 23.1 47.8 28.5 Using non-sterile needles/ 67.5 45.7 51.5 30.2 57.3 35.1 syringes Through HIV/AIDS infected 8.7 4.4 6.1 3.5 7.1 3.8 mother during pregnancy/ delivery Sex with HIV infected person 20.3 25.4 19.3 19.0 19.6 21.1 Through breast feeding by a HIV 11.7 3.1 6.4 1.3 8.3 1.8 infected mother Not using condoms during sex 12.4 15.2 8.6 10.4 10.0 11.9 Sex with sex workers 10.1 12.8 9.4 8.8 9.6 10.1 Sex with multiple partners 44.3 46.9 34.1 37.6 37.7 40.6 No. of correct22 ways known 0 20.7 33.3 36.9 51.9 31.0 46.0 1 17.2 22.4 15.2 21.2 15.9 21.6 2 35.5 29.4 27.6 17.1 30.4 21.0 3 or more 26.7 14.8 20.3 9.8 22.7 11.4 Mean 1.8 1.3 1.4 0.9 1.5 1.0 N 784 1,179 1,386 2,520 2,170 3,699

22

The first six responses listed in Table 3.6b were considered as correct knowledge of HIV transmission as these responses are very specific.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.6b: Knowledge of routes of HIV transmission: female

30


Figure 3.3b: Percentage of female youth who could correctly identify two or more routes of HIV transmission, baseline and endline surveys

* p <=0.05; ** p <=0.01; *** p <=0.001

Tables 3.7a and 3.7b present knowledge of routes of HIV transmission by background characteristics. Knowledge of routes of HIV transmission was associated with age; in general, the proportion of youth who knew two or more ways of HIV transmission was higher among 20-24 years old compared to 15-19 years old and the pattern was similar for both males and females. Unmarried youth of both sexes knew more than married youth. Level of education and household economic status measured by wealth index were positively associated with knowledge of two or more correct routes of HIV transmission. Variation in knowledge also existed between urban and rural residents and residents of different geographic divisions. Urban residents were more likely to have correct knowledge of two or more routes of transmission compared to rural counterparts. Overall, the knowledge was higher among youth of Khulna and Dhaka divisions compared to Rajshahi and Sylhet divisions (Tables 3.7a).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.7a: Knowledge of routes of HIV transmission by background characteristics: males

31

Percentage of male youth who knew at least two correct routes of HIV transmission by selected background characteristics Background characteristics Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Age 15-19 45.6 19.0 34.7 25.0 38.1 23.0 20-24 48.6 33.3 34.6 19.5 39.1 24.0 Education No education 22.6 19.0 5.3 8.7 10.2 11.6 Primary incomplete 18.5 17.6 15.5 15.4 16.5 16.5 Primary complete 25.7 34.8 15.7 18.5 18.7 24.3 Secondary incomplete 57.2 45.2 45.6 33.2 49.3 37.5 Secondary and above 81.0 100.0 76.0 66.7 78.0 76.2 Division Barishal 53.1 33.3 37.5 27.1 39.1 27.5 Chittagong 43.5 27.3 28.4 16.1 34.8 21.0 Dhaka 49.8 35.4 36.0 23.1 42.6 29.9 Khulna 48.9 50.0 49.5 32.2 49.4 36.9 Rajshahi 41.9 18.8 32.7 11.8 34.6 13.3 Sylhet 28.2 25.0 19.5 16.1 20.5 15.9


Wealth index Lowest Second Middle Fourth Highest All

18.5 30.5 50.5 56.6 62.8 46.9

19.6 24.4 34.9 44.1 60.6 32.5

12.5 28.7 28.4 43.3 49.9 34.7

12.7 15.4 20.1 27.9 33.3 19.9

14.5 29.2 35.5 47.7 54.0 38.5

14.8 18.2 25.7 33.3 40.0 23.9

Table 3.7b: Knowledge of routes of HIV transmission by background characteristics: females Percentage of female youth who knows at least two correct routes of HIV transmission, by selected background characteristics Background characteristics Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Age 15-19 60.8 40.6 46.7 25.6 51.5 30.2 20-24 68.1 46.1 57.7 27.6 63.3 33.6 Education No education 14.3 23.1 9.6 9.1 11.6 12.9 Primary incomplete 28.3 24.5 10.4 12.1 16.8 16.1 Primary complete 33.3 43.6 25.0 17.8 27.5 26.7 Secondary incomplete 68.3 53.8 55.4 38.2 60.0 43.1 Secondary and above 93.5 89.5 84.2 85.1 88.4 87.1 Division Barishal 63.2 34.6 46.1 23.6 48.0 24.6 Chittagong 56.8 44.2 53.7 45.9 55.1 45.0 Dhaka 65.3 48.7 48.9 28.4 58.2 38.4 Khulna 78.7 51.8 57.2 37.3 63.5 40.8 Rajshahi 46.2 28.3 45.3 18.7 45.5 20.5 Sylhet 57.7 31.8 35.8 22.9 38.6 23.8 Wealth index Lowest 27.6 18.6 20.1 9.8 22.4 12.3 Second 46.8 32.5 34.8 20.4 39.2 24.1 Middle 63.3 49.4 43.7 23.5 50.8 31.9 Fourth 70.5 57.8 56.9 38.9 61.6 45.4 Highest 77.7 68.1 68.8 52.6 72.5 57.9 All 62.1 44.3 47.8 26.9 53.1 32.4

Knowledge of ways to prevent HIV

To ascertain knowledge regarding prevention of HIV/AIDS respondents were asked about different ways of preventing HIV. They were asked a general question as to whether there was anything a person can do to prevent HIV and if so, what should be done. Tables 3.8a and 3.8b show the percentage of male and female youth and adolescents by their prevention knowledge. Out of the respondents who had heard about HIV, the most frequently cited way to prevent HIV was to use condoms, cited by 54% of married and 53% of unmarried males. The other ways to prevent HIV cited by male youth were avoid sex with sex workers, avoid HIV infected/unscreened blood transfusion, avoid sex with multiple partners and use sterile syringes/needles. Knowledge of use of condoms as a way to prevent HIV increased slightly among male youth in the past three years. In the 2005 baseline survey only 52% of males cited condom use as a way to prevent HIV. Use of sterile syringes/needles, avoid sex with multiple partner, use of condoms, and avoid sex with HIV infected persons were the most cited responses by females to prevent HIV infection. Knowledge about condoms as a way to prevent HIV had not improved among females since the 2005 baseline

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

3.2.3

32


survey. In the endline survey 18% of unmarried and 22% of married female youth cited condom use as a way to prevent HIV infection, compared to about 27% in the baseline. Tables 3.8a and 3.8b also show the number of correct ways to prevent HIV known by the respondents. As shown in Table 3.8a, 21% of unmarried males could mention three or more ways of HIV prevention and an additional 25% could mention two ways of HIV prevention giving rise to 46% of unmarried males who could mention two or more ways of HIV prevention. Among the married males, only 11% could mention three or more ways and another 23% could mention two ways of HIV prevention and thus only 34% of married males could mention two or more ways of HIV prevention. Urban males knew more than rural males and unmarried males knew more than married males. The mean number of correct routes of HIV prevention was 1.2 for married males and 1.4 for unmarried males which did not change much compared to the baseline survey conducted in 2005 (1.2 for all males). Table 3.8b presents comparable findings for females and shows that 17% of unmarried females could mention three or more ways of HIV prevention and an additional 33% could mention two ways of HIV prevention giving rise to 49% of unmarried females who could mention two or more ways of HIV prevention. Among the married females, only 12% could mention three or more ways and another 20% could mention two ways of HIV prevention and thus only 31% of married females could mention two or more ways of HIV prevention. Urban females knew more than rural females and unmarried females knew more than married females. The mean number of correct routes of HIV prevention was 1.3 for unmarried females and 1.0 for married females which did not change much compared to the baseline survey conducted in 2005 (1.3 for all females). Figures 3.4a and 3.4b compare correct knowledge about two or more ways of HIV prevention for male and female youth and adolescents respectively at baseline and endline. While the HIV prevention knowledge for males had increased significantly over time for all groups, for females the knowledge has increased slightly for all groups and decreased for urban married group.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.8a: Knowledge of ways to prevent HIV: males

33

Percentage of male youth with knowledge of ways to prevent HIV by type of residence Knowledge of ways to prevent Urban Rural HIV Unmarried Married Unmarried Married Limit sex within marriage 10.7 13.1 14.1 15.9 Use condom during sex 60.4 61.6 49.1 50.6 Avoid HIV infected/unscreened 48.4 30.8 31.8 18.4 blood transfusion Use sterile syringes/needles 47.3 32.3 35.7 18.0 HIV infected women should 2.9 .9 3.0 1.5 consult doctors before getting pregnant Have faithful partner 0.7 1.2 1.0 0.8 Avoid sex with HIV infected 12.1 13.4 12.7 10.4 person Avoid sex with sex workers 55.6 67.2 46.0 51.5 Avoid sex with multiple partners 24.5 22.7 26.3 26.0 Use new blade in salon 4.4 2.6 3.2 1.9 No. of correct23 ways known 0 17.2 21.2 28.7 33.4 1 27.2 35.2 29.5 37.2 2 27.8 27.9 24.2 21.0 3 or more 27.8 15.7 17.6 8.4 Mean 1.7 1.4 1.3 1.0 N 1,351 345 2,906 718 23

Total Unmarried Married 13.0 15.1 52.7 54.1 37.1 22.4 39.3 3.0

22.6 1.3

0.9 12.5

0.8 11.4

49.1 25.8 3.6

56.6 25.0 2.2

25.1 28.8 25.3 20.8 1.4 4,257

29.5 36.5 23.2 10.7 1.2 1,062

The first six responses were considered as correct knowledge of HIV prevention as these responses are very specific.


Figure 3.4a: Percentage of male youth who could correctly identify two or more ways of HIV prevention, baseline and endline surveys

* p <=0.05; ** p <=0.01; *** p <=0.001

Percentage of female youth with knowledge of ways to prevent HIV by type of residence Knowledge of ways to prevent HIV Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Limit sex within marriage 7.4 9.5 9.7 11.7 8.9 11.0 Use condom during sex 22.4 26.7 15.2 19.6 17.8 21.9 Avoid HIV infected/unscreened 60.2 40.2 44.7 23.8 50.3 29.1 blood transfusion Use sterile syringes/needles 62.6 42.0 47.1 27.4 52.7 32.1 HIV infected women should 8.3 3.6 5.2 3.1 6.3 3.2 consult doctors before getting pregnant Have faithful partner 1.5 1.0 1.2 1.1 1.3 1.1 Avoid sex with HIV infected 22.5 24.2 17.3 15.0 19.2 17.9 person Avoid sex with sex workers 7.8 11.0 7.8 7.4 7.8 8.5 Avoid sex with multiple partners 39.8 42.9 31.9 32.7 34.8 35.9 Use new blade in salon 1.8 2.1 1.2 0.8 1.4 1.2 No. of correct24 ways known 0 22.9 37.0 39.4 51.4 33.4 46.8 1 17.6 21.3 16.2 22.2 16.7 21.9 2 39.2 25.7 28.8 16.5 32.5 19.5 3 or more 20.3 16.0 15.7 9.8 17.3 11.8 Mean 1.6 1.2 1.2 0.9 1.3 1.0 N 784 1,179 1,386 2,520 2,170 3,699

Tables 3.9a and 3.9b present information on knowledge of HIV prevention by selected background characteristics. As shown in these tables, knowledge about HIV prevention among males and females was associated with age; in general, the proportion of young people who could mention two or more ways to prevent HIV was higher among those who were 20-24 years old compared to the younger age group of 15-19 years. Young people who were unmarried and lived in urban areas had better knowledge compared to married and rural residents. Educational 24

The first six responses were considered as correct knowledge of HIV prevention as these responses are very specific.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.8b: Knowledge of ways to prevent HIV: female

34


Figure 3.4b: Percentage of female youth who could correctly identify two or more ways of HIV prevention, baseline and endline surveys

* p <=0.05; ** p <=0.01; *** p <=0.001

attainment and economic status of household, as measured by the wealth index, were positively associated with prevention knowledge. Young people with secondary education or more had the highest level of knowledge compared to lower levels of education. Variation in knowledge also existed by geographic division.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.9a: Knowledge of HIV prevention by background characteristics: males

35

Percentage of male youth who knows at least two correct ways of HIV prevention by selected background characteristics Background characteristics Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Age 15-19 54.1 33.3 40.2 35.0 44.5 34.4 20-24 57.8 44.1 44.3 29.1 48.7 33.9 Education No education 33.6 33.3 14.7 18.7 20.1 22.8 Primary incomplete 24.5 25.0 21.6 21.5 22.5 22.6 Primary complete 39.7 47.8 25.0 29.2 29.4 36.0 Secondary incomplete 65.1 54.8 52.0 44.9 56.2 48.4 Secondary and above 90.1 100.0 83.1 69.2 85.9 81.0 Division Barishal 53.1 53.1 38.7 29.8 40.3 30.8 Chittagong 42.1 42.1 30.7 18.2 35.5 23.0 Dhaka 60.1 60.1 47.1 34.0 53.3 42.1 Khulna 66.0 66.0 55.7 37.8 58.2 43.1 Rajshahi 52.3 52.3 40.6 26.0 43.0 27.2 Sylhet 33.3 33.3 25.8 24.6 26.5 25.7 Wealth index Lowest 30.7 31.5 19.1 18.6 22.9 22.9 Second 37.7 35.9 33.0 24.3 34.4 27.9 Middle 58.2 45.1 36.8 35.3 43.7 38.9 Fourth 64.1 55.2 49.8 38.8 54.5 44.4 Highest 72.5 68.8 59.0 42.2 63.3 48.1 All 55.6 43.3 41.8 29.4 46.2 33.9


Table 3.9b: Knowledge of HIV prevention by background characteristics: females Percentage of female youth who knows at least two correct ways of HIV prevention by selected background characteristics Background characteristics Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Age 15-19 58.3 38.7 42.8 23.1 48.0 27.8 20-24 64.6 43.3 59.2 28.3 61.9 33.2 Education No education 11.8 22.4 9.6 9.6 10.5 13.1 Primary incomplete 26.7 19.7 11.2 14.3 16.2 16.1 Primary complete 23.2 41.0 22.2 14.3 22.5 23.6 Secondary incomplete 66.1 51.8 51.2 37.2 56.5 41.9 Secondary and above 93.6 84.2 78.9 85.1 85.8 84.7 Division Barishal 68.4 38.5 45.1 26.0 47.4 27.2 Chittagong 58.2 47.4 50.3 42.5 53.6 45.0 Dhaka 59.7 43.7 43.7 26.3 52.7 34.9 Khulna 78.7 50.0 52.4 33.3 59.9 37.5 Rajshahi 46.2 25.9 42.3 20.6 43.2 21.6 Sylhet 57.7 31.8 34.0 22.3 37.2 23.3 Wealth index Lowest 23.3 17.7 19.5 11.5 20.6 13.3 Second 46.4 29.5 31.6 20.6 36.9 23.3 Middle 58.9 41.6 40.9 20.2 47.3 27.1 Fourth 67.2 56.3 52.0 38.7 57.3 44.8 Highest 75.9 69.2 64.8 50.9 69.3 57.1 All 59.5 41.8 44.5 26.4 49.9 31.3

Comprehensive knowledge of HIV

Comprehensive knowledge of HIV was assessed by constructing a composite indicator “percentage of youth who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission” by combining five responses relating to prevention of sexual transmission of HIV. The responses included: a) food and water can not transmit HIV; b) a healthy looking person can have HIV; c) condom use can prevent HIV; d) HIV transmission can be reduced by having sex with only one faithful partner, and e) deep kissing cannot transmit HIV25. Tables 3.10a to 3.11b present the composite indicator on comprehensive knowledge of HIV. Responses on five individual variables, which were used to create the composite variable, are also presented by selected background characteristics.

25

Tables 3.10a and 3.10b present an additional response on “mosquito bite cannot transmit HIV” to construct UNGASS indicator 13. The baseline survey did not collect this information and thus UNGASS 13 cannot be constructed for baseline survey to compare it with the endline survey.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

3.2.4

36


37 66.7 69.8 86.4 78.8 36.0 58.1 20.9 29.5 1,351

49.0 75.9 89.8 82.6 26.7 40.1 13.1 19.1 345

56.8 66.3 80.8 76.3 31.8 47.6 14.8 22.3 2,906

33.0 67.5 82.0 76.3 20.1 31.8 7.9 11.3 718

59.9 67.4 82.6 77.1 33.1 50.9 16.8 24.6 4,257

38.2 70.3 84.6 78.4 22.2 34.4 9.7 13.8 1,062

29

28

27

26

70.9 60.8 63.4 68.4 30.8 55.9 11.6 22.4 784

54.1 61.7 72.8 72.2 27.1 40.3 9.3 16.0 1179

53.0 57.9 51.9 55.3 29.7 41.9 9.5 13.8 1386

35.3 53.2 58.8 61.2 22.5 30.7 6.8 9.2 2521

59.5 59.0 56.1 60.0 30.0 47.0 10.3 16.9 2170

Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and e) Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and f)

Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and e) Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and f)

N

Correct knowledge about the followings: Food and water can not transmit HIV (a) Healthy looking person can have HIV (b) Use of condom prevent HIV (c) HIV transmission can be reduced by having sex with only one faithful partner (d) Deep kissing cannot transmit HIV (e) Mosquito bite cannot transmit HIV (f) 28 Comprehensive knowledge 29 UNGASS indicator 13

41.3 55.9 63.3 64.7 24.0 33.7 7.7 11.4 3699

Percentage of female youth who both correctly identified ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission Urban Rural Total Unmarried Married Unmarried Married Unmarried Married

Table 3.10b: Comprehensive knowledge of HIV by residence and marital status: female

N

Correct knowledge about the followings: Food and water can not transmit HIV (a) Healthy looking person can have HIV (b) Use of condom prevent HIV (c) HIV transmission can be reduced by having sex with only one faithful partner (d) Deep kissing cannot transmit HIV (e) Mosquito bite cannot transmit HIV (f) Comprehensive knowledge26 UNGASS indicator 13 27

Percentage of male youth who both correctly identified ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission Urban Rural Total Unmarried Married Unmarried Married Unmarried Married

Table 3.10a: Comprehensive knowledge of HIV by residence and marital status: male

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008


38

29

28

65.0 70.9 71.0 66.6 59.5 63.8 73.7 69.3 72.9 68.8 54.6 72.3 73.8 65.1 67.7 59.1 64.9 72.1 72.6 69.1 68.0

63.1 52.1 25.6 34.5 42.9 69.5 94.2 43.1 62.9 56.4 64.7 52.5 47.6 33.9 45.6 51.5 68.5 73.0 55.6

68.7 78.0 85.5 87.4 91.9 83.0

79.4 78.4 83.2 86.6 86.8 73.4

63.9 71.1 83.7 90.0 97.5

87.1 81.1

78.9 86.9

65.1 70.8 78.2 84.2 85.3 77.3

75.6 73.4 78.0 81.7 77.4 74.3

63.9 67.5 76.7 82.3 94.2

79.5 76.3

73.6 81.0

19.0 21.4 28.8 37.7 44.1 30.9

20.8 24.2 31.1 40.7 32.1 28.5

13.1 19.7 22.7 38.8 55.7

34.1 29.5

33.9 28.0

Percentage with correct knowledge for individual questions Healthy Use of HIV transmission can be Deep kissing looking person condom reduced by having sex can not can have HIV prevent with only one faithful transmit HIV (b) HIV (c) partner (d) (e)

59.3 52.0

Food and water can not transmit HIV (a)

32.3 38.2 47.9 58.1 57.8 47.6

34.4 56.9 48.9 55.0 41.6 47.7

27.1 31.3 39.6 58.0 70.5

54.5 44.4

51.2 44.2

Mosquito bite cannot transmit HIV (f)

Comprehensive knowledge28 (a,b,c,d,e)

UNGASS indicator29 (a,b,c,d,f)

7.8 8.6 15.3 19.1 23.6 15.4

10.6 9.8 17.5 23.7 13.3 10.7

4.4 7.1 8.9 20.1 37.5

19.4 13.5

16.9 13.8

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and e) Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and f)

Age 15-19 20-24 Residence Urban Rural Education No education Primary incomplete Primary complete Secondary incomplete Secondary and above Division Barishal Chittagong Dhaka Khulna Rajshahi Sylhet Wealth index Lowest Second Middle Fourth Highest All

Background characteristics

10.6 12.8 22.8 31.7 31.0 22.5

17.0 17.8 26.8 32.8 15.8 19.2

9.4 9.6 14.9 29.1 48.3

27.4 20.1

22.9 22.0

Percentage of male youth who both correctly identified ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission

Table 3.11a: Comprehensive knowledge of HIV by background characteristics: male

905 1,027 1,115 1,103 1,169 5,319

395 612 1,785 737 1,370 421

746 814 783 2,651 325

1,695 3,624

2,623 2,696

N


39

31

30

56.6 57.6 61.3 54.9 40.1 43.7 53.4 63.5 68.8 57.7 53.5 61.0 67.6 50.7 46.0 42.8 53.9 62.0 62.1 63.9 57.0

60.8 41.6 21.5 27.1 30.5 59.5 85.8 35.0 53.7 54.5 49.9 41.2 43.0 22.5 37.5 46.2 59.6 73.9 48.0

41.4 56.4 60.8 67.4 76.3 60.6

53.0 62.2 64.0 64.9 59.7 44.4

41.0 43.4 49.7 69.1 87.9

69.0 56.4

56.3 65.7

43.4 58.8 65.2 70.3 76.6 63.0

55.8 71.8 69.3 63.3 56.5 48.2

43.9 48.6 54.1 70.6 84.5

70.7 59.1

59.6 67.0

14.5 20.3 24.9 32.2 39.1 26.2

25.0 24.5 28.9 28.0 26.0 14.1

6.5 15.0 16.9 33.0 52.1

28.6 25.0

25.4 27.2

Percentage with correct knowledge for individual questions Healthy Use of HIV transmission can be Deep kissing looking person condom reduced by having sex can not can have HIV prevent with only one faithful transmit HIV (b) HIV (c) partner (d) (e)

49.8 45.8

Food and water can not transmit HIV (a)

21.4 31.5 37.4 48.4 54.2 38.6

31.7 43.8 44.2 40.8 30.3 37.2

17.1 22.0 26.1 48.0 62.1

46.5 34.7

40.4 36.4

Mosquito bite cannot transmit HIV (f)

Comprehensive knowledge30 (a,b,c,d,e)

Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and e) Those who correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission (responses a,b,c,d and f)

Age 15-19 20-24 Residence Urban Rural Education No education Primary incomplete Primary complete Secondary incomplete Secondary and above Division Barishal Chittagong Dhaka Khulna Rajshahi Sylhet Wealth index Lowest Second Middle Fourth Highest All

Background characteristics

UNGASS indicator31 (a,b,c,d,f)

2.8 5.9 7.5 10.8 16.0 8.6

6.8 9.3 9.4 11.2 8.0 2.5

1.0 2.9 3.5 11.4 26.7

10.2 7.8

8.3 9.0

4.3 8.9 12.7 17.7 23.4 13.4

8.0 13.9 17.7 15.5 7.7 15.1

5.2 4.7 7.2 17.5 28.9

18.6 10.8

13.8 13.0

Percentage of female youth who both correctly identified ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission

Table 3.11b: Comprehensive knowledge of HIV by background characteristics: female

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

1,100 1,269 1,166 1,180 1,154 5,869

439 707 1,970 814 1,540 398

613 851 794 3,371 240

1,962 3,906

3,191 2,677

N


As shown in Tables 3.11a and 3.11b, 15% of males and 9% of females had comprehensive knowledge of HIV. When knowledge was tested separately, 56% of males and 48% of females hold the view that food and water cannot transmit HIV. Higher proportion of males (68%) than females (57%) knew correctly that a healthy looking person can have HIV. Knowledge on ways of preventing sexual transmission of HIV was high on two related questions: 83% of males and 61% of females knew use of condoms as a way to prevent HIV, and 77% of males and 63% of females believed that HIV transmission can be reduced by having sex with only one faithful partner. However, only 31% of males and 26% of females correctly identified that deep kissing cannot transmit HIV. Urban youth have significantly higher correct knowledge compared to rural youth. Similarly, unmarried youth have significantly higher correct knowledge than married youth. And these patterns were true for both males and females. Education and household economic status were the two key determinants of comprehensive HIV knowledge among youth. For instance, comprehensive knowledge was much higher among males (38%) and females (27%) with secondary or higher level of education compared to those with no education (4% of males and one percent of females). Similarly, comprehensive knowledge was significantly higher among youth of households with the highest wealth quintile (24% of males and 16% of females) compared to those of lowest quintile (8% of males and 3% of females). Figure 3.5a presents comparable figures between baseline and endline surveys showing percentage of male youth and adolescents who both correctly identified ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission. It is apparent that the comprehensive knowledge about HIV has increased significantly over time for males. Figure 3.5b presents the same figures for females and shows that comprehensive knowledge about HIV among females has decreased over time and this decrease is mostly due to decrease in certain knowledge about the disease such as use of condoms prevents HIV and HIV transmission can be reduced by having sex with only one partner.

*p <=0.05, ** p <=0.01, *** p <=0.001

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 3.5a: Percentage of male youth who both correctly identify ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission, baseline and endline surveys

40


Figure 3.5b: Percentage of female youth who both correctly identify ways of preventing sexual transmission of HIV and who rejected major misconceptions about HIV transmission, baseline and endline surveys

*p <=0.05, ** p <=0.01, *** p <=0.001

3.2.5

Misconceptions about HIV

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Based on the information collected using a 22-item knowledge questionnaire, an attempt was made to assess prevalence of misconceptions among youth. The misconceptions were classified as general misconceptions, and misconceptions about transmission and prevention of HIV. Tables 3.12a to 3.12b present prevalence of all these types of misconceptions and reflect high levels of misconceptions among both male and female youth. For example, 43% of unmarried and 65% of married males, and 45% of unmarried and 63% of married females believed that HIV can be transmitted by cough or sneeze, and more than half of married males and females had misconception that HIV can be spread through sharing food or water. Although the prevalence of misconceptions about HIV transmission is high in 2008, when compared with the baseline findings, this type of misconceptions has reduced significantly since 2005 for both males and females. However the decrease is more marked among males than females (Figure 3.6a and 3.6b).

41

Table 3.12a: Misconceptions related to HIV transmission: males Percentage of male youth with misconceptions relating to HIV transmission by type of residence HIV can be transmitted by

Urban Married

Total

Unmarried

Married

Unmarried

Married

Cough/ sneeze

36.9

57.8

46.0

68.5

43.1

65.1

Sharing food/ water Sharing bath/ pond Deep kissing Mosquito bites

33.3 26.8 64.0 41.9

51.0 40.4 73.3 59.9

43.2 36.5 68.2 52.4

67.0 54.7 79.9 68.2

40.1 33.5 66.9 49.1

61.8 50.0 77.8 65.6

1,351

345

2,906

718

4,257

1,062

N

Unmarried

Rural


Table 3.12b: Misconceptions related to HIV transmission: females Percentage of female youth with misconceptions related to HIV transmission by type of residence HIV can be transmitted Urban Rural Total by Unmarried Married Unmarried Married Unmarried Married Cough/ sneeze 35.0 52.0 50.4 67.6 44.8 62.6 Sharing food/ water 29.1 45.9 47.0 64.7 40.5 58.7 Sharing bath/ pond 21.7 40.6 40.8 56.7 33.9 51.6 Deep kissing 69.2 72.9 70.3 77.5 70.0 76.0 Mosquito bites 44.1 59.7 58.1 69.3 53.0 66.3 N 784 1,179 1,386 2,520 2,170 3,699

Figure 3.6a: Misconceptions relating to HIV transmission among male youth, baseline and endline surveys

*p <=0.05, ** p <=0.01, *** p <=0.001

Figure 3.6b: Misconceptions relating to HIV transmission among female youth, baseline and endline surveys

*p <=0.05, ** p <=0.01, *** p <=0.001

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

[

42


The prevalence of misconceptions regarding prevention of HIV is high as shown in Tables 3.12c and 3.12d and Figures 3.7a and 3.7b. In general, a slightly higher proportion of females than males had this kind of misconceptions. For instance, 66% of males reported that washing genitals after sex could prevent transmission of HIV whereas the same figure was 72%. Similarly, 81% of males mentioned that using oil or lubricant with condoms can prevent HIV and the same figure for females was 86%. Since 2005, most of the misconceptions regarding prevention of HIV have decreased for males, but not for the females as shown in Figures 3.7a and 3.7b. For females, some misconceptions have increased over time. Table 3.12c: Misconceptions related to HIV prevention: males Percentage of male youth with misconceptions relating to HIV prevention by type of residence One can prevent HIV by Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Washing genital after sex 60.1 70.6 66.1 74.9 64.2 73.5 Using oil or lubricant with 77.6 80.6 81.3 82.3 80.1 81.7 condom Taking antibiotic 52.9 67.4 57.3 70.1 55.9 69.1 Taking vaccine 51.3 67.2 57.3 71.2 55.4 69.9 Sex during menstruation 72.3 67.0 72.5 73.0 72.4 71.0 N 1,351 345 2,906 718 4,257 1,062 Table 3.12d: Misconceptions related to HIV prevention: females Percentage of female youth with misconceptions relating to HIV prevention by type of residence One can prevent HIV by Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Washing genital after sex 69.0 70.1 69.5 75.3 69.3 73.6 Using oil or lubricant with 87.6 84.4 87.3 85.3 87.4 85.0 condom Taking antibiotic 51.9 68.5 62.8 75.0 58.9 72.9 Taking vaccine 55.5 70.1 67.0 77.2 62.9 75.0 Sex during menstruation 79.4 72.9 75.0 76.4 76.5 75.3 N 784 1,179 1,386 2,520 2,170 3,699

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 3.7a: Misconceptions relating to HIV prevention among male youth, baseline and endline

43

*p <=0.05, ** p <=0.01, *** p <=0.001


Figure 3.7b: Misconceptions relating to HIV prevention among female youth, baseline and endline surveys

*p <=0.05, ** p <=0.01, *** p <=0.001

3.3

Awareness and knowledge of STIs and care seeking for STIs 3.3.1

Awareness about STIs

According to the endline survey, awareness about any STIs other than HIV/AIDS was quite low among respondents (Tables 3.13a and 3.13b). Females were less aware of STIs (31% of married and 30% of unmarried) than males (51% of married and 47% of unmarried). Urban males were more aware than rural males, but no significant difference in awareness about STIs was found between urban and rural females. A comparison with the baseline data indicated an increase in awareness about STIs among female youth and adolescents and remained unchanged for male youth and adolescents. In 2005, 46% of male youth and adolescents had heard about the disease compared to 48% in 2008. On the other hand, in 2005, 25% of female youth and adolescents had heard about the disease compare to 31% in 2008 (p<=0.001) 3.3.2

Knowledge about STIs

For in-depth understanding about knowledge of STIs respondents were asked if they were aware of different types of STIs. Both unprompted and prompted responses were recorded. It was evident that knowledge regarding types of STIs was even lower than general awareness. For example, less than 10%ages of males and less than five percent of females could name the most common STIs --syphilis and gonorrhea -- without any prompting. Prompted knowledge for these diseases was also low. Overall, females had poorer knowledge compared to males and rural youth had less knowledge compared to urban youth (Tables 3.13a and 3.13b).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Similar to the 2005 baseline survey, the 2008 endline survey was also designed to assess awareness and knowledge about STIs; knowledge about symptoms of STIs, and modes of transmission and prevention of STIs among youth. The surveys also collected information on care seeking behavior of those who had STI symptoms in the last six months preceding the surveys.

44


Knowledge of routes of transmission of STIs According to the survey results, for males the most cited modes of STI transmission were having sex with sex workers, and not using condoms during sex. For females the most commonly mentioned responses were sex with a STI infected person, not using condoms during sex, and receiving STI infected blood. When correct knowledge about different routes of transmission was combined, 45% of unmarried and 43% of married males could correctly mention two or more routes of transmission of STIs. Knowledge of routes of STI transmission was significantly lower among females than males. Urban males were more likely to know ways of STI transmission compared to rural males but both urban and rural females were equally ignorant about different modes of STI transmission. Knowledge of ways to prevent STIs As shown in Table 3.13a and 3.13b, the most commonly cited ways to prevent STIs for both males and females were avoid sex with sex workers and use condoms during sex. Less than 50% of males could correctly mention two or more ways of prevention of STIs compared to less than 20% of females. Urban males had better STI prevention knowledge compared to rural males; however there was no such difference for females. Marital status did not show any effect on the STI prevention knowledge for males or females.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.13a: Knowledge about STIs: males

45

Percentage of male youth having knowledge about STIs by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Heard about STIs 54.9 56.7 43.1 47.5 46.8 50.5 Knows different STIs Syphilis (unprompted) 10.7 11.6 6.9 7.6 8.2 8.9 Syphilis (prompted) 26.3 40.6 24.0 31.6 24.7 34.5 Gonorrhea (unprompted) 9.2 7.8 5.8 5.6 6.9 6.3 Gonorrhea (prompted) 31.4 45.5 32.5 40.0 32.2 41.7 Chlamydia (unprompted) 0.1 0.0 0.0 0.1 0.1 0.1 Chlamydia (prompted) 4.6 5.8 5.3 5.7 5.1 5.7 Genital herpes (unprompted) 4.0 4.3 6.2 4.6 5.5 4.5 Genital herpes ((prompted) 34.7 35.4 32.1 33.0 32.9 33.8 Knows routes to STI infection Unprotected sex with STI 13.3 14.9 14.6 11.9 14.2 12.9 infected person Receiving STI infected blood 19.0 16.1 9.9 5.9 12.8 9.2 Through pregnancy/delivery by 0.6 0.3 0.4 0.1 0.4 0.2 a STI infected mother Sex with a STI infected person 13.6 13.9 11.4 12.9 12.1 13.2 Not using a condom during sex 32.3 34.2 26.9 23.9 28.6 27.2 Having sex with sex worker 44.4 54.4 34.8 37.7 37.8 43.1 Sex with multiple partners 17.8 14.9 19.6 18.9 19.0 17.6 Knows no. of routes of STIs infection 0 32.9 26.2 39.5 38.5 37.4 34.6 1 15.4 23.0 19.2 22.5 18.0 22.7 2 32.1 28.3 28.0 28.9 29.3 28.7 3 or more 19.7 22.4 13.3 10.0 15.3 14.0 Mean 1.4 1.5 1.2 1.1 1.2 1.2


Knows ways to prevent STIs Limit sex within marriage Use condom during sex Have faithful partner Use new/sterile syringes/ needles Avoid HIV infected/ unscreened blood transfusion Avoid sex with sex worker Avoid sex with multiple partners Knows no. of ways to prevent STIs 0 1 2 3 or more Mean N

11.3 47.7 2.4 13.7

17.0 50.4 1.3 11.1

11.9 36.9 1.9 8.5

17.5 36.6 1.7 5.7

11.7 40.3 2..1 10.2

17.3 41.0 1.5 7.5

10.8

7.5

7.1

4.4

8.3

5.4

44.7 17.8

53.1 15.2

39.8 19.5

38.8 16.5

41.4 18.9

43.5 16.1

32.6 11.8 33.8 21.8 1.4 1,350

25.8 19.7 32.5 22.0 1.5 344

38.9 16.6 27.9 16.5 1.2 2,906

37.7 19.5 28.1 14.7 1.2 718

36.9 15.1 29.8 18.2 1.3 4,256

33.8 19.6 29.5 17.1 1.3 1,063

Percentage of female youth having knowledge about STIs by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Heard about STIs 32.1 38.7 28.9 27.7 30.1 31.2 Knows different STIs Syphilis (unprompted) 3.3 2.0 1.3 1.2 2.0 1.4 Syphilis (prompted) 11.1 11.5 10.5 8.0 10.7 9.1 Gonorrhea (unprompted) 2.8 1.2 1.4 0.8 1.9 0.9 Gonorrhea (prompted) 14.7 13.0 13.2 12.3 13.7 12.5 Chlamydia (unprompted) 0.5 0.1 0.2 0.0 0.3 0.0 Chlamydia (prompted) 8.7 5.3 8.5 3.8 8.6 4.3 Genital herpes (unprompted) 1.9 2.7 2.1 2.3 2.0 2.4 Genital herpes ((prompted) 28.7 36.5 29.9 28.9 29.4 31.3 Knows routes to STI infection Unprotected sex with STI 6.4 5.4 6.0 4.8 6.2 5.0 infected person Receiving STI infected blood 10.0 7.1 9.2 5.8 9.5 6.2 Through pregnancy/delivery by 2.9 3.2 2.1 2.1 2.4 2.5 a STI infected mother Sex with a STI infected person 6.8 8.9 7.3 7.9 7.1 8.2 Not using a condom during sex 6.7 8.6 6.6 6.6 6.6 7.2 Having sex with sex worker 3.9 5.4 4.7 4.7 4.4 4.9 Sex with multiple partners 15.3 15.7 17.0 16.4 16.4 16.2 Knows no. of routes of STIs infection 0 70.2 66.3 68.0 69.2 68.8 68.3 1 13.0 17.9 15.9 16.8 14.8 17.2 2 12.2 12.0 12.0 10.5 12.1 11.0 3 or more 4.6 3.8 4.1 3.5 4.3 3.6 Mean 0.5 0.5 0.5 0.5 0.5 0.5 Knows ways to prevent STIs Limit sex within marriage 3.6 6.5 6.4 7.7 5.4 7.3 Use condom during sex 13.6 15.9 10.2 12.0 11.4 13.3 Have faithful partner 2.8 2.1 1.5 1.5 2.0 1.7 Use new/sterile syringes/ needles 9.8 6.0 8.2 5.5 8.8 5.6 Avoid HIV infected/ unscreened 8.3 4.6 6.7 3.5 7.3 3.8 blood transfusion Avoid sex with sex worker 5.6 5.8 5.6 6.8 5.6 6.5 Avoid sex with multiple partners 14.5 13.7 16.2 13.5 15.6 13.6

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.13b: Knowledge about STIs: females

46


Knows no. of ways to prevent STIs 0 1 2 3 or more Mean N

69.5 12.5 10.1 7.9 0.5 784

66.2 18.2 11.2 4.4 0.5 1,179

68.2 15.6 10.8 5.4 0.5 1,386

68.5 16.9 10.6 4.0 0.5 2,520

68.6 14.5 10.5 6.3 0.5 2,170

67.8 17.2 10.8 4.2 0.5 3,699

As shown in Figure 3.8a and 3.8b, there was significant improvement in the correct knowledge about two or more than two routes of STI transmission among males and females between baseline and endline surveys. Similarly, there was significant improvement in the correct knowledge about two or more modes of STI prevention among both males and females (Figures 3.9a and 3.9b). Figure 3.8a: Percentage of male youth who could correctly identify two or more ways of transmission of STIs, baseline and endline surveys

*** p <=0.001

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 3.8b: Percentage of female youth who could correctly identify two or more ways of transmission of STIs, baseline and endline surveys

47

*** p <=0.001


Figure 3.9a: Percentage of male youth who could correctly identify two or more ways of prevention of STIs, baseline and endline surveys

*** p <=0.001

*** p <=0.001

Knowledge of STI Symptoms Table 3.14a and 3.14b show respondentsâ&#x20AC;&#x2122; knowledge about STI symptoms. Separate questions were asked to assess knowledge about STI symptoms among males and females. In general, young people had very low knowledge about STI symptoms and the knowledge was even lower among females. Males seemed to know better about STI symptoms in males compared to STI symptoms in females. Similarly, females knew more about STI symptoms in females compared to STI symptoms in males. Unmarried males knew less compared to married males about STI symptoms in women and the pattern was similar for females where unmarried females knew less than their married counterparts about STI symptoms in women.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 3.9b: Percentage of female youth who could correctly identify two or more ways of prevention of STIs, baseline and endline surveys

48


The most cited STI symptoms among males were ulcer in genital region and burning sensation during urination followed by urethral discharge. About 30% of males (31% of married and 30% of unmarried) mentioned ulcer in genital region as a symptom of STIs in men. Another one-sixth (17%) of males mentioned burning sensation during urination as an STI symptom in men. The most cited STI symptoms in females mentioned by males were genital ulcer and vaginal discharge followed by pain during coitus. Table 3.14 a: Knowledge about STIs symptoms: males Percentage of male youth having knowledge about STIs by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married STI symptoms in men Urethral discharge 9.5 14.4 10.5 12.7 10.2 13.2 Ulcer in genital region 33.4 37.9 28.2 27.6 29.8 30.9 Burning sensation during 13.7 14.8 18.2 17.1 16.8 16.4 urination Pain in scrotum 1.9 2.0 2.9 2.8 2.6 2.6 Other 0.5 0.3 0.1 0.0 0.3 0.1 Don’t know 53.8 46.5 56.8 56.0 55.8 53.0 STIs symptoms in women Genital ulcer 9.3 14.3 11.8 13.9 11.0 14.0 Increase vaginal discharge 13.5 27.7 8.7 18.2 10.2 21.2 Pain during coitus 0.7 3.2 1.0 5.7 0.9 4.9 Other 0.0 0.3 0.2 0.1 0.2 0.2 Don’t know 81.8 65.4 81.9 69.7 81.9 68.3 N 1,350 344 2,906 718 4,256 1,063 Table 3.14 b: Knowledge about STIs symptoms: females Percentage of female youth having knowledge about STIs by residence and marital status

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Urban

49

Rural

Total

Unmarried

Married

Unmarried

Married

Unmarried

3.6 3.6 5.4

9.5 10.4 6.8

2.7 3.1 3.6

6.1 6.7 5.5

3.0 3.3 4.2

7.2 7.9 5.9

1.7 0.0 90.3

3.0 0.2 80.3

0.9 0.0 92.7

1.6 0.0 86.4

1.2 0.0 91.9

2.0 0.1 84.5

Genital ulcer Increase vaginal discharge Pain during coitus Other

21.0 14.6 0.4 0.1

31.1 17.7 3.9 0.0

16.7 11.7 1.1 0.0

21.0 13.0 3.9 0.0

18.3 12.8 0.9 0.1

24.2 14.5 3.9 0.0

Don’t know

72.6

61.7

76.9

70.7

75.4

67.8

784

1,179

1,386

2,520

2,170

3,699

STI symptoms in men Urethral discharge Ulcer in genital region Burning sensation during urination Pain in scrotum Other Don’t know

Married

STIs symptoms in women

N


Prevalence of STI symptoms and treatment sought for STI symptoms As shown in Table 3.15a and 3.15b, about 20% of males and a quarter of females reported having experienced one or more signs/symptoms of STIs during the last 12 months preceding the survey. Although there was no significant difference in reported STI symptoms between urban and rural residents, married females reported significantly higher levels of STI symptoms compared to unmarried females (Tables 3.15b). The most commonly cited symptoms among males were burning sensation during urination (11% for unmarried and 13% for married males) followed by ulcer in the genital region (8% for unmarried and 7% for married males). For females, the most commonly cited symptoms were increased vaginal discharge for both married and unmarried females (19 and 15% respectively) and pain during coitus for married women (16%). Almost 5% of unmarried and 8% of married females reported having had genital ulcers. Table 3.15 a: Reported signs/symptoms of STIs in men Percentage of male youth who reported experiencing signs/symptoms of STIs during the last 12 months prior to the survey according to residence and marital status Signs/Symptoms

Urban Unmarried

Rural Married

Total

Unmarried

Married

Unmarried

Married

Urethral discharge Ulcer in genital region Burning sensation during urination Pain in scrotum

1.3 7.6

0.9 7.3

1.8 8.5

1.8 7.0

1.6 8.2

1.5 7.1

11.5

12.2

11.1

13.6

11.3

13.2

2.4

2.9

3.2

4.0

2.9

3.7

One or more signs/ symptoms

18.1

18.8

19.7

20.2

19.2

19.8

1,350

344

2,906

719

4,256

1,063

N

Table 3.15 b: Reported signs/symptoms of STIs in women Percentage of female youth who reported experiencing signs/symptoms of STI during the last 12 months prior to the survey according to residence and marital status Urban Unmarried

Rural Married

Total

Unmarried

Married

Unmarried

Married

Genital ulcer Increase vaginal discharge Pain during coitus

3.6 12.8 0.0

10.3 19.1 15.5

5.0 15.5 0.5

7.3 19.4 16.4

4.5 14.5 0.4

8.2 19.3 16.1

One or more signs/ symptoms

14.9

31.7

17.7

30.7

16.8

31.0

N

784

1,179

1,386

2,520

2,170

3,699

Among those who experienced one or more STI symptoms in the last 12 months preceding the survey, 62% of males and 53% of females reported to have sought care from someone A variety of service providers were used for this purpose including trained providers such as doctors, hospitals and clinics and untrained providers such as healers, village doctors, pharmacies and others.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Signs/Symptoms

50


Table 3. 16: STI treatment Percentage of youth who reported experiencing one or more STI symptom(s) in the last year and sought care by type of providers and area of residence STI treatment Urban Rural Total Male Female Male Female Male Female Sought care from any source 55.8 52.5 65.1 52.9 62.4 52.8 N 310 491 719 1,020 1,028 1,510 Type of providers used Doctors 45.6 49.9 38.7 37.6 40.6 41.6 Hospital/clinic 7.0 28.3 7.0 16.5 7.0 20.3 Pharmacy 29.4 12.0 21.4 12.4 23.6 12.2 Healer 7.5 5.6 13.4 9.5 11.8 8.3 Village doctor 9.0 7.1 14.5 16.6 13.1 13.5 Homeopath 5.0 12.8 3.9 13.9 4.2 13.5 Friend 1.9 0.2 4.8 1.4 4.0 1.0 Canvasser 4.2 0.1 6.8 0.0 6.1 0.0 Pir/Fakir/ huzur 0.2 2.9 1.0 8.2 0.8 6.5 Other 0.6 0.1 1.2 0.9 1.0 0.6 173 258 468 540 641 797 N

Tables 3.17a and 3.17b present information on STI treatment seeking pattern by background characteristics. As shown in these tables, 24 % of males sought care from a trained provider such as doctors, hospitals, and clinics, and an additional 39% sought care from untrained providers or sources and the same figures were 25% and 27% respectively for females. As expected, urban residents and young people from wealthy households sought care from trained providers more than rural residents and young people belonging to poorer households, but these differences were bigger for females.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.17 a: STI treatment by background characteristics: males

51

Percentage of male youth seeking treatment for STIs and source of care by selected background characteristics Background characteristics Sought Source of care treatment Trained provider 32 Untrained provider Age 15-19 64.4 21.7 42.7 20-24 60.4 25.2 35.2 Marital status Unmarried 62.0 23.9 38.1 Married 63.5 21.8 41.7 Residence Urban 55.8 24.8 31.0 Rural 65.1 22.9 42.1 Wealth index Lowest 69.1 18.9 50.3 Second 56.6 19.0 37.6 Middle 65.3 24.0 41.3 Fourth 57.6 25.6 32.2 Highest 63.8 29.9 34.0 All 62.4 23.5 38.8

32

Trained providers include services from doctors, hospitals and clinics

N 489 540 819 211 310 719 175 205 242 211 197 1,028


Table 3.17 b: STI treatment by background characteristics: females Percentage of female youth seeking treatment for STIs and source of care by selected background characteristics Background characteristics Sought Source of care N treatment Trained provider 30 Untrained provider Age 15-19 48.8 23.1 25.7 754 20-24 56.8 27.6 29.2 757 Marital status Unmarried 48.9 23.6 25.3 364 Married 54.1 25.9 28.1 1,147 Residence Urban 52.5 33.2 19.3 491 Rural 52.9 21.6 31.4 1,020 Wealth index Lowest 48.2 19.3 28.9 305 Second 49.4 18.5 30.7 336 Middle 46.4 19.1 27.3 304 Fourth 62.0 33.5 28.5 316 Highest 59.4 39.4 20.1 249 All 52.8 25.3 27.4 1,510

3.3.4 Prevalence of Syphilis33 Among the 2,591 specimens tested for syphilis, 1.3% and 0.3% of specimens were found to be positive for RPR and TPHA respectively (Table 3.18). About 0.3% of specimens were positive for both RPR and TPHA indicating current infection. Table 3.18: Prevalence of Syphilis by background characteristics Percentage of youth tested positive for RPR, TPHA and both RPR and TPHA Characteristics

RPR (+ve)

TPHA (+ve)

RPR and TPHA (+ve)

N

15-19

1.3

0.3

0.3

1,269

20-24

1.2

0.4

0.4

1,322

Male Female

1.3 1.2

0.3 0.4

0.3 0.4

1,306 1,285

Marital status Never married Ever married

1.2 1.3

0.2 0.5

0.2 0.5

1,373 1,218

2.2 0.3

0.7 0.0

0.7 0.0

1,315 1,276

1.3

0.3

0.3

2,591

Sex

Residence Urban Rural All 33

Presented from the serological part of the survey only

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Age

52


3.3.5

Prevalence of Herpes Simples Virus 2 (HSV234)

Among the 2,591 specimens tested, 4.5% were HSV2 IgG positive, indicating either a current or past exposure to HSV2 (Table 3.19). IgG positive samples were also tested for IgM and it was found that 1.2% of samples were positive indicating the prevalence of current HSV2 infection. There was no significant difference in the prevalence of HSV2 between males and females or among urban or rural residents. The prevalence was significantly higher among the older age group between 20-24 years compared to the younger group between 15-19 years. The prevalence was also significantly higher among married youth compared to unmarried youth and people of the older age group were more likely to be married. There was no significant difference in the prevalence of HSV2 by history of premarital or extramarital exposure. Table 3.19: Prevalence of HSV2 by background characteristics Percentage of youth tested positive for HSV2 by background characteristics Characteristics IgG (+ve) IgM (+ve) IgG and IgM (+ve) Age

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Sex

53

15-19 20-24

Male Female Marital status Never married Ever married Religion Muslim Hindu Other Residence Urban Rural Division Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Premarital sexual history Had history of premarital sex No history of premarital sex Extramarital sexual history35 Had history of extramarital sex No history of extramarital sex All

3.4

N

3.4 5.6

0.9 1.4

0.9 1.4

1,269 1,322

5.1 3.9

1.1 1.2

1.1 1.2

1,306 1,285

3.5 5.7

0.9 1.5

0.9 1.5

1,373 1,218

4.4 4.2 22.7

1.1 0.7 9.1

1.1 0.7 9.1

2,285 284 22

4.3 4.8

0.9 1.4

0.9 1.4

1,315 1,276

4.7 5.3 3.2 4.8 5.6 3.7

1.0 1.3 1.4 0.9 1.4 0.7

1.0 1.3 1.4 0.9 1.4 0.7

297 379 554 440 519 403

6.2 4.2

2.1 1.0

2.1 1.0

421 2,171

5.1 5.7 4.5

2.5 1.4 1.2

2.5 1.4 1.2

79 1,139 2,591

Sexual behavior and condom use 3.4.1

Premarital sex

Information was collected from young males and females about whether they had experienced premarital sex. Survey results showed that about 23% of males (both urban and rural) and less than one percent (0.5% of urban and 1.0% of rural) of females had a history of premarital sex. 34 35

Presented from the serological part of the survey only Among married respondents only


There was no significant difference in the prevalence of premarital sex between urban and rural youth (Table 3.20). Table 3.20: History of premarital sex Percentage of male36 youth with history of premarital sex by age and residence Age

Urban

Rural

Total

N

15-19

12.8

16.8

15.5

2,623

20-24

31.5

29.2

29.9

2,696

All

22.4

23.0

22.8

5,319

Youth who had premarital sex were also asked about their sex partners during last premarital sex. Girl friends, commercial sex workers, and cousins were the common premarital sex partners of males. Boyfriends, cousins and casual acquaintances were the common premarital sex partners of females. The majority of last premarital sex took place at home (own home/otherâ&#x20AC;&#x2122;s home). Males also had sex in hotels and brothels. When the level of premarital sex is compared between the baseline and endline surveys, it is apparent that premarital sex among male youth has decreased significantly during the three years period (25% in 2005 versus 23% in 2008, p <=0.01). 3.4.2

Extramarital sex

The 2008 endline survey collected information on extramarital sex among young males and females aged 15-24 (Table 3.21). Results show that the prevalence of extramarital sex among males was nine percent and there was no significant difference in prevalence between urban and rural males. As observed in the case of premarital sex, commercial sex workers (51%), girlfriends (27%) and cousins (20%) were the main sex partners of males outside of their marriages, whereas cousins and casual acquaintances were the main partners of females. The mean number of partners for extramarital sex during the last six months among males and females were 1.7 and 1.0 respectively.

Percentage of male37 youth with history of extramarital sex by age and residence Age

Urban

Rural

Total

N

15-19

a

a

a

1,307

20-24

9.3

8.8

9.0

2,391

All

9.3

9.2

9.2

3,698

a â&#x20AC;&#x201C; number is small

Similar to premarital sex, the majority of extramarital sex also took place at home. About 58% of respondents who admitted having had sex outside of their marriage had last sex at their own home or at someone elseâ&#x20AC;&#x2122;s home. When compared between baseline and endline surveys, the level of extramarital sex among males did not increase over time (7% in baseline survey and 9% in endline survey).

36 37

Information on females is not presented as the number of females reporting history of premarital sex was low. Information on females is not presented as the number of females reporting extramarital sex was low.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.21: History of extramarital sex

54


3.4.3

Sex with commercial sex workers (CSWs) and paid sex

Male youth who reported to have premarital or extramarital sex were also asked whether they had sex with commercial sex workers (CSW) during the last sex act. It was found that about 30% of the males who had premarital or extramarital sex had sex with CSWs. Experience with commercial sex was higher among urban youth (39%) compared to rural youth (27%). When compared with the baseline data, percentage of males having had sex with CSWs has increased significantly between the baseline and endline surveys (25% in baseline and 30% in endline; p <0.01). Males who reported ever having premarital or extramarital sex were asked whether they paid for having sex last time; about 35% of such males reported yes. Paid sex was significantly more prevalent among older adolescents and urban residents. 3.4.4

Higher risk sex

Sex with more than one partner was considered as higher risk sex. Out of the male youth who reported to ever had sex, about 6% reported to have sex with more than one partner in the last six months. Practice of higher risk sex was significantly higher among unmarried (9.5%) males compared to married males (0.3%). There is a slight decrease in the percentage of youth reporting experience of higher risk sex between baseline and endline surveys (8% in baseline and 6% in endline; p <=0.05). 3.4.5

Age at first sex and sex before age 15

It is important to know at what age youth experience their first sex (premarital or within marriage). Tables 3.22a and 3.22b show that among those who ever had sex, 12% of males and 31% of females experienced first sex before the age of 15. Among those who ever had sex, 12% of males and 1% of females experienced first sex before the age of 15 meaning that girls first sex before the age of 15 is more likely to be marital. Table 3.22a: Sex before the age of 15: males Percentage of male youth who had first sex before the age of 15 by background characteristics38 % Had first sex (all) before age 15

% Had first premarital sex before age 15

Age 15-19 20-24

31.8 5.8

31.5 5.6

443 1468

Residence Urban Rural

11.4 12.0

11.1 11.8

605 1306

10.1 13.3 10.0 13.2 12.9

9.7 12.9 9.8 13.2 12.9

434 442 399 333 303

11.8

11.6

1,911

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Background characteristics

55

N

Wealth index Lowest Second Middle Fourth Highest Total 38

Among those who ever had sex


Table 3.22b: Sex before the age of 15: females Percentage of female youth who had first sex before the age of 15 by background characteristics39 Background characteristics % Had first sex (all) before % Had first premarital sex age 15 before age 15 Age 15-19 32.2 1.2 20-24 29.8 0.5 Residence Urban 24.6 0.2 Rural 33.5 1.0 Wealth index Lowest 37.9 1.3 Second 37.8 0.9 Middle 28.4 0.3 Fourth 27.0 0.9 Highest 17.2 0.3 Total 30.6 0.8

3.4.6

N 1,320 2,397 1,181 2,536 823 884 725 674 611 3,717

Use of condoms

Premarital sex Respondents were asked whether they used condoms in premarital sex. They were then specifically asked whether they had used a condom in their last premarital sex. Among those who ever had premarital sex 37% of males 40 reported using a condom at last sex. Pharmacies and shops were the main sources of condom supply. For those who did not use a condom during last sex, the main reasons for not using one included lack of awareness about condoms, and nonavailability of a condom during sex.

Respondents who mentioned having extra marital sex were asked about their use of condoms at last extramarital sex. It was found that about 46% of males who had such exposure used condoms at last extra marital sex. The major reason cited for using a condom was to prevent HIV. The other reasons that were mentioned included prevention of pregnancy and prevention of other STIs. Shops and pharmacies were mentioned as the main two sources of condom supply for those who used condoms. For those who did not use condoms the main cited reason for not using was unavailability of condoms. Higher risk sex

Sex with more than one sexual partner is considered as higher risk sex. Youth who had more than one sex partner in the last six months prior to the survey were asked about condom use during last sex. About 55.3% of male youth who had higher risk sex used condoms during the last higher risk sex. Figure 3.10 presents information on condom use during premarital, extramarital and higher risk sex, and compares findings from baseline and endline surveys. As shown in this figure, condom use in premarital and extramarital sex did not change over time. However, condom use during higher risk sex increased significantly in endline survey compared to baseline survey (55% compared to 41%; p <=0.05). 39 40

Among those who ever had sex Females who reported having history of premarital sex is low, and thus, condom use in premarital sex is not reported for females.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Extramarital sex

56


Figure 3.10: Percentage of male youth using condom in premarital, extramarital and higher risk sex, baseline and endline surveys

*p <=0.05 Comprehensive Knowledge and Condom Use

Condom use among youth having comprehensive prevention knowledge in last premarital and higher risk sex act was 59% and 81% respectively. Figure 3.10a represents that youth having comprehensive knowledge are using condom more at their last sex in both pre-marital sex act and higher risk sex acts than who does not have any comprehensive knowledge.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 3.10a: Percentage of male youth using condom in last premarital and higher risk sex by comprehensive HIV knowledge, endline survey

57

3.5

Perceived HIV risk, barriers in condom use and self-efficacy in overcoming barriers 3.5.1

Perceived risk of HIV

Young people were asked about their perceived risk of becoming infected by HIV. Overall, two percent of young people though that they were at risk of the getting the disease. Male youth and adolescents had higher perceived risk compared to female youth and adolescents. When compared with the baseline findings, there is significant increase in the perceived risk of becoming infected by HIV in overall sample and among males (Figure 3.11).


Figure 3.11: Percentage of young people who perceived risk of becoming infected by HIV, baseline and endline surveys

3.5.2

Perceived barriers in accessing STI services

The most commonly mentioned barriers for male youth in accessing STI services were perceived high costs of services, absence of facilities providing STI services nearby and inconvenient clinic hours. Among female youth absence of an STI facility close by and not maintaining confidentiality by doctor/paramedic were the main barriers, followed with inconvenient clinic hours and perceived high costs of STI services. About one third of male youth and half of female youth perceived not enough confidentiality as a barrier to seeking STI services. There was no clear pattern of difference in the responses by sex, residence or marital status of the respondents (Table 3.23a and 3.23b). Perceived barriers in using condoms

The most commonly mentioned barrier in accessing condoms included perceptions that the community dislikes youth buying condoms, unwillingness of sellers to sell condoms to youth, no confidentiality about selling condoms, and no source of condoms nearby. While the majority of married males perceived that the community would not like it if a young person purchases a condom (58%), the same perception was much lower among unmarried males (24%). Unmarried males also identified unwillingness of sellers to sell condoms to youth (23%) and lack of confidentiality about condom sales (26%) as common barriers, whereas married males perceived these barriers less. The pattern was found to be similar for female respondents (Table 3.23a and 3.23b). 3.5.3

Self-efficacy to overcome barriers

Tables 3.24a and 3.24b present information on young peopleâ&#x20AC;&#x2122;s perceptions about their ability to overcome barriers in accessing STI services and condoms. While married and unmarried youth had similar pattern of agreement for certain statements, they had different kinds of responses for other statements. For example, while the majority of married males agreed that they would be able to convince their regular or irregular partners in using condoms (43%), the proportion of unmarried males who agreed to the same statement was much less (28%). More married males also agreed that they would feel comfortable in buying condoms from a seller who was known to their family (68%) compared to unmarried males (28%). Similar patterns of responses were obtained from female respondents; however, females had much less confidence in being effective in convincing an irregular partner to use a condom (8% or less).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

3.5.3

58


59 35.1 35.2 1.3 28.9 30.1 12.4 23.2 25.8 19.1 24.1 4,257

10.4 7.5 14.9 13.9 57.1 718

Total

36.9 35.8 1.3 27.3 34.2

Unmarried

31.4 31.6 1.3 27.2 35.5 8.3 6.4 15.4 12.9 58.4 1,063

Married

Percentage of female youth and their perception about barriers in accessing STI services and condoms by residence Perceived barriers Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Accessing STIs services No nearby clinic/facility for STI services (No & DK) 35.3 29.5 46.6 45.0 42.5 40.1 Inconvenient clinic time 34.9 29.0 44.6 38.9 41.1 35.7 Unwillingness of doctor/paramedic to provide treatment 1.9 1.0 3.9 3.9 3.2 3.0 Not maintaining confidentiality by doctor/paramedic 52.0 48.7 49.6 44.2 50.5 45.6 High cost for STI treatment 20.3 26.1 21.5 30.2 21.1 28.9 Accessing condoms No source of condoms nearby 39.4 15.0 44.8 26.4 42.9 22.8 Unwillingness of sellers to sell condoms to youth 62.9 17.7 65.4 25.8 64.5 23.2 Not maintaining confidentiality about condom sales 59.4 32.7 57.6 35.3 58.3 34.5 Unaffordable price of condoms 50.9 21.9 52.7 29.2 52.0 26.9 Community do not like if youth purchase condoms 32.7 63.7 39.2 63.3 36.8 63.5 N 784 1,178 1,386 2,520 2,170 3,699

Table 3.23b: Perceived barriers in accessing STI services and condoms: female

Percentage of male youth and their perceptions about barriers in accessing STI services and condoms by residence Perceived barriers Urban Rural Unmarried Married Unmarried Married Accessing STIs services No nearby clinic/facility for STI services (No & DK) 25.5 20.0 39.5 Inconvenient clinic time 29.5 22.9 37.9 Unwillingness of doctors/ paramedics to provide treatment 1.1 0.9 1.4 Not maintaining confidentiality by doctor/paramedic 29.7 27.0 28.6 High cost for STI treatment 29.8 38.0 30.2 Accessing condoms No source of condoms nearby 7.3 3.8 14.8 Unwillingness of sellers to sell condoms to youth 22.4 4.1 23.6 Not maintaining confidentiality about condom sales 25.5 16.5 26.0 Unaffordable price of condoms 17.4 10.8 19.9 Community do not like if youth purchase condoms 23.0 61.2 24.5 N 1,351 345 2,906

Table 3.23a: Perceived barriers in accessing STI services and condoms: male

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008


60

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 3.24b: Self-efficacy for overcoming barriers: female Percentage of female youth and their ability to overcome barriers relating to own marriage and partner, STI treatment, use of drugs and condoms by residence Agreed with following statements Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Feeling comfortable to talk about own marriage with parents & key adults 50.1 38.0 42.4 Feeling comfortable to talk about own partner with parents & key adults 47.6 36.0 40.2 Feeling comfortable to discuss about STI problems with doctor/paramedic 55.2 59.8 52.8 59.9 53.6 59.9 Feeling comfortable to discuss about STI problems with partner 11.6 66.8 10.0 68.0 10.6 67.6 Friends/peers cannot influence decision to inject a drug 16.3 15.3 15.7 17.1 15.9 16.5 Can ask partner to use condoms 12.8 83.3 19.4 76.1 17.1 78.4 Can convince irregular partner to use condoms 5.0 6.3 8.2 9.3 7.0 8.4 Can buy condoms from a seller who is known to own family 18.4 55.5 18.0 49.4 18.2 51.3 Feeling confident to demand STI treatment from nearby clinic/hospital 74.2 86.1 69.0 77.0 70.9 79.9 Feeling confident to refuse to have sex with someone who presses for it 94.4 95.8 91.0 91.4 92.2 92.8 Confident to decide about sex partner 58.9 90.8 58.7 79.6 58.8 83.2 N 784 1,179 1,386 2,520 2,170 3,699

Table 3.24a: Self-efficacy for overcoming barriers: male Percentage of male youth and their ability to overcome barriers relating to own marriage and partner, STI treatment, use of drugs and condoms by residence Agreed with following statements Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Feeling comfortable to talk about own marriage with parents & key adults 37.7 35.2 36.0 Feeling comfortable to talk about own partner with parents & key adults 35.3 30.7 32.1 Feeling comfortable to discuss about STI problems with doctor/paramedic 76.1 81.7 76.4 80.6 76.3 81.0 Feeling comfortable to discuss about STI problems with partner 30.3 80.0 26.7 80.1 27.8 80.1 Friends/peers cannot influence decision to inject a drug 4.7 6.4 7.7 8.5 6.8 7.8 Can ask partner to use condoms 39.4 91.9 35.6 88.7 36.8 89.7 Can convince irregular partner to use condoms 27.9 46.1 28.7 41.2 28.4 42.8 Can buy condoms from a seller who is known to own family 29.5 71.6 28.0 65.9 28.5 67.8 Feeling confident to demand STI treatment from nearby clinic/hospital 83.3 91.3 79.5 86.2 80.7 87.9 Feeling confident to refuse to have sex with someone who presses for it 77.3 83.2 74.5 79.2 75.4 80.5 Confident to decide about sex partner 66.3 85.2 63 77.9 64.1 80.2 N 1,350 344 2,906 718 4,256 1,062


3.6

Use of illicit substances

As shown in Table 3.25, overall, less than 10% of male youth41 reported ever using any illicit substance in their lifetime. The proportion of young males who ever used illicit substances was significantly higher among urban residents compared to rural residents, and higher among married males compared to unmarried males. The type of illicit substances that were commonly used included: alcohol, cannabis (ganja), heroin and injecting drugs. About one percent of married males mentioned ever having used injecting drugs in their lifetime. Table 3.25: Use of illicit substances

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Percentage of male youth reporting illicit substance use by residence Drug use Urban Rural Unmarried Married Unmarried Married Ever used any illicit substance 5.3 11.3 2.3 7.0 N 1,350 345 2,906 718 Type of illicit substance used Injection 0.0 1.3 0.0 1.4 Alcohol 73.6 65.4 57.3 40.5 Marijuana Yaba 0.0 3.7 0.0 0.0 Cocaine 0.0 2.8 1.8 0.0 Heroin 1.7 10.8 8.7 5.6 Cannabis (Ganja) 46.8 72.5 53.4 84.3 Others 8.1 5.2 11.2 2.7 N 71 39 68 50

61

41

Number of females reporting use of illicit substance was negligible

Total Unmarried Married 3.3 8.4 4,256 1,063 0.0 65.6

1.4 51.4

0.0 0.9 5.1 50.0 9.6 139

1.6 1.2 7.9 79.2 3.8 89


Chapter 4 Young Peopleâ&#x20AC;&#x2122;s Exposure to GFATM Activities


Chapter 4: Young People’s Exposure to GFATM Activities This chapter presents information on young people’s exposure to different GFATM activities targeted at young people. In particular it presents information on their exposure to the slogan Bachte Holey Jante Hobe (Live to Learn), the TV serial Heeraphul, the radio series Jholmolia and the booklet Nijeke Jano. It also provides information on young people’s exposure to some other GFATM activities, such as participation in HIV-related workshops, rallies, HIV-related youth group activities, attendance in YFHS and HIV-related talks from community or religious leaders. Information is presented by gender, marital status and place of residence of young people to see whether there was any a significant difference in the exposure of GFATM activities by these characteristics. These youth-focused GFATM activities started in 2005 and thus information on exposure of these interventions was collected in endline survey only.

4.1

Exposure to the slogan Bachte Holey Jante Hobe

Exposure to the slogan Bachte Holey Jante Hobe was generally high. Among the respondents who had heard the slogan, most of them had also seen an advertisement with the slogan, and almost all of them had seen it as a TV advertisement. Other types of advertisements with the slogan that were mentioned by more than five percent of youth and adolescents included posters, banners and billboards.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 4.1a: Exposure to the slogan Bachte Holey Jante Hobe: male

63

Percentage of male youth exposed to the slogan Bachte Holey Jante Hobe by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Heard about the phrase Bachte 97.2 96.8 93.5 89.6 94.6 92.0 Holey Jante Hobe Seen advertisement with the 94.9 92.2 88.5 80.0 90.5 84.1 phrase Bachte Holey Jante Hobe N 1,350 345 2,906 719 4,257 1,062 Type of advertisement seen on Bachte Holey Jante Hobe TV advertisements 98.4 97.2 97.1 97.9 97.5 97.7 Billboard 14.6 9.5 11.8 7.3 12.7 8.1 Poster/banner 23.8 15.6 22.7 14.8 23.0 15.1 Sticker 0.8 0.2 1.9 1.5 1.5 1.1 Calendar 1.0 0.8 2.6 1.5 2.1 1.3 Bus 2.7 2.3 3.1 1.8 3.0 2.0 Written on wall 2.7 1.4 2.9 1.8 2.9 1.6 Paper/ magazine 2.2 0.8 1.5 0.7 1.7 0.8 Other 1.7 2.3 0.9 0.4 1.2 1.1 N 1,281 318 2,571 5,75 3,852 893 Table 4.1b: Exposure to the slogan Bachte Holey Jante Hobe: female Percentage of female youth exposed to the slogan Bachte Holey Jante Hobe by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Heard about the phrase Bachte 97.7 90.8 85.6 74.7 90.0 79.8 Holey Jante Hobe Seen advertisement with the 96.3 92.3 90.0 80.1 92.5 84.5 phrase Bachte Holey Jante Hobe N 784 1,179 1,386 2,521 2,170 3,699


Type of advertisement seen on Bachte Holey Jante Hobe TV advertisements Billboard Poster/banner Sticker Calendar Bus Written on wall Paper/ magazine Other N

99.0 11.3 16.4 0.5 1.0 1.5 4.2 1.6 0.7 738

98.3 8.7 9.6 0.1 0.2 0.7 2.2 0.8 2.1 988

96.4 8.8 16.9 0.6 1.2 1.3 1.8 1.0 0.9 1,067

97.4 4.6 6.7 0.1 0.5 0.4 1.1 0.6 0.7 1,509

97.4 9.8 16.7 0.6 1.1 1.4 2.8 1.2 0.8 1,805

97.8 6.2 7.9 0.1 0.4 0.5 1.5 0.7 1.3 2,496

The proportion of young people who had heard the slogan was significantly higher among males, unmarried youth and those who lived in urban areas. Urban unmarried females had the highest exposure to the slogan by all channels of exposure and rural married women the lowest (75%).

4.2

Exposure to the TV serial Heeraphul

Overall, there was exposure to the TV serial Heeraphul; females had higher exposure to the serial compared to males. As shown in Tables 4.2a and 4.2b, only 12% of married males and 16% of unmarried males had watched the serial. On the other hand, 26% of unmarried and 17% of married females had watched the serial. As expected, urban youth had better exposure to the serial compared to rural youth. Similarly, unmarried youth had watched the serial more than married youth. These patterns were consistent for both males and females. Among the youth who had watched the serial, most of them watched a few episodes, more than 10% watched many but less than five percent of females and less than two percent of males watched all episodes. The presence of multiple satellite channels maybe considered in this aspect.

Percentage of male youth by their exposure to the TV serial Heeraphul by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Watched the TV serial Heeraphul 19.1 18.8 13.9 8.9 15.6 12.1 N 1,350 345 2,906 718 4,257 1,063 Number of episodes seen of Heeraphul None 6.2 10.8 11.2 12.5 9.2 11.6 Very few 70.5 73.8 61.3 73.4 64.8 73.6 Many 22.1 13.8 26.3 14.1 24.6 14.0 All 1.2 1.5 1.2 1.4 0.8 N 258 65 403 64 662 129 Table 4.2b: Exposure to the TV serial Heeraphul: female Percentage of female youth by their exposure to the TV serial Heeraphul by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Watched the TV serial Heeraphul 33.8 23.4 20.9 13.5 25.5 16.6 N 783 1,178 1,386 2,520 2,170 3,699 Number of episodes seen of Heeraphul None 7.5 9.7 11.8 16.2 9.7 13.2 Very few 50.8 60.3 51.9 62.5 51.4 61.6 Many 34.6 27.4 33.9 18.3 34.2 22.4 All 7.1 2.5 2.4 2.9 4.7 2.8 N 266 277 289 339 555 615

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 4.2a: Exposure to the TV serial Heeraphul: male

64


4.3

Exposure to the radio series Jholmolia

Listenership to the radio series Jholmolia was found to be low. As shown in Tables 4.3a and 4.3b, only 5% of males and a similar proportion of females had listened to this radio series. Rural female youth reported the highest exposure to this program (7.3%). Among the listeners of Jholmolia, less than 2% listened to all episodes and the majority listened to very few episodes only. Table 4.3a: Exposure to the radio serial Jholmolia: male Percentage of male youth by their exposure to the radio serial Jholmolia by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Listen the radio serial Jholmolia 3.5 5.8 5.3 5.7 4.7 5.7 N 1,351 345 2,906 718 4,256 1,063 Number of episodes listen on Jholmolia None 10.9 15.0 7.8 16.7 8.5 15.0 Very few 76.1 75.0 60.8 66.7 64.0 70.0 Many 13.0 10.0 29.4 16.7 25.5 15.0 All 0.0 0.0 2.0 0.0 2.0 0.0 N 46 20 153 42 200 60 Table 4.3b: Exposure to the radio serial Jholmolia: female Percentage of female youth by their exposure to the radio serial Jholmolia by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Listen the radio serial Jholmolia 3.8 4.9 7.3 4.5 6.0 4.6 N 784 1,179 1,386 2,520 2,170 3,699 Number of episodes listen on Jholmolia None 10.0 22.4 13.7 9.6 13.1 14.0 Very few 70.0 62.1 63.7 76.3 65.4 71.9 Many 20.0 12.1 18.6 13.2 18.5 12.9 All 0.0 3.4 3.9 0.9 3.1 1.2 N 30 58 102 114 130 171

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

4.4

65

Exposure to HIV-related class in school

Tables 4.4a and 4.4b present young peopleâ&#x20AC;&#x2122;s exposure to HIV related classes in school. Among those young people who were studying in a school at the time of data collection, 46% of unmarried males and 57% of unmarried females reported having attended classes related to HIV issues. The same figure was 23% and 26%, respectively, for married males and married females. It is important to note than despite this low coverage of HIV-related classes in schools, most students who had attended these classes acknowledged that they had learnt HIV-related issues from these classes. Table 4.4a: Exposure to HIV-related class in school: male Percentage of male youth42 and their exposure to HIV related lessons in school by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Attended class on HIV-related issues 48.9 28.5 44.7 20.6 46.1 23.2 N 867 123 1,768 218 2,635 340 Has learnt from attending HIV97.9 94.3 95.8 88.9 96.5 92.4 related class N 424 35 790 45 1,214 79 42

Collected from respondents attending Grade 6 or higher


Table 4.4b: Exposure to HIV-related class in school: female Percentage of female youth43 and their exposure to HIV related lessons in school by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Attended class on HIV-related 63.4 28.1 53.6 25.4 57.3 26.3 issues N 620 629 1,057 1,305 1,678 1,933 Has learnt from attending HIV93.9 89.3 93.1 86.1 93.5 87.2 related class N 394 177 568 332 960 509

4.5

Exposure to other GFATM activities

Tables 4.5a and 4.5b present information on exposure to other GFATM activities. While exposure to some programs such as LSE was very low (less than ten percent), exposure to some other GFATM activities were relatively high. For example, 11% of unmarried males and 17% of unmarried females had seen the booklet Nijeke Jano. About 20% of males had heard about HIV from community leaders, but the same figure was less than ten percent for females. Table 4.5a: Exposure to other GFATM activities: male Percentage of male youth and their exposure to other GFATM activities by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Seen the booklet Nijeke Jano 13.8 7.8 10.3 3.8 11.4 5.1 Received training on LSE 6.4 7.3 4.7 2.9 5.2 4.3 Heard about HIV from 18.5 19.7 19.8 20.9 19.4 20.5 community leaders Heard about HIV from religious 17.9 18.9 17.1 16.2 17.4 17.0 leaders N 1,350 344 2,906 718 4,256 1,062

Percentage of female youth lescents and their exposure to other GFATM activities by residence and marital status Urban Rural Total Unmarried Married Unmarried Married Unmarried Married Seen the booklet Nijeke Jano 21.2 10.4 15.4 3.8 17.4 5.9 Received training on LSE 7.3 4.8 5.7 3.1 6.3 3.7 Heard about HIV from 11.4 11.5 8.3 6.1 9.4 7.8 community leaders Heard about HIV from religious 6.4 6.1 3.5 2.3 4.6 3.5 leaders N 784 1,179 1,386 2,521 2,170 3,699

43

Collected from respondents attending Grade 6 or higher

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 4.5b: Exposure to other GFATM activities: female

66


Chapter 5 Gatekeepersâ&#x20AC;&#x2122; Interview Results


Chapter 5: Gatekeepersâ&#x20AC;&#x2122; Interview Results This chapter presents information from interviews with gatekeepers. In particular, it presents a summary profile of gatekeepers, their knowledge about HIV/AIDS related issues, their attitudes towards providing SRH information, SRH and HIV/AIDS education and intervention options, and condom use and supply.

5.1

Profile of gatekeepers

In order to be able to examine the differences in the indicators for gatekeepers it was important that the samples of gatekeepers in the baseline and endline survey were comparable. In both surveys, information on age, education, religion, occupation, income and media exposure was collected from parents, teachers and religious/community leaders. After comparing endline results with baseline it was observed that the two samples were more or less comparable with respect to background characteristics. Table 5.1a: Profile of gatekeepers All

4.9 31.9 63.2 45.1 31.2 12.3 9.8 20.9 25.8 85.5 13.1 1.4 50.4 49.6 15.4 16.1 21.3 16.1 17.0 14.2 2,155

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Percentage of gatekeepers by background characteristics Background characteristics Type of gatekeepers Parents Teachers Religious/ community leaders Father Mother Age <30 1.7 2.6 10.5 10.1 30-40 10.4 48.1 44.9 29.2 40+ 87.9 49.3 44.6 60.7 Mean age 51.3 41.3 40.3 45.3 Education No education 43.3 48.2 0.3 4.1 Primary incomplete 16.0 17.8 6.0 Primary complete 12.1 13.3 7.9 Secondary incomplete 21.7 18.1 1.4 43.7 Secondary and above 6.9 2.6 98.3 38.3 Religion Islam 86.4 84.8 80.5 89.9 Hinduism 12.4 13.8 18.4 8.2 Others 1.3 1.4 1.1 1.9 Residence Rural 50.2 50.6 51.4 49.7 Urban 49.8 49.4 48.6 50.3 Division Barisal 15.3 15.3 15.8 15.0 Chittagong 16.5 15.7 16.4 15.8 Dhaka 20.8 21.7 20.3 22.1 Khulna 16.2 15.9 16.4 15.8 Rajshahi 17.2 17.0 16.9 16.9 Sylhet 14.1 14.4 14.1 14.2 N 711 724 354 366

68


The majority of parents, teachers and community leaders were in their forties (Table 5.1a). Only about 41% of fathers and 34% of mothers had completed primary or higher level education, which was somewhat lower compared to the baseline survey. All the teachers and the majority of community leaders had secondary or higher education. As expected, most subjects were Muslims. Among parents, mothers were mostly housewives and fathers were involved in agriculture, trading/small business, and services. Among the religious/community leaders, the main occupation was imam (37%), agriculture (16%), business (24%), and trading (12%). The median monthly household income of parents, teachers, and religious/community leaders was 5,000, 10,000 and 7,000 taka, respectively (Table 5.1b). Table 5.1b: Profile of gatekeepers

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Percentage of gatekeepers by background characteristics Background characteristics Type of gatekeepers Parents Teachers Religious/ community leaders Father Mother Primary occupation Teacher 1.4 1.0 100.0 3.3 Imam/religious leader 0.1 36.6 Other service 13.5 3.2 3.3 Business 23.6 1.4 24.3 Agriculture 35.0 0.3 15.8 Housewife 0.7 89.1 3.3 Skilled workers 14.9 4.1 1.1 Others 10.7 1.0 0.0 12.3 Monthly income No income 0.3 â&#x2030;¤ 1000 0.7 3.6 0.3 0.5 1001-5000 56.1 53.5 10.7 41.8 5001-10000 33.2 32.3 55.6 36.6 10000+ 10.0 10.6 33.3 20.8 Median 6,501.9 6,382.7 11,662.2 8,998.1

69

Mean Media exposure (at least once a week) Newspaper/magazine Radio TV N

All

17.8 6.3 6.1 12.4 14.3 30.7 6.5 5.9

5,000

5,000

10,000

7,000

0.0 1.6 45.3 37.2 15.9 7,733. 5 6,000

34.0 39.2 77.5 711

12.8 19.3 62.8 724

98.6 44.1 96.3 354

87.4 41.0 80.1 366

46.6 33.6 76.1 2,155

Exposure to media such as newspaper/magazine, radio and TV was much higher amongst teachers and religious/community leaders compared to parents. Access to TV was found to be widespread among all gatekeepers. Reading newspaper/magazine was almost universal amongst teachers (99%) and religious/community leaders (87%), but it was low among fathers (34%) and lowest among mothers (13%). Overall, listening to radio was low among all gatekeepers (Table 5.1b).

5.2

Knowledge about HIV/AIDS related issues

Results in Table 5.2 indicate that gatekeepers were well aware of the key issues related to HIV/AIDS. About 84% of fathers, 74% of mothers, and almost all the teachers (100%) and religious/community leaders (97%) had heard of HIV/AIDS. Although awareness about occurrence of HIV/AIDS in Bangladesh among teachers and community leaders showed a slight


increase in the endline survey compared to the baseline survey, a substantial decrease of awareness (61% in endline versus 75% in baseline) was observed among parents. Perception that the HIV/AIDS epidemic can spread among youth and adolescents had also decreased among parents (75% in baseline compared to 74% in endline). Table 5.2: Gatekeepersâ&#x20AC;&#x2122; knowledge and awareness about key HIV/AIDS issues Percentage of gatekeepers having knowledge and awareness about key HIV/AIDS issues Knowledge/Awareness Type of gatekeepers Parents Teachers Religious/ community Father Mother All leaders Heard about HIV/AIDS 84.1 74.3 79.2 100.0 97.0 Aware of occurrence of HIV/AIDS in 72.7 50.1 61.3 96.6 89.1 Bangladesh Perceive that HIV can spread among youth 81.6 66.3 73.9 99.2 94.8 Fear that there may be an HIV/AIDS epidemic among the general public in Bangladesh Know that condom use prevents diseases Know that condom use prevents HIV Heard about STIs (other than HIV) N

All

85.6 71.8 81.6

89.2

67.3

78.1

92.4

93.2

83.0

72.3 67.1 58.6 711

39.9 41.9 35.8 724

56.0 54.4 47.1 1,435

96.3 97.2 91.2 354

85.5 84.2 79.5 366

67.6 66.5 59.9 2,155

Knowledge of routes of HIV transmission was low (Table 5.3) and did not show much improvement during the last three years. Overall, teachers were more knowledgeable about these issues than others. In the endline survey, only 10% of fathers, 6% of mothers (8% of parents), 26% of teachers and 16% of religious/community leaders had the knowledge that unprotected sex with an HIV infected person was the cause of HIV transmission. The comparable figures from the baseline survey were 8% for parents, 30% for teachers and 18% for religious/community leaders. The mean number of correct knowledge about routes of HIV/AIDS infection (out of 6 correct routes) were 0.6 amongst parents, 2.1 amongst teachers and 1.2 amongst religious/community leaders (Table 5.3) indicating only a slight change from the baseline period (Figure 5.1).

Percentage of gatekeepers by knowledge of routes of HIV transmission Type of gatekeepers Parents Teachers Father Mother All Knowledge of routes of HIV transmission Unprotected sex with HIV infected person Receiving HIV infected blood Use of non-sterile needles/syringes Through HIV infected mother during pregnancy/delivery Sex with HIV infected person Through breast feeding by a HIV infected mother Not using a condom during sex Having sex with a sex worker Sex with multiple partners

Religious/ community leaders

All

10.1 21.5 28.7 1.1

5.8 15.6 22.7 2.5

7.9 18.5 25.6 1.8

26.0 70.9 83.1 8.5

15.8 35.0 49.7 3.0

12.3 29.9 39.2 3.1

7.9 0.4

11.6 1.1

9.8 0.8

25.7 7.3

19.4 1.9

14.0 2.0

16.0 49.4 16.6

3.6 7.9 27.3

9.8 28.4 22.0

22.6 54.5 39.0

16.9 61.5 30.1

13.1 38.3 26.2

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 5.3: Knowledge of routes of HIV transmission

70


No. of correct44 routes known 0 1 2 3or more Mean N

56.7 22.8 15.5 5.1

66.2 15.7 11.6 6.5

61.5 19.2 13.5 5.8

3.7 16.9 40.7 38.7

32.8 26.0 27.0 14.2

47.1 20.0 20.3 12.6

711

724

1,435

354

366

2,155

0.7

0.6

0.6

2.1

1.2

1.0

Figure 5.1: Knowledge of routes of HIV transmission, baseline and endline surveys

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

As shown in Table 5.4 knowledge of the ways of HIV prevention amongst gatekeepers was similar to that of the routes of transmission and did not show much improvement during the three year period. Knowledge of limiting sex within marriage as a way of prevention of HIV decreased in the endline survey among all types of gatekeepers (9% for parents, 32% for teachers and 21% for religious/community leaders in endline compared to 17%, 41% and 30% in baseline. However, knowledge of use of condoms during sex as a way to prevent HIV increased among teachers. In the endline survey, about 16% of parents, 49% of teachers, and 31% of religious/community leaders perceived that condom use can prevent diseases compared to 17% of parents, 39% of teachers and 31% of religious/community leaders in the baseline. The mean number of correct knowledge about different ways to prevent HIV (out of 6 ways) was 0.7 amongst parents, 2.2 amongst teachers and 1.3 amongst religious/community leaders, which shows no change from the baseline figures (Figure 5.2). Table 5.4: Knowledge of HIV prevention Percentage of gatekeepers by knowledge of ways to prevent HIV Type of gatekeepers Parents Teachers Father Mother All Knowledge of ways to prevent HIV Limit sex within marriage Use condoms during sex

44

71

11.1 23.1

7.9 8.7

9.5 15.8

31.6 48.9

Religious/ community leaders 21.3 31.4

The first six responses were considered as correct knowledge of HIV transmission as these responses are very specific.

All

15.1 23.9


Avoid HIV infected/unscreened blood transfusion Use sterile syringes/needles HIV infected women should consult doctors before getting pregnant Have a faithful partner Avoid sex with HIV an infected person Avoid sex with a sex worker Avoid sex with multiple partners No. of correct45 ways known 0 1 2 3 or more Mean N

22.1

16.7

19.4

65.0

35.5

29.6

22.6 2.8

20.0 2.2

21.3 2.5

73.2 5.6

38.8 2.7

32.8 3.1

0.4 7.5 48.5 17.2

1.2 10.1 7.0 24.2

0.8 8.8 27.6 20.7

2.5 25.4 49.2 33.3

1.9 20.8 56.8 27.3

1.3 13.5 36.1 23.9

52.0 22.9 17.6 7.5 0.8 711

67.5 14.5 13.0 5.0 0.6 724

59.9 18.7 15.3 6.2 0.7 1,435

3.7 15.3 41.2 39.8 2.2 354

29.2 26. 32.0 12.8 1.3 366

45.4 19.4 22.4 12.9 1.0 2,155

As shown in Table 5.5, awareness of HIV prevention programs in Bangladesh was found to be high among teachers (97%) and community leaders (74%), showing some increase from the baseline survey. However, among parents this awareness decreased from 49% to about 32% during the last three years. When asked to name specific prevention programs, TV/radio programs were the most widely reported HIV prevention programs followed by the government HIV prevention program and school education program. Less than 25% of gatekeepers mentioned about NGO HIV prevention programs. Table 5.5: Awareness about HIV prevention programs Percentage of gatekeepers by their awareness about HIV prevention programs Type of gatekeepers Parents Teachers Father Mother All Aware of HIV prevention programs in Bangladesh N 45

38.8

25.3

32.0

96.6

Religious/ community leaders 73.8

711

724

1,435

354

366

The first six responses were considered as correct knowledge of HIV transmission as these responses are very specific.

All

49.7 2,155

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 5.2: Knowledge of ways to prevent HIV, baseline and endline surveys

72


Types of programs aware of School education program Peer education program HIV/AIDS rally Radio/TV program Govt. HIV prevention program NGO HIV prevention program Others N

21.4 1.4 8.7 80.1 33.0 16.7 9.4 276

16.9 2.2 5.5 76.5 14.2 7.7 9.8 183

19.6 1.7 7.4 78.6 25.5 13.1 9.6 459

60.5 2.9 19.0 86.0 43.0 32.5 7.6 342

27.8 1.1 16.7 74.1 45.2 29.6 13.0 270

34.7 2.0 13.4 79.8 36.0 23.4 9.8 1,071

As gatekeepers can play a vital role in providing SRH information to young people, the HIV/AIDS intervention strategy included sensitization of gatekeepers though meetings and workshops. Table 5.6 shows a poor picture of awareness about HIV/AIDS youth programs in the community and low attendance of gatekeepers in courtyard meetings with youth. Only 7% of parents, 37% of teachers, and 25% of community leaders were found aware about HIV/AIDS youth programs in the community. Types of programs they were aware about included education programs in schools (67%), courtyard meetings with youth (28%) and peer education programs (19%). Teachers had the highest awareness about school education programs compared to other types of gatekeepers; religious/community leaders and mothers knew most about courtyard meetings, whereas fathers knew the most about peer education programs in the community. As shown in Table 5.6, more than 95% of parents and 75% of religious/ community leaders and teachers had not attended any community meetings on HIV/AIDS. In other words, less than 4% of parents and about one-fourth of teachers and community leaders participated in one or more sensitization meetings or workshops for youth. Religious/community leaders showed the highest attendance in such meetings (mean number 1.6) compared to teachers (mean number 0.8) and parents (mean number 0.2)

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 5.6: Awareness and participation in HIV and SRH related youth programs in the community

73

Percentage of gatekeepers by their awareness and participation in HIV related youth programs in the community Type of gatekeepers All Parents Teachers Religious/ Aware of HIV/AIDS youth program 7.5 7.6 7.5 37.3 24.6 15.3 in the community N 711 724 1,435 354 366 2,155 Type of youth programs aware of Courtyard meeting with youth 22.6 36.4 29.6 20.5 36.7 27.9 Education program in a school 50.9 50.9 50.9 78.0 68.9 66.7 Peer education program 28.3 21.8 25.0 16.7 15.6 19.1 Life skills education program 9.4 7.3 8.3 9.1 5.6 7.9 Others 11.3 3.6 7.4 10.6 11.1 9.7 N 53 55 108 132 90 330 No. of such meetings attended 0 96.5 96.1 96.3 76.0 74.9 89.3 1 2 3 or more Mean no. of meetings attended N

0.4 0.8 2.2 0.2 711

1.1 0.8 2.0 0.1 724

0.8 0.8 2.1 0.2 1,435

5.4 7.6 11.0 0.8 354

2.7 5.2 17.2 1.6 366

1.9 2.7 6.1 0.5 2,155


5.3

Attitude towards providing SRH and HIV/AIDS information

The attitude of parents, teachers and religious/community leaders towards providing SRH information to youth and adolescents was found to be very positive. Almost all of them agreed that young people should receive SRH and HIV/AIDS related information and services (Table 5.7). However, almost half of the gatekeepers (56% of parents, 47% of teachers and 49% of community leaders) were in favor of providing this information to boys when they are 15 years or older. The recommended age for girls was lower with more than half of the gatekeepers wanting to provide such information to girls when they are 13 years or younger.

Percentage of gatekeepers by their attitudes towards providing SRH information to youth and adolescents Type of gatekeepers All Parents Teachers Religious/ community Fathers Mothers All leaders Young people should receive SRH and 98.6 96.3 97.4 99.7 99.7 98.2 HIV/AIDS information and services Recommended age for males Age <13 26.9 29.4 28.2 20.3 27.6 26.8 Age 13 5.5 6.6 6.1 8.5 7.9 6.8 Age 14 11.5 7.2 9.3 24.6 15.3 12.9 Age 15 22.5 20.4 21.5 23.2 21.0 21.7 Age >15 33.6 36.3 35.0 23.4 28.1 31.9 Recommended age for females Age <13 48.0 40.6 44.3 46.0 49.7 45.5 Age 13 11.8 8.7 10.2 15.8 12.8 11.6 Age 14 10.4 8.7 9.5 17.5 15.0 11.8 Age 15 13.9 19.9 16.9 11.0 10.9 14.9 Age >15 15.9 22.1 19.0 9.6 11.5 16.2 Suggested ways By parents/guardians 33.6 42.0 37.8 42.7 35.5 38.2 By peers/friends 33.1 23.8 28.4 24.9 28.4 27.8 By sisters/brothers/ brothers or 17.0 28.0 22.6 5.6 10.7 17.8 sisters in law By grand mothers 24.8 21.1 22.9 8.2 11.2 18.5 By imams/ religious leaders 5.5 0.6 3.0 13.6 26.0 8.6 By teachers/school 31.1 19.1 25.0 83.1 52.2 39.2 By doctors/health workers/health 19.1 16.4 17.8 26.3 27.9 20.9 centers By radio 21.1 7.7 14.4 28.2 20.5 17.7 By TV 43.3 29.7 36.4 55.9 46.4 41.3 By newspaper/magazine/ leaflet 4.2 3.3 3.8 22.9 12.0 8.3 Others 32.6 14.6 19.9 50 50.6 32.5 Would allow own child to attend 95.4 93.4 94.4 96.6 97.8 95.3 programs providing HIV/AIDS and SRH information N 711 724 1,435 354 366 2,155

Among parents the most cited way of providing preventive information was by parents themselves (38%), followed by TV (36%). Among teachers, the most cited way of providing such information was by teachers themselves (83%), followed by TV (56%). Among community leaders, the most cited way of providing such information was by teachers (52%), followed by TV (46%).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 5.7: Attitudes towards providing SRH and HIV/AIDS information to youth and adolescents

74


About one-fourth of gatekeepers believed that preventive information can be provided through peers/friends. About 26% of religious and community leaders thought that imams were appropriate to disseminate such information to youth (Table 5.7). However, only a negligible proportion of parents (3%) and teachers (14%) considered imams or religious leaders as appropriate to provide HIV/AIDS and SRH information. When asked about their willingness to permit their own children to attend programs providing HIV/AIDS and SRH education (Table 5.7), more than 90% of all types of gatekeepers responded in an affirmative way. The main reason for allowing youth to attend these programs was to raise awareness. The principal reason for not permitting them to receive this information was that young people would get spoiled by having this information. Table 5.8 presents information on gatekeepersâ&#x20AC;&#x2122; attitudes towards discussing SRH issues with young people themselves. Most of them (88% of parents, 98% of teachers, and 95% of community leaders) were of the opinion that they themselves should discuss SRH issues with youth and adolescents; however, when asked about their position in discussing such matters, a quarter of them acknowledged that they would not be able to discuss these issues with youth. Mothers, teachers and community leaders seemed more confident in providing SRH information to young people than fathers. The main reasons for not wanting to discuss SRH issues with youth were that such information would spoil young people and that it was impossible to discuss such issues with young people.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 5.8: Attitudes towards discussing SRH issues with youth and adolescents

75

Percentage of gatekeepers by their attitude towards discussing SRH issues with youth and adolescents Type of gatekeepers Parents Teachers Religious/ community Father Mother All leaders Felt that s/he should discuss SRH issues 87.8 88.5 88.2 97.7 95.1 with youth and adolescents N 711 724 1435 354 366 Reasons for discussing Raise awareness 88.6 88.3 88.5 93.6 92.0 Prepare for future SRH 8.8 4.8 6.8 20.2 16.4 Improve skills in discussing their SRH 6.9 6.4 6.6 14.7 9.2 Increase knowledge on SRH 15.2 15.0 15.1 26.0 18.1 N 624 641 1265 346 348 Reasons for not discussing Youth and adolescents will be spoiled 40.2 36.1 38.2 37.5 44.4 They will learn it at the right time 12.6 18.1 15.3 0.0 11.1 Impossible to discuss this with youth and 44.8 27.7 36.5 75.0 61.1 adolescents Parents/guardians do not know about 11.5 26.5 18.8 25.0 0.0 HIV/AIDS N 87 83 170 8 18 Personal position in discussing Can discuss easily 27.3 54.0 40.8 57.1 49.5 Can discuss somewhat easily 36.6 17.8 27.1 36.7 35.0 Cannot discuss at all 36.1 28.2 32.1 6.2 15.6 N 711 724 1435 354 366

All

90.9 2,155 90.0 10.9 8.5 17.6 1959 38.8 14.3 40.3 17.3 196 44.9 30.0 25.1 2,155


5.4

Suggested SRH and HIV/AIDS education and intervention options

Results in Table 5.9 indicate gatekeepers very positive attitudes towards providing HIV/AIDS and SRH education through schools/colleges/technical colleges/ madrasas . For instance, more than 97% of parents, teachers and religious/community leaders would be supportive of HIV/AIDS education in these institutions. Almost the same proportion (96%) would approve education about STIs by the same means. A slightly lower proportion, but about 80% of all types of gatekeepers were supportive of education on condoms in these educational institutions, marking a substantial increase from the baseline survey (Figure 5.3). Table 5.9: Support in selective interventions in schools, colleges, technical colleges or madrasa Percentage of gatekeepers who support provision of HIV/AIDS and SRH education in schools/ colleges/technical colleges or madrasas Type of gate keeper All Parents Teachers Religious/ community leaders Father Mother All HIV/AIDS education 96.8 96.1 96.4 99.2 100.0 97.5 Education about STIs 95.2 93.4 94.3 99.2 98.6 95.8 Education on condoms 81.4 74.4 77.9 77.1 83.9 78.8 N 711 724 1,435 354 366 2,155

Teachers were asked about the status of current provision of HIV/AIDS and SRH education in their schools. About 82% of teachers said that HIV/AIDS was taught in their schools; however, only 40% of teachers taught this topic themselves and one third of them admitted feeling uncomfortable while teaching the chapter on HIV/AIDS.

5.5

Attitudes towards condom use and supply

About 70% of gatekeepers believe that condom use can prevent diseases. When asked about itsâ&#x20AC;&#x2122; role in preventing HIV, most of the gatekeepers also believed that condom use can prevent HIV. Gatekeepers were also asked whether they agreed with several statements related to the use and supply of condoms. The majority of gatekeepers agreed that condoms must be used to prevent

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 5.3: Percentage of gatekeepers supportive of condom education in schools, colleges, technical colleges and madrasa

76


STIs, indicating a slight improvement in this indicator compared to the baseline results. (87% of parents, 95% of teachers and 92% of religious/ community leaders in endline compared to 82% of parents, 94% of teachers and 83% of religious/community leaders in baseline). About 89% of parents, 97% of teachers of 93% of religious/community leaders agreed with the statement that condoms must be used to prevent the spread of HIV. Although the knowledge of condom use as a preventive measure for STIs and HIV was quite high amongst the gatekeepers, they showed very conservative attitude towards condom supply to unmarried youth and adolescents. Only 26% of gatekeepers supported selling condoms to unmarried adolescents and the same figure was 29% in selling condoms to unmarried youth (Table 5.10). A similar pattern was observed in the baseline survey. Table 5.10: Attitudes towards condom use and supply Percentage of gatekeepers by their attitude towards condom use and supply Type of gatekeepers Parents Teachers Father Mother All Believes that condoms can prevent diseases Believes that condoms can prevent HIV Agrees with following statements Condoms must be used to prevent STIs Condoms must be used to prevent HIV Condoms should be sold to married male and female adolescents Condoms should be sold to unmarried male and female adolescents Condoms should be sold to married male and female youth Condoms should be sold to unmarried male and female youth N

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

5.6

77

Religious/ community leaders 85.5 84.2

All

72.3 67.1

39.9 41.9

56.0 54.4

96.3 97.2

67.6 66.5

91.0 92.1 94.2

82.6 86.7 93.5

86.8 89.4 93.9

95.5 97.5 98.3

91.8 93.2 91.8

89.0 91.4 94.2

33.9

9.9

21.8

34.7

30.9

25.5

95.2

92.4

93.8

98.3

92.1

94.2

35.2

11.5

23.2

42.4

37.2

28.7

711

724

1,435

354

366

2,155

Awareness and exposure to GFATM activities

Gatekeepers were asked if they were aware of different GFATM activities (asked by their names) in their area. While their awareness about the advertisement Bachte Hole Jante Hobe was high, their awareness about other GFATM activities such as the TV serial Heeraphul, radio serial Jholmolia or the booklet Nijeke Jano was found to be below 20% (Table 5.10). Table 5.11: Awareness about GFATM activities Percentage of gatekeepers by awareness about GFATM activities in their area Type of gatekeepers Type of GFATM activities being aware of Parents Teachers Religious/ community leaders Advertisements on Bachte Hole Jante Hobe 77.4 99.7 94.3 TV serial Heeraphul 11.1 28.5 14.5 Radio serial Jholmolia 3.1 5.1 5.2 Booklet â&#x20AC;&#x2DC;Nijeke Janoâ&#x20AC;&#x2122; 3.5 41.0 19.1 HIV/AIDS rally 8.2 0.0 0.0 N

1,435

354

366

All 83.9 14.6 3.8 12.3 5.4 2,155


Chapter 6 Health Service Providersâ&#x20AC;&#x2122; Interview Results


Chapter 6: Health Service Providersâ&#x20AC;&#x2122; Interview Results This chapter presents information from interviews with health service providers. In particular it presents a summary profile of service providersâ&#x20AC;&#x2122; views about provision of services for young people, especially about the quality of services provided, service utilization by young people, their perceptions about the HIV epidemic and HIV prevention and their involvement and attitude towards HIV intervention programs.

6.1

Profile of service providers

The profile of service providers in both baseline and endline surveys was largely similar. The average age of service providers was 40 years and 66% of them were male. About 39% of service providers had a Bachelor in Medicine and Bachelor in Surgery (MBBS)/ Fellow of Royal College of Physicians and Surgeons (FCPS)/ Masters of Public Health (MPH) degree and others were mostly paramedic level providers engaged in providing SRH services. The other providers had either paramedic training, diploma in nursing, Licentiate Medical Faculty doctors (LMF) training, diploma in medical assistance or a rural medical practitioner (RMP) training (Table 6.1).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 6.1: Profile of service providers

79

Percentage of service providers by selected background characteristics Type of residence Urban Rural Age < 30 19.8 17.7 30-40 36.3 28.5 40+ 44.0 53.8 Mean 39.4 40.5 Sex Male 60.4 71.8 Female 39.6 28.2 Marital status Ever married 88.7 90.1 Never married 11.3 9.9 Professional education MBBS/FCPS/MPH 51.9 25.4 FWV training 12.6 19.4 Diploma in Nursing 3.3 1.4 Paramedic training 12.9 7.6 LMF/ Palli (village) doctor/ RMP training 8.5 20.0 Diploma in Medical Assistant/SACMO 6.3 22.5 Others (Pharmacist training/ General education/FWA) 4.4 3.7 Type of providers by background Doctors/physicians 52.5 25.6 Paramedics 34.1 49.3 Drug sellers/pharmacists 13.5 25.1 Type of providers by affiliation Government providers 56.9 37.9 NGO providers 7.9 24.7 Private providers 35.2 37.4 N 364 355

All 18.8 32.4 48.8 40.0 66.1 33.9 89.4 10.6 38.8 16.0 2.4 10.3 14.2 14.3 4.0 39.2 41.6 19.2 47.3 16.4 36.3 719

Half of the qualified doctors were from government services followed by private practitioners. Among the other service providers about half were from government services, one-fourth from


the NGO sector, and the rest were private practitioner. Government providers were working in government/ municipal hospitals, Upazilla Health Complexes, Maternal and Child Welfare Center (MCWC), and Family Welfare Centre (FWC). NGO providers were from NGO clinics. Private practitioners were either practicing in their own chamber or they were drug sellers cum service providers.

6.2

Quality characteristics of existing services

To examine the status and quality of services provision for young people, information was collected on training and orientation of service providers, service provision in the facility and the clinic environment. Table 6.2 shows that overall two-thirds of service providers received training on SRH and HIV/AIDS issues. A higher proportion of NGO (72%) and Government providers (58%) than private providers (47%) received such training. Table 6.2: Providersâ&#x20AC;&#x2122; training and characteristics of existing service provision

However, orientation training about youth and adolescent services was relatively low. A higher proportion of NGO providers (55%) received such an orientation compared to government (40%) and private providers (30%). The respondents also reported that only one-fourth of other staff in their hospital/clinic/facility received such an orientation. When compared with the same findings from baseline survey, a decreasing trend is observed for all types of providers (Figure 6.1). Availability of instruments needed for providing SRH services to young people was very limited particularly in government and private facilities as shown in Table 6.2. Only 33% of government and 21% of private providers had enough instruments compared to 72% for NGO providers. Most of the government and NGO health service providers reported that there was a signboard in their facility listing available services and clinic working hours. There is slight improvement in this reporting since the baseline survey conducted in 2005 (Figure 6.2). Availability of print materials such as leaflets/booklets for clients to take home was very limited in government and private facilities. However, as reported by the providers most of the government and NGO providersâ&#x20AC;&#x2122; facilities had education posters displayed. Overall, less than one-third of all service providers were of the opinion that their existing facility provided a comfortable setting for youth-friendly services to adolescent and youth clients. Youth friendly

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Percentage of service providers by their response to selected indicators related to training received, service provision and environment in the clinic Type of provider All Govt. NGO Private provider provider provider Received training on SRH and HIV/AIDS 57.9 72.0 47.1 56.3 Received orientation on providing services to youth and 39.7 55.1 30.3 38.8 adolescents Other staff in the facility had orientation on providing 27.4 53.4 10.3 25.5 services for youth and adolescents Have enough instruments for providing SRH services 32.6 72.0 20.7 34.8 Services and clinic hours are listed on a signboard 87.1 94.1 62.1 79.1 Printed leaflets/books are available for clients 28.8 72.9 12.3 30.0 Educational posters are displayed 82.9 95.8 48.7 72.6 Has written guidelines to provide services to youth and 12.4 51.7 8.0 17.2 adolescents Has privacy in consultation room 80.0 94.9 69.7 78.7 Has provision of youth-friendly services 26.5 61.9 17.2 28.9 N 340 118 261 719

80


service provision was more prevalent in NGO facilities (62%) than government (26%) and private facilities (17%). Figure 6.1: Percentage of providers who received orientation training about providing services to youth clients, baseline and endline surveys

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 6.2: Percentage of providers who mentioned that services and clinic hours are listed on a signboard in their facility, baseline and endline surveys

81

6.3

Provision of services to adolescents and yout h

When asked about the provision of health services to young people, about 93% of all service providers reported that they provided SRH services to youth and adolescents and about 92% also reported that they provided STI services, indicating some improvements between the baseline and endline surveys (84% and 87%, respectively, in baseline survey). The type of STI services that were provided included testing, treatment and counseling for STI patients; 41% of providers also mentioned having referred STI clients to other facilities for further treatment. The pattern was similar in all three service provider categories. There was a high prevalence of referral practices as reported by all types of service providers. The type of patients who were referred included severe STI management, complicated deliveries and high-risk pregnancies.


More than half of the providers mentioned providing family planning services to married adolescents and youth; however, only about a quarter reported providing the same service to everybody, irrespective of their marital status. As shown in Figure 6.3, there is no significant change in the status of distribution of contraceptives to youth clients with regard to marital status. Table 6.3: Type of services provided to young people Percentage of service providers providing different types of services to young people Type of provider Govt. provider

NGO provider

All Private providers

Provide RSH services to young people

92.6

97.5

91.6

93.0

Provide STI services

92.4

95.8

90.4

92.2

N

340

118

261

719

STI testing STI laboratory STI treatment Counseling

24.2 8.9 76.1 67.5

43.4 16.8 85.8 75.2

24.2 11.4 82.2 54.2

27.5 11.2 79.9 64.1

Referral N

43.0 314

42.5 113

39.0 236

41.5 663

Provide referral services N

96.5 340

96.6 118

94.6 261

95.8 719

Types of services referred Severe STI Complicated delivery/ caesarian Danger symptoms during pregnancy

44.8 73.5 68.3

53.5 67.5 73.7

55.1 53.4 55.1

49.9 65.3 64.4

N

10.7 36.9 22.3 328

15.8 32.5 19.3 114

12.1 39.3 20.2 247

12.0 37.0 21.0 689

Provide FP services to young people Married only Everybody None N

67.4 20.3 12.4 340

59.3 26.3 14.4 118

45.6 26.1 28.4 261

58.1 23.4 18.5 719

Type of FP methods provide Condoms Oral pill Injectables Others N

90.9 92.3 70.1 17.1 298

99.0 92.1 71.3 15.8 101

92.5 90.9 32.6 0.5 187

92.8 91.8 58.4 11.6 586

Family planning Excessive bleeding MR

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Type of STI services provided

82


Figure 6.3: Percentage of providers who distribute contraceptives to all youth clients irrespective of marital status, baseline and endline surveys

About 97% of all service providers held the opinion that youth and adolescents of the locality knew about the SRH services provided by their facility. More than 90% of providers also believed that male and female youth and adolescents come to their facility to seek services. They reported that among young males who sought a service a majority came for general health issues followed by STIs, reproductive health, and family planning advice. Young females mostly sought services for general health, reproductive health, STIs, family planning, and antenatal care (Table 6.4).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 6.4: Type of services provided to young people

83

Percentage of service providers by their perceptions about types of services provided to young people Type of provider All Govt. NGO Private provider provider provider Perceive that local youth and adolescents are aware of SRH 96.2 99.1 96.7 96.9 services provided Male youth and adolescents come to seek services 86.0 90.4 96.2 90.4 Female youth and adolescents come to seek services 96.5 96.5 94.6 95.8 N 340 118 261 719 Type of services young males seek General health 86.7 91.3 93.5 90.1 Family planning 43.5 39.4 34.8 39.5 Reproductive health 48.7 59.6 38.7 46.8 HIV/AIDS 5.9 17.3 2.6 6.6 STI 57.6 66.3 69.6 63.6 N 271 104 230 605 Type of services young females seek General health 85.2 90.1 94.2 89.0 Family planning 49.0 54.1 41.2 47.1 Reproductive health 57.6 69.4 41.6 54.0 HIV/AIDS 3.3 10.8 3.1 4.5 STI 47.7 66.7 49.6 51.6 Tetanus Toxoid (TT) 19.7 48.6 7.1 20.3 Antenatal care (ANC) 48.0 62.2 38.9 47.3 Child health 33.9 49.5 40.7 39.0 N 304 111 226 641


The results in Table 6.5 showed that service providers had somewhat positive attitudes towards providing SRH services to unmarried young people. About 71% of all service providers reported that adolescent clients were served without regard to their marital status. However, 49% of service providers required parental/spousal consent for providing these services. The services for which parental/spousal consent was required prior to providing services were mainly menstrual problem of unmarried girls (49%), family planning (46%), STI problems of unmarried girls (44%), and menstrual regulation (37%) (Table 6.5). Table 6.5: Access to services Percentage of service providers by their response on whether knowing marital status and prior consent is required for providing SRH services Type of provider

All

Govt. provider

NGO provider

Private provider

Serve young clients without regard to marital status Parental/spousal consent are required for getting services N

73.2 52.9 340

76.3 50.0 118

66.7 44.8 261

71.3 49.5 719

Type of services for which consent is needed Menstrual problem for unmarried girls STI problem for unmarried girls Menstrual problem for married girls STI problem for married girls STI problem for unmarried boys Family planning Menstrual regulation Others N

51.1 41.1 20.6 27.8 13.3 53.9 45.0 2.8 180

52.5 57.6 18.6 45.8 13.6 39.0 27.1 5.1 59

45.3 41.9 26.5 30.8 24.8 36.8 30.8 3.4 117

49.4 44.1 22.2 31.7 17.1 45.8 37.4 3.4 356

Table 6.6: Privacy in the health facilities Percentage of service providers by their response on privacy issues in delivering SRH services Type of provider Govt. NGO Private provider provider provider Both visual and auditory privacy are maintained 80.0 94.9 67.7 Consultation process is private 92.1 100.0 87.0 Written procedure exists to protect client’s confidentiality 25.9 58.5 14.2 N 340 118 163

6.4

All 78.7 91.5 27.0 719

Perception about peoples’ attitude towards condom supply and STI services for young people

Service providers were asked what they think about peoples’ attitude towards condom supply and STI treatment for young people. Although the knowledge of condom use as a preventive measure for STIs and HIV/AIDS was quite high amongst service providers, they showed

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

When asked about the privacy in the health facility, about four-fifths of all providers reported that they provide both visual and auditory privacy in their facilities. This figure was highest for NGO providers (95%) and lowest for private providers (68%). However, only about one-fourth of all providers reported that they had a written procedure to protect clients’ confidentiality (Table 6.6).

84


conservative attitudes towards selling condoms to unmarried youth and adolescents (Table 6.7). Sixty percent of providers agreed that condoms should be sold to unmarried youth or adolescents 6.7). Similarly, only about one-fifth of them felt that unmarried young people would be treated in a respectful manner if they requested a condom at a clinic or if they visited a pharmacy to buy condoms (Table 6.8) and this figure was lower than in the baseline survey (28%). However, nearly two-thirds believed that young people would be treated in a respectful manner if they requested STI services or information on STIs at a clinic (70%) or a pharmacy (63%). Table 6.7: Knowledge about condom use Percentage of service providers who agree with the following statements regarding condom use Statements Type of provider Govt. NGO Private provider provider provider Condoms must be used to prevent STIs 99.7 99.2 98.5 Condoms can prevent spreading HIV/AIDS 98.8 99.2 97.7 Condoms should be sold to married adolescents 99.7 100.0 98.9 Condoms should be sold to unmarried adolescents 53.5 65.3 59.4 Condoms should be sold to married youth 99.1 100.0 99.6 Condoms should be sold to unmarried youth 56.2 72.0 64.4 N 340 118 261

All 99.2 98.5 99.4 57.6 99.4 61.8 719

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 6.8: Perception about social barriers to condom supply & STI treatment

85

Percentage of service providers by their perception about peoplesâ&#x20AC;&#x2122; attitude towards condom supply, sexual health information and treatment to adolescents & youth Perceive that Type of provider All Govt. NGO Private provider provider provider Unmarried young people would be treated in a respectful 17.6 30.5 21.5 21.1 manner, if they requested a condom at a clinic Unmarried young people would be treated in a respectful 17.4 24.6 20.3 19.6 manner, if they visit a pharmacy to buy a condom. Young people would be treated in a respectful manner, if they 65.6 80.5 70.1 69.7 requested STI services or information on STIs at a clinic Young people would be treated in a respectful manner, if they 60.3 63.6 65.1 62.6 went to a pharmacy for services or information on STIs N 340 118 261 719

6.5

Perception about the HIV/AIDS epidemic and its prevention

Almost all of the service providers were aware of the global HIV/AIDS epidemic and they perceived that the epidemic is likely to spread to adolescents and youth. About two-thirds of service providers perceived that HIV/AIDS has already spread widely amongst young people of Bangladesh (Table 6.9). They held the opinion that commercial sex workers, migrant workers, transport workers, those who visit commercial sex workers, and injecting drug users were the main risk groups in the HIV/AIDS epidemic. When asked whether they were aware of HIV/AIDS prevention programs going on in Bangladesh, almost all service providers answered positive. They reported being aware of radio/TV programs, government and non-government HIV/AIDS prevention programs, HIV/AIDS rallies and peer education programs (Table 6.9).


Table 6.9: Perception about HIV/AIDS epidemic and HIV/AIDS programs in Bangladesh Percentage of service providers by their perception about HIV/AIDS epidemic in Bangladesh and awareness about HIV/AIDS programs in Bangladesh Type of provider Govt. provider Aware of global HIV/AIDS epidemic Perceive that HIV/AIDS epidemic is likely to spread among adolescents Perceive that HIV/AIDS epidemic is likely to spread among youth Perceive that HIV/AIDS has already spread widely among Bangladeshi youth Aware of HIV/AIDS prevention programs in Bangladesh N Type of HIV prevention programs aware of School education program Peer education program HIV/AIDS rally Radio/TV program Govt. HIV/AIDS prevention program NGO HIV/AIDS prevention program Family planning program N

6.6

NGO provider

All

Private provider

99.4 98.8

100.0 98.3

99.6 96.6

99.6 97.9

99.7

100.0

98.5

99.3

64.1

60.2

59.0

61.6

98.5 340

98.3 118

97.7 261

98.2 719

26.9 2.7 34.6 86.6 60.3 43.9 22.4 335

28.4 12.9 47.4 89.7 67.2 69.0 18.1 116

23.5 4.3 31.0 91.0 52.2 42.0 14.1 255

25.9 5.0 35.4 88.7 58.5 47.3 18.7 706

Involvement and attitudes towards HIV/AIDS intervention programs

Table 6.10: Involvement and willingness to participate in HIV/AIDS activities Percentage of service providers by their involvement and willingness to participate in HIV/AIDS related activities HIV/AIDS related activities Type of provider All Govt. NGO Private provider provider provider Involved with HIV/AIDS related activities 82.6 93.2 73.6 81.1 N 340 118 261 719 Type of activities involved Meeting with adolescents 13.5 35.5 4.7 14.8 Attending a HIV/AIDS rally 16.4 33.6 12.5 18.4 Giving advice on condom use 63.0 76.4 63.0 65.5 Giving advice for using sterile needles/syringes 53.0 48.2 55.7 53.0 N 281 110 192 583 Willing to support following activities Counsel youth how HIV/AIDS spreads 99.1 100.0 98.5 99.0 Counsel married youth about condom use 99.4 99.2 98.5 99.0 Counsel unmarried youth about condom use 82.6 89.0 85.8 84.8 N 340 118 261 719

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

About four-fifths of service providers reported being involved in an HIV/AIDS activity. Involvement and participation in HIV/AIDS activities was highest among providers from the NGO sector and lowest among providers from the private sector. The main HIV/AIDS activities of providers were giving advice for condom use, providing advice for using sterile needles/syringes, and attending HIV/AIDS rallies (Table 6.10). Almost all of them stated willingness to support and contribute to HIV/AIDS activities in the form of counseling married and unmarried youth on HIV/AIDS prevention and condom use.

86


Chapter 7 Policy Planners Interview Results


Chapter 7: Policy Planners Interview Results This chapter presents major findings from interviews with policy planners. It describes their views about HIV/AIDS as a problem in Bangladesh. It also presents policy planners’ awareness and knowledge about current HIV/AIDS prevention programs in Bangladesh. Their suggestions on different strategies that can be adopted to prevent HIV/AIDS are also presented.

Profile of policy planners interviewed

7.1

All policy planners (5) were male and were working in their present position for the last five to ten months. Prior to the present position they worked in other ministries and offices including the Ministry of Foreign Affairs, Ministry of Health, Ministry of Education, and the World Bank. All of them were administrative cadres of the Government of Bangladesh holding different ranks and senior positions for the last 20-25 years. At the time of the interview, most of them were in the position of the Joint Secretary, and two of them were Director Generals (DG) in their respective offices and all were the focal person for HIV/AIDS in their respective ministries.

7.2

Policy planners’ perceptions about HIV as a problem for Bangladesh

The policy planners were asked about their views on HIV/AIDS as a problem in Bangladesh in the context of the global scenario. All of them acknowledged that HIV/AIDS was a problem for Bangladesh. The following reasons for this were identified: 

   

High prevalence of HIV/AIDS in neighboring countries like India and Myanmar (3) and People from Bangladesh very frequently go to neighboring and other countries where they can contract HIV/AIDS (3) People are not sufficiently aware of HIV/AIDS and get involved in risky sexual behavior (2) Drug abuse ‘Free mixing’(boys and girls can meet before marriage) Low education

Some policy planners (3) thought that young people were particularly vulnerable to HIV/AIDS because of the following reasons:  Young people are easily attracted to opposite sex (1)  Drug use among youth has increased significantly (1)  Premarital sex has increased (1)  Frustration due to broken family (lack of family ties, divorce and/or separation between parents) makes young people vulnerable (1) Two policy planners considered the general population to be vulnerable, not young people in particular. One of them explained his opinion from an economic point of view: “Youth do not have enough money to buy sex. People from the middle class are at risk due to their financial condition only; they can afford to go to commercial sex workers. People of higher socio-economic status do not go to sex workers, but select sex partner from among their few close acquaintances. Girls who come to cities in search of job are vulnerable and therefore get sexually abused. Service holders and businessmen are vulnerable as they can afford to buy sex. Males aged 25-35 years are most vulnerable. Young people aged 15-25 have little access to sex as they do not have the adequate money.”

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

One of them explained it in the following way: “HIV/AIDS is not an epidemic or crisis at the moment, but definitely a problem for Bangladesh”.

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The other policy planner who spoke about the vulnerability of the general population said that behavior of young people in Bangladesh was controlled by social values. However, he acknowledged that transport workers such as truck drivers and their assistants traveled to different places and stayed there for several days, spent nights at hotels and had sex with commercial sex workers and therefore, were vulnerable to HIV. He added that workers of tea gardens and those working in the industrial belt were also vulnerable due to their risky sexual behavior. All policy planners (5) felt that urban youth were more vulnerable than their rural counterparts because they had more opportunities of meeting someone from the opposite sex. Opinions regarding vulnerability among school-attending and not-school-attending youth were divided; two policy planners viewed young people who were going to school as more vulnerable as they interacted with people from the opposite sex more often. Two other policy planners thought that out-of-school youth were more vulnerable because they had more free time for fun, including time for sex. Some regarded males (1) and married (1) people as being more vulnerable than others.

7.3

Awareness towards HIV prevention programs in Bangladesh

In general, focal persons were found to be aware of HIV prevention programs in Bangladesh. While referring to types of programs they were aware of, they referred to the programs they had been implementing under their own ministries (4). In addition, they referred to mass media campaigns such as the Bachte Hole Jante Hobe slogan and TV spots (3), seminars (2), and concerts targeting the HIV/AIDS issue (1). Two participants made references to HIV/AIDS and STD Alliance of Bangladesh (HASAB) life skills education program and PIACT’s school curriculum intervention, one mentioned World AIDS Day, and another referred to the NGO awareness building program.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Policy planners briefly described involvement of their respective ministries in HIV prevention as follows:  The ministry of Religious Affairs runs a project that offers training to imams, priests and monks on poultry raising and gardening as part of their human resource development initiatives. Information on HIV/AIDS is included in this training curriculum. 3,500 imams were trained every year through seven Imam training academies and HIV and gender equity were discussed during the training. This project is targeted to cover 350,000 imams in 200,000 mosques nationwide.

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The Ministry of Youth Affairs has different income generation/skill development training programs for youth. Sixty training institutions are offering training on livestock raising, poultry and agriculture to youth, hoping to make them self-sufficient in future. A chapter on HIV has been incorporated in this training curriculum. The Ministry of Education has inserted a chapter on HIV in the text books of 6-10th grade students and imparted training to the class teachers, supported by GFATM funds. Teachers were reported to be teaching HIV in the classroom after that. The Ministry of Labor has two projects on HIV prevention; one with tea garden laborers and the other for garments workers, with support from UNFPA. The Ministry of Social Affairs has 147 rehabilitation centers for different groups of people including a centre for retarded people, commercial sex workers, a juvenile centre and a bohemian centre, and has worked on including HIV information into the teaching curriculum for these different centers.


Three policy planners mentioned some GFATM activities and their involvement in it, as they were the focal person for these activities.

7.4

Preferred source of HIV/AIDS information

The policy planners opined that the mass media, peers, parents, teachers, service providers, program personnel, and policy planners had a definite role to play in prevention of HIV in Bangladesh. One policy planner suggested adopting a holistic approach, that is, to include civil society, administration, teachers, imams, service providers and media to prevent HIV in the country. Media All focal persons (5) mentioned that electronic media could play a vital role in providing information on HIV prevention and building awareness and they wanted to see the current efforts to continue. One policy planner said: “HIV/AIDS information through mass-media is presently ongoing, and appears to be very effective.” Another policy maker said: “Mass media campaigns are easy to understand.” Another policy planner suggested arranging documentaries, film shows, dramas and concerts through electronic media for raising awareness.

Parents/Guardians Fathers, mothers and guardians were mentioned as the closest for their children. However, as mentioned by the majority of the policy planners (4 out of 5), in Bangladeshi culture discussion about HIV/AIDS and SRH seldom happened between parents and children. Parents and their children were not open with each other on these topics and felt shy discussing such issues. Accordingly to one focal person: “A girl seeks her mother’s advice when she experiences her first menstruation, but a boy maintains a distance with his father and never discusses when he has wet dream. Some youth think that their father, mother and guardians do not have much knowledge on HIV/AIDS in order to provide information to them.” Another participant suggested that parents could provide a CD on HIV prevention and condom use to their children. He also acknowledged the limitation of this approach, as access to CD/DVD players may be limited to certain youth. Teachers Four policy planners held the opinion that teachers could play a vital role as HIV/AIDS information had already been included in the school curriculum and teachers had close contact with students.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Peers Some policy planners were supportive of building awareness through peers (3). According to them young people listen and learn from peers and get easily motivated by each other. One policy planner particularly mentioned that there were approximately 8,000 youth clubs in Bangladesh that can be used as platforms to offer information on HIV/AIDS through peers. The Youth Ministry, they said, could play a very important role, as it works solely with youth. Another policy planner in support of the peer approach suggested forming peer groups at the schools to further HIV/AIDS prevention.

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However, one policy planner said: “At present, teachers avoid teaching about HIV/AIDS in the classroom. There should be strong monitoring to see to what extent lessons are being taught in the classroom. Students should also be taught reproductive health in the classroom. Girls get health-related information from their mother, aunt, sister-in-law but boys do not discuss with anybody. Therefore, if teachers teach HIV in the classroom boys will get guidance. Formation of peer groups within classes should also be considered”. Another focal person said: “Girls become mature earlier and can be taught about HIV from class eight onwards. Boys should be educated from 11th class onwards. Schools, colleges and universities should be brought under the HIV awareness program. Teachers need to be trained in this field”. Another focal person suggested providing HIV/AIDS information through audiovisual material such as documentaries and films, which could be shown to students in the classroom to complement what teachers did not teach. Service providers Service providers could play an important role in HIV/AIDS prevention in Bangladesh as mentioned by four participants. They could play different roles as they were in direct contact with the local community. One policy planner said that generally young people do not seek services for STIs at the primary stage. They visit service centers when the disease starts be severe. Service providers could play an active role and train youth on HIV/AIDS whenever they use their services as patients. Role of Imams (Religious leaders) Imams could play a positive role as mentioned by all policy planners. However, they cautioned that most people might not do what they say. One respondent said: “People listen to religious and community leader, but do not follow their advice”. One participant mentioned that it should not be expected from imams that they work for HIV related issues spontaneously. They first need orientation in order to be included in preventive activities.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Another participant said: “Imams may be uncomfortable with the issue and therefore need orientation beforehand. In order to play a positive role, imams have to be motivated”.

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Another focal person said that religious leaders would be effective in providing HIV/AIDS information in religious gatherings, on TV or at the personal level. He suggested that the Islamic Foundation should work for the prevention of HIV/AIDS on a large scale. Program people Policy makers said that program people in charge of implementing different healthcare programs could develop peer groups and impart training. They could play a key role in providing HIV/AIDS information to youth, e.g. on how HIV was not transmitted. Policy makers When focal persons talked about their own position they stated that policy makers could play an important role as per need. They were the key people to decide on how funds should be allocated and spent for HIV prevention. The Ministry of Religious Affairs could play a positive role by providing guidance from the religious viewpoint. The Ministry of Health could determine


health policy for a successful HIV/AIDS strategy. The Ministry of Education should include HIV information in the school curriculum, train teachers and implement other programs. One policy planner said: “Since our ministry works exclusively with youth, we should be given the responsibility of implementing HIV projects”. One policy planner said: “We have many policies but we never implemented them due to lack of commitment. Coordination between the HIV/AIDS program management and political leaders should also be strengthened so that the program gains momentum.” Youth Friendly Health Service (YFHS) The concept of YFHS seemed to be relatively new as most of the policy planners could not say anything about. However, one focal person said: “Young people feel shy to visit a doctor who has a signboard “Skin and Venereal Diseases Specialist”. Young people avoid visiting these doctors and hide it, if they are suffering”. He suggested establishing clinics similar to Green Umbrella clinics so that young people could seek services from there. According to this participant, the provision of more youth-friendly health clinics is required in Bangladesh. Life skills education (LSE) The concept of LSE programs appeared to be relatively new to the policy planners, as three of them did not recognize the program. One policy planner mentioned that a HIV project of UNFPA offered 10 lessons on life skills and that program should be scaled up.

7.5

Attitude towards the use of condoms

One respondent said: “It is embarrassing for a father and a son to watch a condom advertisements on TV sitting together. I also feel embarrassed when watching advertisements for sanitary napkins”. They suggested that publicity on condoms should be designed carefully; language should be polished, artistic and sophisticated (2). Instead of providing HIV prevention information directly, messages could be provided through drama, concerts, cinema, feature films and electronic media should be used (2). One policy planner said: “Information on condoms should be given at the personal level”. Another respondent said distribution of condoms using a female-to-female approach will be effective for bringing condoms to youth. To get rid of the social barriers and difficulties of buying condoms, one participant cited an example from Japan saying that users can buy condoms from a so called “Love box”, placed in selected locations, by dropping a coin into the box. However, he also acknowledged that this may not be a realistic option for Bangladesh.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

All focal persons opined that condoms can prevent HIV transmission. However, most of them (4 out of 5) did not want to provide condom messages directly and openly to a general audience. They told that parents and children could not watch such advertisements together and that Bangladesh’s society was conservative and this issue was culturally sensitive (2).

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The focal persons also discussed barriers to condom promotion. One policy planner said that young people felt shy to buy condoms in front of others and many people criticized youth for buying condoms. One policy planner said: “Condoms are available everywhere in urban areas, but limited in rural areas. Thus, condom supply should be increased in rural areas”. Only one focal person was in favor of condom promotion through the mass media. He said: “Condom messages are currently given through the mass media and no negative reaction is seen so far.” He further said, “Condom messages should also include the fact that condoms can prevent STIs (syphilis, Gonorrhea)”. He added that presently youth can easily buy a condom from the open market. However, he was skeptical about the promotion of condoms through youth clubs, as he perceived that the community would not accept this approach. Two participants stated that the use of condoms by unmarried youth was not acceptable. As mentioned, it was apparent to them that media could play a role in raising awareness of condoms. However, they pointed out that media advertisements should not lure young people to go for sex. Availability of condoms in pharmacies and reducing the price for condoms would increase condom access for youth. Two policy planners thought that the price for condoms was high and needed to be reduced for the poor.

7.6

Role as an individual

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

All policy planners except one said that they were not comfortable in having discussions on condoms with their own children. One policy planner said: “I discussed this with my daughter, but she felt shy”.

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Chapter 8 Assessment of Community Readiness


Chapter 8: Assessment of Community Readiness This chapter presents findings from the national assessment of community readiness. This component of endline assessment covered participants from all 6 divisions of Bangladesh. The majority of all groups felt that their community was vulnerable to HIV (Figure 8.1). In approximately 70% of communities, all types of participants (headmasters, imams, drug vendors, and business leaders), answered that only “bad” people in the community were vulnerable to HIV (level 3). “Bad” people was used to refer to anyone practicing socially unacceptable behavior, such as having sex outside marriage, injecting drugs, engaging in homosexual activity, or selling sex professionally. In about 20% of communities, each group believed that HIV was a problem in other countries, such as India, Thailand, or Africa, but that the issue was not a problem in Bangladesh (level 1). Only in about 10% of communities did each group believe that Bangladesh was vulnerable to HIV, but that their particular community was not at risk (level 2). In about one percent of communities, headmasters and imams believed that HIV was not a problem at all (level 0).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 8.1: Stage 1—Level of vulnerability46 by participant type

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No group had exact or completely accurate knowledge of HIV transmission (Figure 8.2). Responses on knowledge of spread of HIV fell into two categories. Most (44 to 67% depending on the group) were level 3, meaning that HIV is spread through having sex with a sex worker or with a “bad” person, as defined previously. The second most common response (33 to 52% of groups) was level 2 meaning that most members of their group knew that HIV was spread through blood transfusions and unsafe needle sharing, but not by sex. Only among Imams did any respondents score below a 2.

46

Levels of vulnerability: Level 0 – HIV/AIDS not a problem, people spreading false information/lies; Level1 – Spread of HIV/AIDS a problem elsewhere, not Bangladesh; Level2 –HIV/AIDS a problem, including Bangladesh, but not in my/our community; Level3 – HIV/AIDS a problem, including my/our community, but among high risk people only (“bad” people, drug users, promiscuous, sex workers) and Level 4 – HIV/AIDS a problem, including my/our community and in the general population.


Figure 8.2: Stage 2— Knowledge of HIV transmission47 by participant type

In all groups, representatives most commonly reported knowledge of prevention that was scored as either level 4: highly effective modes of prevention (condoms) or level 2: correct but vague ideas about prevention, mentioning HIV awareness and not engaging in premarital sex (Figure 8.3). More drug vendors (67%) reported highly effective methods compared to any other group; with drug vendors in twice as many communities scoring level 4 compared to imams (28%). In a few communities imams, business leaders and drug vendors received lower scores.

47

Levels of knowledge of HIV transmission include: Level 0 – Unaware of HIV/AIDS; Level 1 – Aware of HIV/AIDS, but unaware of its spread (epidemic); Level 2- Aware of HIV/AIDS, aware of its spread (epidemic), but not how it spreads; Level 3 – Aware of HIV/AIDS, aware of its spread (epidemic) and how it spreads, and Level 4 – Aware of HIV/AIDS, aware of its spread (epidemic), how it spreads and know current situation in Bangladesh

48

Levels of knowledge of HIV prevention include: Level 0- No ideas/nothing can be done; Level 1- Have ideas, but incorrect/regressive; Level 2 – Have correct ideas/knowledge about HIV/AIDS prevention; Level 3- Have correct ideas/knowledge about HIV/AIDS prevention and discussing HIV/AIDS prevention with others, and Level 4 – Have correct ideas/knowledge about HIV/AIDS prevention and having formal discussions about what could be done

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 8.3: Stage 3—Knowledge of HIV prevention48 by participant type

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Few groups had reached the planning stage of readiness (Figure 8.4). In over 95% of communities, both drug vendors and business leaders had made no decisions with regard to strategies to encourage HIV prevention among youth (level 0). While scores were somewhat higher among both imams and teachers, in 87% and 73% of communities, respectively, these leaders also reported no action. However, in 14% of communities teachers were reported to have discussed well-articulated strategies to encourage AIDS prevention among youth, which they planned to execute as a group (level 3); this was also true for Imams in 11% of communities. In another 10% of communities, the headmasters had specific strategies, which they discussed not only within their group but with other groups in- and outside their community (level 4).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 8.4: Stage 4—Planning49 by participant type

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No group had exact or completely accurate knowledge of HIV transmission (Figure 8.2). Responses on knowledge of spread of HIV fell into two categories. Most (44 to 67% depending on the group) were level 3, meaning that HIV is spread through having sex with a sex worker or with a “bad” person, as defined previously. The second most common response (33 to 52% of groups) was level 2 meaning that most members of their group knew that HIV was spread through blood transfusions and unsafe needle sharing, but not by sex. Only among Imams did any respondents score below a 2.

49

Levels of planning include: Level 0- No awareness of the need for a plan and no indication of planning; Level 1 – Awareness of the need for a plan, but no indication of planning; Level 2- Awareness of the need for a plan and have decided they need/should have a plan; Level 3- Debating, convincing or actually working on a plan, and Level 4- Detailed or fully developed a plan


Figure 8.5: Stage 5—Preparation50 by participant type

Few of the groups had initiated any prevention activities (Figure 8.6). Over 98% drug vendors and business leaders reported no initiation of activity by their group (level 0), while headmasters in 84% of the communities and imams in 89% of the communities had not initiated any activities. However, approximately 10% of headmasters and imams reported that their groups had taken concrete action (level 1).

50

Levels of preparation include: level 0- No preparation; Level 1- Planned activities presented/discussed in community; Level 2Identify key participants and responsibilities; Level 3- Prepare for implementation of a planned set of activities, and Level 4 – Agreed upon implementation strategy(ies) begun.

51

Levels of initiation include: Level 0 – Nothing initiated; Level 1- Concrete action(s) taken by a single group; Level 2- Concrete action(s) taken by more than one group; Level 3 – Groups planning coordination of activities, and Level 4- Coordinated, concrete actions by more than one group.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Figure 8.6: Stage 6—Initiation51 of HIV prevention activities by participant type

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Chapter 9 Conclusion and Recommendations


Chapter 9: Conclusion and Recommendations This report provides a detailed look at the current situation with regard to HIV knowledge, attitude and behaviors among youth in Bangladesh, their exposure to the interventions of the national HIV prevention program and the knowledge and attitudes of gatekeepers who influence the information and services that youth receive. Overall, knowledge about HIV and condom use among youth has increased and misconceptions and risky sexual behaviors have decreased from 2005 to 2008. Improvements were seen in knowledge of safe sex, modes of transmission of HIV, misconceptions about HIV transmission and prevention, and knowledge of STI transmission and prevention for both male and female youth. However, in all cases, larger improvements were seen among males compared to females.

The continued need for mass media interventions is clear both from this survey and from other studies [10, 11]. Models of behavior change suggest the stages that people go through before a new behavior is implemented [12-14]: first people have limited knowledge of the problem the new behavior will address or do not think it is an important issue for them, in the next stage they begin to better understand the problem and believe it is personally relevant, next they start to think about how to carry out the behavior and plan to do so, then they try the new behavior, usually on a sporadic basis and finally they adopt the behavior as a part of their regular practice. Mass media programs have been shown to have an important role at all stages of this process, helping people to move from one stage to the next by providing them with the information they need, which may change in terms of both the content and source depending on where they are in terms of the stages of change [15]. It should be noted that while many youth still remain in the first stage of behavior change, a significant proportion have moved into stages three and four. Given that more youth fall at the early stages of the process, mass media should continue to focus on providing them with the information they need to understand the problem and to understand why it is relevant to their lives. Mass media is also important to efforts to build support and acceptance for HIV prevention among youth. Studies of community readiness for HIV prevention show that the community in Bangladesh recognizes the potential for an HIV epidemic but is not ready yet in terms of preparation and action [16]. Mass media, in combination with other programmatic approaches, can help to move both individuals and communities to a place at which they are prepared to prevent an epidemic. In terms of specific approaches to mass media, this report and other studies and assessments conducted under this project show the importance of television [10, 11, 17]. As the endline results show, television was by far the most commonly accessed mass media channel, with more than twice as many youth reporting weekly exposure to television than to radio, which was the

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

The increases in knowledge and safer sex practices reflect the importance of ongoing interventions to maintain this improvement. Before the baseline survey, which was the first national survey of youth, studies had documented poor knowledge of sexual and reproductive health among youth [5, 6, 8, 9]. The baseline survey showed variable knowledge of HIV and STIs and supported the need for interventions. Multiple interventions have been conducted by various groups since the inception of this program, but the national program under which this survey was conducted is the largest effort to improve knowledge and behaviors of youth and is likely to have reached more youth than any other program. The data from the endline survey on coverage of the GFATM interventions highlights that the mass media campaign has been particularly successful in reaching youth throughout the country. The Bachte Holey Jante Hobe slogan successfully reached the vast majority of youth in Bangladesh, covering more than 90% of all groups except married females. Even among this group, which has more limited access to media, over 70%t had heard the slogan.

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second most common source. In addition to general exposure, youth confirmed its importance as a source of HIV informationâ&#x20AC;&#x201D;they reported that it was by far their most common source of information. However, when the data are disaggregated by the socioeconomic characteristics of the respondents, it is clear that some groups have less access to television than others. Not only did females report watching TV weekly, but viewership was less common among rural youth than among urban youth, was less common among those who were married compared to those who were unmarried and educated youth were more likely to watch regularly. Any strategy moving forward should consider the different exposure of different groups and aim to reach those youth who are more difficult to reach through this channel.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

In terms of behavior change, the endline shows a notable change in condom use, especially among male youth who engage in higher risk sex (meaning that they had more than one sex partner in the past six months). This change is promising given that condom use is the most effective means of preventing transmission, particularly in a setting like Bangladesh where heterosexual transmission will likely be the main driver of the epidemic if it moves beyond the injecting drug user population. This increase must, however, be interpreted with some caution because it may reflect improved knowledge rather than improved practice. In general, when people are aware that they should use condoms, they are more likely to report that they are using them. In fact there is a tendency for reported use to increase faster than actual use because people are reporting what they know they should be doing. At the same time, even if the increase is partially attributable to such socially desirable reporting, it suggests that some male youth are moving farther along in the process of behavior change and that they need information and services that will support them in implementing condom use as a regular practice. This is again a place where mass media can play a role by disseminating messages about condom use that will help to sustain and increase the changes already seen.

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A promising finding with regard to condoms is the high levels of support for SRH education among teachers and the proportion of gatekeepers that support condom education in schools. This increased substantially in all groups but especially among teachers and imams. Community opposition has long been cited as a reason for moving slowly with efforts to increase SRH knowledge of youth but these data suggest that support is being built. However, in general the data from gatekeepers suggests continued low awareness and lack of engagement. Attitudes toward providing condoms to young people, both married and unmarried, remain conservative. While teachers and religious leaders are aware of HIV prevention programs at the national level, few gatekeepers in any group knew about those programs taking place in their locality. As other studies have shown, adult community members can be engaged actively in HIV prevention efforts [16, 18, 19]. The ongoing support needed to ensure their participation should be considered in future program initiatives. STI among youth is a particular concern in the context of prevention of HIV. This assessment suggests that a significant proportion of youth suffer from one or more STI symptoms and many of them do not seek care from a trainer provider. Rather they choose untrained or traditional providers or do nothing. Given a significant proportion of youth seek STI care from untrained providers, program should consider feasibility of incorporating these providers into the provision of STI management services by training them in HIV prevention. The lack of change in a few indicators and the improvements in others suggest that strategies must continue to be strengthened and revised to address key areas where further improvements are needed. The ongoing effort to improve knowledge and practices of youth has begun to have an impact but there is substantial room for improvement. For example, while the proportion of youth that knew two or more routes of transmission increased significantly among both males and females, this still reflects less than two in five youth. Likewise, while condom use among male youth has increased, the increase is only significant for condom use at last high risk sex, not pre or extramarital sex. The continued low levels of support for sale of condoms to unmarried


youth deserve particular attention given that condoms are the only means by which youth can protect themselves against sexual transmission of HIV and STIs. The limited improvements that have been shown are not unexpected given the short time between the two surveys; for the types of indicators assessed, five or more years is often required before change, especially behavior change, can be shown. The improvements seen in this report may not be the total reflection of the project interventions as it had limited coverage among the survey participants. Of the 360 PSUs included in the survey, less than a third had been covered by the teachers training intervention at the time of the endline survey and other interventions (Life skills education, youth friendly health services, and NGO mainstreaming) had taken place in less than 5% of the PSUs included in the endline survey. Even in those PSUs where an intervention took place, with the exception of the mass media interventions, it is not anticipated that all youth would be covered. Though the program has reached 54 districts, but not all interventions have reached all districts and in many cases only a limited area (e.g., the district town) was covered by interventions, therefore, this national survey among youth would be giving diluted results about the total impact of this project. The coverage data do, however, suggest that married youth, especially females, are far less likely to be beneficiaries of program interventions. All of the current interventions (e.g., mass media, LSE, prevention messages given by imams) have been most effective in reaching male youth, particularly unmarried youth. This may be appropriate given that this is the group most likely to be practicing risk behaviors. However, HIV prevention efforts for all youth, particularly female youth and married male youth need to be strengthened in order to enable those less at risk to protect themselves when they do come into contact with higher risk groups. For example, married female youth may be exposed to risk through their partners who are often older males. Any targeted efforts need to take into account the realities of females lives including the social norms that constrict their mobility and limit their access to information; mass media may not be a feasible option as these women are less likely to watch television, read newspapers or attend school. This represents a challenge for programs but the findings from specific operations research studies (presented elsewhere) provide some specific recommendations.

The results of the 2008 endline assessment provide a current picture of the situation with regard to HIV knowledge and behaviors among youth in Bangladesh. They highlight that while youth continue to be at risk because of their behaviors, knowledge is improving and misconceptions are decreasing. Continued efforts can further the improvements that have already been seen and can move youth from a state at which they know the correct information to one at which they can implement it in order to prevent HIV.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

In addition to the issue of limited program coverage, the baseline and endline surveys were not designed to assess the impact of the program, rather they were designed to assess secular trends in the status of HIV knowledge and behaviors among young people.

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Chapter 10 Appendix


104

30.1 34.1 21.3 14.5

Percent of young people aged 15-24 who correctly identify different ways of preventing HIV transmission 0 1 2 3 or more

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

* p <=0.05; ** p <=0.01; *** p <=0.001; NA = not available

44.4 26.2 21.1 8.3

40.4 23.5 20.7 15.4

42.3 24.0 20.7 13.0

NA

NA

Percentage of young people aged 15-24 years who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission. (include 'Mosquito Bite' in the definition)

Percent of young people aged 15-24 who correctly identify different routes of HIV transmission 0 1 2 3 or more

10.0

10.4

Percentage of young people aged 15-24 years who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission. (include 'deep kissing' in the definition)

33.7

Female 36.1

29.4

Percentage of young people aged 15-24 who correctly identify two or more ways of preventing HIV transmission

Awareness, knowledge and misconceptions on HIV/AIDS transmission and prevention

Male 35.8

35.4 28.6 21.0 15.0

43.3 25.1 20.9 10.7

NA

10.2

31.6

Total 36.0

Baseline, 2005

Percent of young people aged 15-24 who correctly identify two or more routes of HIV transmission

Indicator name

Indicator area

25.9 30.3 24.9 18.8

38.9 25.5 23.4 12.2

22.5

15.4***

35.6***

Male 43.7***

41.9 20.0 24.3 13.9

40.5 19.5 24.5 15.6

13.4

8.6*

40.1***

Female 38.1*

Endline, 2009

34.3 24.9 24.6 16.2

39.7 22.4 24.0 14.0

17.7

11.8***

37.9***

Total 40.8***

Notes

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Appendix â&#x20AC;&#x201C; 1: Table of Indicators Comparing Baseline and Endline Findings

Appendix


105 28.3 25.9 8.0 66.2

Percentage of youth who reported experiencing one or more signs/symptoms of STIs

Percentage of youth who sought care for STI symptoms from a trained provider

Percentage of youth who sought care for STI symptoms from a hospital or clinic

Percentage of youth having STI symptoms who visited some type of health service provider

* p <=0.05; ** p <=0.01; *** p <=0.001

31.7

Percentage of youth who knows two or more ways to prevent STIs

62.8

Percentage of young people who believe that antibiotics prevents HIV transmission 28.0

66.7

Percentage of young people who believe that washing after sex prevents HIV transmission (misconception)

Percentage of youth who knows two or more routes of STI infection

63.5

Percentage of young people who believe that coughing and sneezing by HIV infected person transmits HIV

Knowledge of STIs and care seeking behavior

59.7

Percentage of young people who believe that sharing food with HIV infected person transmits HIV

Misconception about HIV/AIDS

Male 1.6

Percentage of young people who perceived risk of becoming infected by HIV

Indicator name

Perceived risk of HIV/AIDS

Indicator area

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

55.6

20.6

28.4

22.4

11.1

10.4

67.7

67.9

63.9

61.7

Female 1.3

61.3

13.3

27.1

25.2

21.4

18.9

65.3

67.3

63.7

60.8

Total 1.4

Baseline, 2005

62.4***

7.0*

23.5**

19.3***

47.7***

44.3***

58.5***

66.1

47.5***

44.4***

Male 2.8***

52.8***

20.3

25.3***

25.7***

15.7***

15.2***

67.7

72.0***

56.1***

52.0***

Female 1.7

Total 2.2***

56.7***

14.4*

24.6***

22.7***

30.8***

29.1***

63.4***

69.2***

52.0***

48.4***

Endline, 2009

Denominator includes young people who had experienced at least one STI symptom in the last year Denominator includes young people who had experienced at least one STI symptom in the last year Denominator includes young people who had experienced at least one STI symptom in the last year

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS

Denominator includes everyone including who have not heard about HIV/AIDS. DK is considered as no perceived risk. Denominator includes everyone including who have not heard about HIV/AIDS

Notes


106

35.2 42.7 41.2

Percentage of young unmarried males used condom during last sex

Percentage of young married males who used condom at last extramarital sex

Percentage of young males who used condom at last higher risk sex in last 6 months

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

* p <=0.05; ** p <=0.01; *** p <=0.001; a = sample size is <25

a

40.6

Percentage of young people aged 15-24 reporting the use of a condom during last sexual intercourse with a non-regular sex partner/s in the last six months

-

-

-

-

24.6

Percentage of young males aged 15-24 who had last premarital or extramarital sex with sex workers

-

7.4

-

8.0

-

25.0 0.7

1.2

11.3

21.0

35.7

13.0

-

-

-

39.4

-

-

-

8.0

-

4.8

27.1

14.5

Baseline, 2005 Female Total 23.8 34.3

11.6

16.6

Male 45.6

Percentage of young married males aged 15-24 who had extramarital sex

Percentage of young women and men aged 15 – 24 who have had sex with a non-marital, non-cohabitating partner in the 6 months Percentage of young males aged 15-24 who had higher risk sex in the last 6 months

Percentage of youth who mentioned use of condom as ‘safe sex’ Percentage of youth who could mention dual use of condom Percentage of youth who had first sex (all) before the age of 15 Percentage of youth who had first premarital sex before the age of 15 Percentage of youth who had history of premarital sex

Knowledge about condoms and safe sex

Sexual practice and condom use

Indicator name

Indicator area

55.3*

45.9

37.1

48.2*

30.4**

9.2

6.4*

21.6

22.8**

11.6

11.8

38.1***

Male 59.1***

-

-

-

a

-

-

-

a

-

0.8

30.6

16.5***

-

-

-

47.7**

-

-

-

7.4

-

4.4

24.3**

27.1***

Endline, 2009 Female Total 27.6** 42.6***

Denominator includes males who ever had higher risk sex.

Denominator includes married males who ever had extramarital sex

Denominator includes married males who had extra marital sex and unmarried males who had sex Denominator includes young women and men aged 15 – 24 who have had sex with a non-marital, non-cohabitating partner in the 6 months Denominator includes unmarried males who ever had premarital sex

Denominator includes married males only

Denominator includes males who ever had sex.

Denominator includes males (unmarried and married) only Denominator includes males and females who ever had sex

Denominator includes who ever had sex

Denominator includes young people who have heard about condoms Denominator includes who ever had sex

Denominator includes all

Notes


107

Support for HIV prevention programs

HIV knowledge

Indicator area

94.0

55.5

58.3 52.1 53.4

26.5

Percentage of parents/guardians who say they will allow their own children to attend programs giving SRH and HIV/AIDS information

Percentage of gatekeepers who support provision of education on condom in school/college/technical college/ madrasa

Percentage of parents who support provision of education on condom in school/college/technical college/ madrasa

Percentage of teachers who support provision of education on condom in school/college/technical college/ madrasa

Percentage of religious/community leaders who support provision of education on condom in school/college/technical college/ madrasa

Percentage of gatekeepers who support selling condom to unmarried youth

17.9

Religious/community leaderâ&#x20AC;&#x2122;s knowledge of unprotected sex being a leading cause of HIV transmission

Baseline, 2005 Female Total 7.9 29.5

Male

Teachers' knowledge of unprotected sex being a leading cause of HIV transmission

Parents' knowledge of unprotected sex being a leading cause of HIV transmission

Indicator name

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Male

28.7

83.9***

77.1***

77.9***

78.8***

94.4

15.8

26.0

Endline, 2009 Female Total 7.9 Notes


Appendix - 2 Sample Size Sample size calculation for behaviour survey The primary objective of the endline survey is to obtain estimates of indicators that will be used to assess changes in key indicators at the population level. Like the baseline survey, estimates of measurable indicators with desired precision are required for Bangladesh as a whole and for sub-populations (domains) such as rural-urban, male-female, married-unmarried by geographic division of Bangladesh. As sexual and reproductive health behavior of youth of metropolitan cities, particularly of Dhaka and Chittagong metropolitan areas, vary considerably from other regions, these two metropolitan areas are considered as separate domains. Thus in total there will be 14 domains (6 Division X 2 rural vs. urban=12 and 2 City corporations) from which independent samples are to be selected. During baseline it was estimated that, a sample size of 208 would be enough to estimate most of the key composite indicators and detect 0.5 points improvement/reduction with desired power 0.80 and with 95% confidence for each domain of analysis; rural-urban, two metropolitan areas, male-female, marriedunmarried and by division. This sample size allowed some analysis by schooling and out of school classification. The endline will also use the same sample and follow the sampling strategy. Thus there will be 2912 youth sample in 14 strata for each of four group; male-female and married-unmarried classification. To determine the adequacy of the existing sample size to detect change, five key indictors of interest were identified:  Knowledge of two means of prevention  Knowledge of condoms as means of prevention  Knowledge of drug use as means of transmission  Practice of condom use at last high risk sex  % with age at sex <18 Given baseline levels we have adequate power to detect a change of 20% in most of the indicators for most groups (see Table 1 for some examples). For indicators that were already above 80% at baseline, we have adequate power to detect 10-15% change, depending on the group/indicator.

Knowledge: two methods of prevention Knowledge: condoms prevent HIV unmarried male unmarried female married male married female Knowledge: IV drug use transmits HIV unmarried male unmarried female married male married female Practice: condom use at last sex Age at sex less that 18 * All calculations assumed 95% confidence and 80% power The following formula was used:

n = D[(Za + Z b ) 2 * ( P1 (1 - P1 ) + P2 (1 - P2 )) /( P2 - P1 ) 2 ]

D 2 2 2 2 2 2 2 2 2 2 2 2 2

P1 0.23 0.74 0.89 0.7 0.9 0.79 0.81 0.84 0.81 0.8 0.76 0.35 0.61

P2 0.43 0.94 0.99 0.9 0.99 0.99 0.94 0.96 0.95 0.95 0.95 0.55 0.41

n 166 98 165 121 193 67 195 179 167 148 97 186 188

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Table 1: Estimated sample size needed to detect change for behavioral survey, per stratum*

108


Parents/guardians will be selected from rural, urban, and metropolitan areas taking 4 from each PSU and thus having a total of 1440 in the sample. Teachers of secondary school, community and religious leaders will be selected from rural, urban, and metropolitan areas (2 from each PSU) giving a total of 720 in the sample. Also 720 health service providers (2 per PSU) will be selected from among government, NGO, and private sector providers. Table 2: Total estimated sample size by category of respondents Respondent Young unmarried male aged 15-24 (1 in 3 HH) Young unmarried female aged 15-24 (1 in 5 HH) Young married male aged 15-24 (1 in 6 HH) Young married female aged 15-24 (1 in 3 HH) Parents/guardians Secondary school teacher/community and religious leaders Health services provider Total

No.* No. sampling Total respondents Units at national level 208*14 2912 208*14 2912 208*14 2912 208*14 2912 4*360 1440 2*360 720 2*360 720 14528

Sample size calculation for serological survey: Based on the prevalence reported for HSV2 and syphilis during the baseline survey (2005), and assuming 95% confidence and 3% allowable error, the sample size for endline survey has been calculated as below. Table 3: Estimated sample size needed to estimate prevalence for serology, per stratum

Sample unmarried male unmarried female married male married female Total

Baseline prevalence HSV2 18.9 12.9 16.8 12.6

Required sample 654 480 597 470 2201

Response rate 0.493 0.54 0.432 0.419

Number invited to participate* 1327 888 1381 1122 4718

Using the following formula:

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Z 2 P(1 - P) n= d2

109

Baseline survey reported 0.6% prevalence for syphilis. Considering 0.6% prevalence for syphilis, 95% confidence interval and 1% allowable error, each of the above four strata will requires 229 samples. Thus the total required sample size is 2201. The baseline survey achieved 51.8% success in collecting blood samples among those who were approached. Considering this scenario, we will require to approach 4718 youth to reach the desired sample size of 2201. In order to enroll the above number of participants, the required number of PSUs will be selected randomly from 360 PSUs.


Appendix 3 Training and field work Field staff for the household listing were recruited in the first week of February 2008 and trained at ACPR from February 18 to 20, 2008. Listing operations were conducted from February 21 to May 4, 2008. Eighteen two-member teams and five supervisors were deployed for the listing operation. The survey questionnaires were pre-tested from April 26 to May 4, 2008. For the pretest, male and female interviewers were trained at ACPR. Interviews were then conducted in Nabinagar of Savar and Aganagar of Keraniganj upazila under the observation of research team members of ACPR and ICDDR,B. Altogether, 84 questionnaires were completed. Based on the experience in the field and suggestions made by pretest staff, modifications were made in the wording and translation of the questionnaire.

The serological component of the survey was conducted by a team comprised of laboratory and field staff of ICDDR,B. Recruitment criteria for the field staff included educational background, prior experience of blood sample collection particularly at the field level, knowledge on universal precautions and commitment to travel extensively across the country. Prior to sampling, a three day long (27-29 May, 2008) in house training was provided for the field staff at ICDDR,B. Training included lectures on objectives of the survey, basic concepts of HIV/AIDS, confidentiality, universal precautions and sample collection procedure. Hands on training was also provided on blood sample collection, serum separation, labeling, recording, sample transportation and preservation. Moreover, to ensure an effective coordination between the behavioral and the serological survey team, serology team members also participated in the selected sessions of the training program provided for the behavioral survey team from May 21 to June 4, 2008. Field staff for the community readiness study were recruited in late August, 2008. Recruitment criteria included educational attainment, experience in other qualitative studies, and the ability to spend up to three months in the field. Training was conducted for 8 days at ICDDR,B, from August 30 to September 7th, 2008, including 2 days for field practice. Training consisted of lectures on the objectives and methodology of the survey, techniques of interviewing, how to complete the interview guidelines and how to score the responses. Fieldwork for the behavioral part of the assessment commenced on June 5, 2008, and was completed on July 31, 2008. It was carried out by 20 interviewing teams. Each team consisted of one male supervisor and one female supervisor, two female interviewers, three male interviewers, and one field assistant. Eleven trained paramedics recruited by ICDDR,B were assigned for collecting venous blood from youth and adolescents for the serological survey. In addition, 3 field research officers and 3 senior research assistants conducted the interviews with community leaders regarding community readiness. A team of two persons conducted the policy plannerâ&#x20AC;&#x2122;s interview; one conducted the interview while the other took notes. The interviews were conducted during October -December 2008.

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Field staff for the main survey was recruited in the second week of May 2008. Recruitment criteria included educational attainment, experience in other surveys, and the ability to spend three weeks in training and at least three months in the field. Training for the main survey was conducted for 15 days at a rented venue, from May 21 to June 4, 2008, including two days for field practice. Training consisted of lectures on the objectives and methodology of the survey, techniques of interviewing, and how to complete the questionnaire. Group discussions and mock interviews between participants were used to gain practice asking questions. Those with satisfactory performance in the course were selected for fieldwork. Those whose performance was considered superior were selected as supervisors.

110


Fieldwork was done in multiple phases. ACPR fielded six quality control teams of two people each to monitor the field activities of the teams. In addition, research team members from ACPR, ICDDR,B, and Population Council monitored the field work by visiting the teams in the field. Moreover, a host of experts from MOHFW and Save the Children, USA also visited teams in the field. Data processing Data processing of the interviews commenced in the last week of June 2008 and was completed on August 20, 2008. It was done at the ACPR office in Dhaka. All the completed questionnaires for the survey were returned to the data processing cell of ACPR. The data processing operations consisted of office editing, data entry, and editing inconsistencies found by computer programs. The data were processed on 12 microcomputers working in double shifts, carried out by 22 data entry operators and two data entry supervisors. To minimize error, a double data entry procedure was followed. Data entry for the community readiness assessment was done at ICDDR,B in Dhaka. All completed scoring sheets were returned to the Dhaka office. These data were entered on two computers. The data processing operations consisted of office editing, data entry, and editing inconsistencies found by computer programs. Data analysis

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

Data were analyzed using SPSS. Initially, frequency counts were run to assess the distribution and skewness of the responses. Age; socio economic background; knowledge of HIV and STI; access to information, services and condoms; self efficacy; barriers and drug were assessed by creating composite indicators. Data were stratified by the four main domains (married and unmarried, rural and urban) by sex. Comparisons were made between baseline and endline using t-tests to test for significant changes in continuous variables and chi-square tests for categorical variables.

111


[1] [2] [3] [4] [5] [6] [7] [8] [9]

[10] [11] [12] [13] [14] [15] [16] [17] [18] [19]

UNAIDS. Report for the global AIDS epidemic. Geneva: UNAIDS 2008. Commission on AIDS in Asia. Redefining AIDS in Asia: Crafting an effective response. New Delhi: Oxford University Press 2008. Haider SJ, Saleh N, Kamal N, Gray A. Study of Adolescents: Dynamics of. Perception, Attitude, Knowledge and Use of Reproductive Health Care. Dhaka, Bangladesh: Population Council; 1997. Barnett B, Schueller. Meeting the needs of youth clients: A guide to providing Reproductive Health Services to adolescents: Family Health International; 2000. Ali A, Mahmud S, Karim F, Chowdhury A. Knowledge and practice of NFPE-AG graduates regarding menstruation. Dhaka: Bangladesh Rural Advancement Committee; 1996. Nahar Q, Tu帽贸n C, Houvras I, Gazi R, Reza M, Huq NL, et al. Reproductive health needs of adolescents in Bangladesh: A study report. Dhaka: ICDDR,B; 1999. Government of Bangladesh. HIV in Bangladesh: where is it going? Dhaka: National AIDS/STD Program, Directorate General of Health Services, Ministry of Health and Family Welfare, Govt. of Bangladesh.; 2001. Bhuiya A. Village health care providers in Matlab, Bangladesh: a study of their knowledge in the management of childhood diarrhoea. J Diarrhoeal Dis Res. 1992 Mar;10(1):10-5. Haseen F, Larson CP, Nahar Q, Huq NL, Quaiyum MA, Reza M, et al. Evaluation of a School-based Sexual and Reproductive Health Education Intervention among Adolescents in Rural Bangladesh: ICDDR, B, Centre for Health and Population Research 2004. NASP. Pre-intervention audience impact study for youth and adolescents in HIV/AIDS 2005. Dhaka: National AIDS/STD Programme, Save the Children-USA with MATTRA and PIACT Bangladesh; 2007. NASP, Save the Children USA, ICDDRB. Impact of an HIV/AIDS Prevention Entertainment Education Program Dhaka: National AIDS/STD Programme, Save the Children, USA and ICDDR,B; 2009 (forthcoming). DiClemente CC, Prochaska JO, Gibertini M. Self-efficacy and the stages of self-change of smoking. Springer 1985:181-200. Prochaska JO, Redding CA, Harlow LL, Rossi JS, Velicer WF. The transtheoretical model of change and HIV prevention: A review. SOPHE 1994:471. Prochaska JO, Velicer WF. Behavior change: The transtheoretical model of health behavior change. American Journal of Health Promotion, Inc. 1997:38-48. Valente TW, Poppe PR, Merritt AP. Mass-media-generated interpersonal communication as sources of information about family planning. Journal of health communication. 1996 Jul-Sep;1(3):247-65. National AIDS/STD Program, Save the Children USA, ICDDR B. An assessment of community readiness for HIV/AIDS prevention interventions in rural Bangladesh. Dhaka: Natonal AIDS/STD Program, Save the Children USA, and ICDDR,B; 2007. NASP. National Baseline HIV/AIDS Survey Among Youth in Bangladesh Dhaka: National AIDS/STD Programme and Save the Children, USA; 2007. NASP, Save the Children USA, ICDDRB. Training Imams to Deliver HIV/AIDS Messages Through Mosques. Dhaka: National AIDS/STD Programme, Save the Children, USA and ICDDR,B; 2009 (forthcoming). NASP, Save the Children USA, ICDDRB. Engaging Non-formal Private Practitioners in Bangladesh: Feasibility and pilot assessments of academic detailing of STI counseling guidelines by medical representatives. Dhaka: National AIDS/STD Programme, Save the Children, USA and ICDDR,B; 2009 (forthcoming).

Endline HIV/AIDS Survey among Youth in Bangladesh, 2008

References

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Endline Survey Report of The Global Fund Round 2 HIV/AIDS Project  

Endline Survey Report of The Global Fund Round 2 HIV/AIDS Project

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