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Survey Conducted by: ASM Amanullah, PhD AbuYusuf Choudhury Professor Kazi Saleh Ahmed Shafiun Nessa Francis Blazo Lutfun Naher Shimul Syeda Rubina Sultana (Bina) A.K.M Monjurul Haque Md. Ziauddin Mohammad Selim Md. Ahaduzzaman Md. Sazzad Hossain Khan Md. Monirul Islam Md. Jafar Iqbal S.M. Sanower Hossain Md. Rabiul Islam Md. Bariul Islam Mahmud Ali Mamun Md. Meherul Hassan Shohel Md. Mofizul Islam Md. Saydur Rahman (Sizan) Md. Badrul Alam Md. Shaha Rujjaman Khujista Jahan Jonaki Farsheda Begum Ranjit Chakma Md. Newton Shaikh Nazmun Nahar Salma Perven Md. Mohiuddin Gobinda Lal Biswas Umme Qulsum Shely Sultana Md. Mojahid Hossain (Mithu) Md. Mostafa Kamal Shamsun Nahar (Lipi) Anima Biswas Md. Saiful Islam Wahiduzzaman FahmidaYesmin


Umma Salma (Nasima) Md. Abdur Rashid Md. Hasan Iqbal Touhida Akter Rahima Begum Kakoli Shishir Paul Haradhan Kumar Paul Ratan Kumar Saha Rebeka Sultana Biswas Afroz Zahan Fatema Begum Shely Sultana Md. Rabiul Islam Md. Mojahid Hossain Md. Jafar Iqbal S.M. Sanower Hossain Mizanur Rahman Sarder

Technical Reviewed by:

Dr. Nizam Uddin Ahmed, Director, HIV/AIDS and Program Advisor, South Asia Region, SC-USA Dr. Lubana Ahmed, Program Manager, ACCESS Program, SC-USA Dr. Kazi Belayet Ali, Program Manager, HIV/AIDS, SC-USA Shaikh Masudul Alam, Deputy Program Manager, SC-USA A.B.M. Kamrul Ahsan, Deputy Program Manager, SC-USA Afzal Hossain, Managing Partner, MATTRA Sanaul Arefeen, Managing Partner, MATTRA Wazir Sattar, Creative Director, Managing Partner, MATTRA Ahmed Rezaul Karim, Assistant Co-ordinator, MATTRA

Published by

National AIDS/STD Programme, Save the Children- USA with MATTRA and PIACT Bangladesh

Layout Design and Desktop Printing Nahid Ad. & Printing

First Print June 2007


Acknowledgements

The work presented here is the contribution of many people. It is gratifying to note the relentless efforts of the colleagues of National AIDS/STD Programme (NASP), Save the Children-USA, MATTRA, and PIACT Bangladesh to complete the study. We personally appreciate the input made by the following colleagues in designing the study and finalizing the report. We express our sincere gratitude to the Chief HIV/AIDS Advisor, NASP and Chairperson, Technical Committee, National AIDS Committee, Program Manager, Dr. Md. Abdus Salim, National AIDS/STD Programme (NASP) and Deputy Programme Managers, Dr. Md. Hanif Uddin, Dr. Md. Mozammel Hoque for their active involvement and monitoring of the data collection. We recognize the kind assistance and cooperation of Dr. Nizam Uddin Ahmed, Director, HPN Sector, Dr. Lubana Ahmed, Program Manager, HIV/AIDS Program, Dr. Kazi Belayet Ali, Deputy Program Manager, Dr. Lima Rahman, Deputy Program Manager and Shaikh Masudul Alam, Deputy Program Manager for providing technical guidance on design questionnaire, data collection and review in successful completion of this survey. We acknowledge support of Mr. Afzal Hossain and Mr. Sanaul Arefeen, Managing partner of Mattra and Mr. Wazir Sattar, Mr. Ahmed Rezaul Karim for their support, feedback and encouragement. Finally special thanks are due to interviewees and to all people who had given their valuable time and information for the study. We thank the household interviewers for their hard in successful completion of this assignment. Finally we are grateful to the participants of the survey and their parents/guardians for their cooperation


Dr. S. M. Mustafa Anower

Director Center for Medical Education & Line Director National AIDS/STD Programme & SBTP Directorate General of Health Services Mohakhali, Dhaka

Foreword The success of any communication campaign depends on proper identification of needs and finding the gaps between the current situation and expected outcome. To assess the gaps and identify the needs of the target audience, it is imperative to understand their present level of KAP on HIV/AIDS among youths and adolescents. To diffuse HIV/AIDS prevention information to youths and adolescents of Bangladesh through some effective campaigns using various mass media and interpersonal channels, it is expected that the interventions would improve the knowledge of target audiences on transmission and prevention of HIV, so that the young population of this country can avert the risks of being attacked by this pandemic. The preintervention audience impact assessment intends to determine the significant changes regarding prevention of HIV/AIDS among youth and adolescents broadcasting and disseminating HIV prevention messages for young people through mass and print media. The survey has been planned to compare the post intervention situation with baseline (pre-intervention situation). PIACT Bangladesh, in collaboration with the Ministry of Health & Family Welfare of the People's Republic of Bangladesh and Save the Children-USA, and Mattra has taken this step to conduct a Pre-Intervention Audience Impact Survey among the youths and adolescents age 15-24 years. I express my sincere thanks to all professionals of National AIDS/STD Programme (NASP) and Save the Children - USA to make this survey a quality and successful one. I also express my thanks PIACT Bangladesh for their sincere effort and successful completion of this valued survey.


Dr. Md. Hanif Uddin

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

Foreword In Bangladesh risk-behaviors related to HIV/AIDS infection among the adolescents and young population is very high. Moreover, these people have less access to correct knowledge and information on HIV/AIDS and STDs which leads them to seek information on sensitive issues from unreliable sources. In the wake of the HIV epidemic, it is imperative that the knowledge level and common queries that adolescents have are investigated and addressed through large-scale campaign using mass media and other techniques such as interpersonal communication, workshops and seminars. "Pre-intervention Audience Impact Study for Youth and Adolescents on HIV/AIDS 2005" is a significant study that shows the existing level of knowledge, attitude and practices related to HIV/AIDS and other STIs among the young people in Bangladesh. The study also examined several issues like HIV/AIDS, necessary life skills to protect youths from HIV and other STIs, sources of their information on HIV/AIDS and STIs, condom use and barriers, health seeking behaviors, and their media exposure and habits. I hope the study will guide us to design an effective media intervention program on HIV/AIDS and find out the current scenario of sexual health of youth and adolescents of Bangladesh. I express my heartfelt thanks to the professionals of Mattra and PIACT Bangladesh to carry out the study. I also thank Save the Children- USA for their continuous support and hard work as the management agency.


Kellyand Stevenson

Country Director Save the Children - USA

Foreword Awareness levels of the youths and adolescents about HIV/AIDS have shown varying levels in Baseline HIV/AIDS Survey amongYouth in Bangladesh - 2005 survey.Youths are marginally more aware than the adolescents. Although the awareness about HIV/AIDS is high but knowledge about STIs is quite low. Awareness about STI among 15-24 years of youths and adolescents is only 21%. Among them 16% have suffered from different STIs sometime in their life. According to 1999/2000 BDHS , 30% of the ever-married female of age under 20 years heard about HIV/AIDS. In the above context, where different groups of youth have demonstrated different levels of awareness regarding HIV/AIDS, ranging from low to moderately high, a Needs Assessment Study was proposed with the specific target group for whom media messages will be developed. The Pre-Intervention Audience Impact Survey 2005 is a nationally representative sample survey undertaken in Bangladesh. As expected, the present study among the youths and adolescents examined several sensitive issues such as awareness of HIV/AIDS, mass media channels, necessary life skills to protect youths from HIV and other STDs, source of their information on HIV/AIDS and STDs/STIs, condom use and barriers, and availability of health services. The survey findings are intended to be useful in planning and implementing the country's HIV/AIDS campaign program under GFATM projects designed to inform young people of the danger of HIV/AIDS, the modes of transmission of the disease, and the ways a person can protect him/her from this disease, promote positive behaviors and thereby, combat HIV/AIDS.


Dr. Nizam Uddin Ahmed Director HIV/AIDS Programme and South Asia program Advisor Save the Children - USA

Foreword People have hardly any access to correct knowledge and information, especially on sexually transmitted diseases (STDs) and HIV/AIDS, which leads them to seek information on sensitive issues from unreliable and inaccurate sources. In the wake of the dangerous HIV epidemic, it is imperative that the knowledge level and common queries that adolescents have are investigated and addressed through large-scale campaign using mass media campaign and other techniques of interpersonal communication such as workshops and seminars. A consortium of MATTRA and PIACT Bangladesh, in collaboration with the Ministry of Health & Family Welfare and Save the Children-USA, has taken this step to conduct a Pre-intervention Audience Impact Assessment among the Youths and Adolescents age 15-24 years. The survey findings will help the sponsors toward designing the media intervention program on HIV/AIDS and find out the current scenario of sexual health of youths and adolescents of Bangladesh. As expected, the present study among the youths and adolescents examined several sensitive issues such as HIV/AIDS, necessary life skills to protect youths from HIV and other STIs, source of their information on HIV/AIDS and STDs/STIs, condom use and barriers, availability of health services, and media habits. The Survey was implemented by collecting data from a nationally representative sample of 4105 adolescents and youths chosen from among men and women. The sample was drawn in terms of households by using a multistage sampling design. A structured was used in the survey to collect the data. I sincerely thank to Mattra and Piact Bangladesh for accomplishment of this highly valuable task. Above all my heartfelt thanks goes to National AIDS/STD Programme (NASP) for their continued support.


CONTENTS Page No. EXECUTIVE SUMMARY

1-5

Chapter 1

6-10

1.

INTRODUCTION 1.1 1.2 1.3

Background The Global Fund to Fight AIDS, TB, and Malaria (GFATM) The Global Fund Project on Prevention of HIV/AIDS among Youth and Adolescents in Bangladesh 1.4 HIV/AIDS and Bangladesh 1.5 Pre-marital Sex Culture in Bangladesh 1.6 Extra-marital sex 1.7 Sexually Transmitted Diseases (STDs) 1.8 Usage of condoms 1.9 Background of This Project 1.10 Objectives of the survey 1.11 Aim of the survey

Chapter 2 2.

6 6 6 7 7 8 8 9 9 10 10 10 11-21

METHODOLOGY AND IMPLEMENTATION OF THE SURVEY 11 2.1

2.2

Methodology 2.1.1 Study Design 2.1.2 Conceptual Framework 2.1.3 Survey Design and Sampling Plan 2.1.4 Sampling Frame: 2.1.5 Slum Sample 2.1.6 Sample Selection 2.1.7 Data description Implementation of the survey 2.2.1 Survey Tools 2.2.2 Pretest and Finalization of Questionnaire 2.2.3 Administering Survey 2.2.4 Number of Teams for Data Collection 2.2.5 Fieldwork for the Survey 2.2.6 Non Response 2.2.7 Data processing/analysis 2.2.8 Ethical issues 2.2.9 Limitations 2.2.10 Usefulness

11 11 11 12 13 14 14 17 17 17 17 18 18 18 19 19 20 20 21


Page No. Chapter 3

22-25

3. SOCIO-DEMOGRAPHIC CHARACTARICTICS OF THE RESPONDENTS 3.1 3.2 3.3 3.4 3.5 3.6

22

Age Educational background Civil status Occupational background Possession/availability of household durables/facilities Key Findings

Chapter 4

22 23 23 23 24 25 26-31

4. MASS MEDIA EXPOSURE 4.1 4.2 4.3 4.4

26

General Habits of Listening to Radio General Habits of Watching Television General Habits of Reading Newspaper Key Findings

Chapter 5

26 27 29 31 32-34

5. KNOWLEDGE ON HIV/AIDS 5.1 5.2 5.3

Awareness of HIV/AIDS Major Sources of Information on General Awareness of HIV/AIDS Specific Media Channels, Sessions, and Programs as Major Sources of Information on General Awareness of HIV/AIDS 5.3.1 Specific Television Channels Providing Information on General Awareness of HIV/AIDS 5.3.2 Specific Television Programs Watched on General Awareness of HIV/AIDS 5.3.3 Specific Sessions of Watching Television Programs on General Awareness of HIV/AIDS 5.3.4 Specific Radio Stations Providing Information on General Awareness of HIV/AIDS 5.3.5 Specific Radio Programs Listened 5.3.6 Specific Sessions of Listening Radio Programs on General Awareness of HIV/AIDS 5.3.7 Specific Newspapers Providing Information on General Awareness of HIV/AIDS 5.3.8 Specific News Items Read on General Awareness of HIV/AIDS

32 32 33 33 33 34 34 35 36 36 37 37


Page No. 5.4 5.5 5.6

5.7 5.8 5.9

5.10 5.11 5.12 5.13 5.14 5.15 5.16

Spontaneous Knowledge on the Perceived Routes of HIV Transmission Major Sources of information on Perceived Routes of HIV Transmission Specific Media Channels, Sessions, and Programs as Major Sources of Information on Perceived Routes of HIV Transmission 5.6.1 Specific Television Channels 5.6.2 Specific Television Programs Watched 5.6.3 Specific Sessions of Watching Television Programs on the Routes of HIV Transmission 5.6.4 Specific Radio Stations 5.6.5 Specific Radio Programs Listened 5.6.6 Specific Sessions of Listening Radio Programs on the Routes of HIV Transmission Spontaneous Knowledge on the Perceived Ways of Preventing HIV Transmission Major Sources of Information on the Perceived Ways of Preventing HIV Transmission Specific Media Channels, Sessions, and Programs as Major Sources of Information on the Perceived Ways of Preventing HIV Transmission 5.9.1 Specific Television Channels Providing Information on the Perceived Ways of Preventing HIV Transmission 5.9.2 Specific Television Programs Watched Providing Information on the Perceived Ways of Preventing HIV Transmission 5.9.3 Specific Sessions of Watching Television Programs on the Perceived Ways of Preventing HIV Transmission 5.9.4 Specific Radio Stations Providing Information on the Perceived Ways of Preventing HIV Transmission 5.9.5 Specific Radio Programs Listened 5.9.6 Specific Sessions of Listening Radio Programs on the Perceived Ways of Preventing HIV Transmission Prompted Knowledge and Media Exposure on HIV-related Risks Practices Media Exposure on HIV-related Risks Practices 5.11.1 Television 5.11.2 Radio Miasmic/Erroneous Beliefs on the Routes of HIV Transmission How to behave with HIV infected person Major Sources of Information on How to Behave with HIV Infected Person Importance of HIV/AIDS related information Media Exposure on Programs About HIV/AIDS Targeting Adolescents andYouths

38 39 40 40 41 41 42 42 43 43 44 45 45 45 46 47 47 48 48 49 49 51 51 53 54 54 56


Page No. 5.16.1 Necessity of providing HIV/AIDS information to adolescents 5.16.2 More perfected media to diffuse HIV/AIDS information 5.16.3 Whether Perceived Threat of HIV/AIDS in Bangladesh 5.16.4 HIV/AIDS-related Stigma 5.16.5 Self-efficacy and Interpersonal Communication on HIV/AIDS 5.17 Key Findings

Chapter 6 6. KNOWLEDGE ON STDs/STIs 6.1 6.2 6.3 6.4 6.5 6.6

Awareness of other Sexually Transmitted Diseases (STDs) Knowledge on Major Ways of Transmitting STDs Major Ways of Protection from STDs/STIs More perfected media to diffuse STDs information Availability of STD Services in the Locality Key Findings

Chapter 7

58 58 59 59 60 61 65-69 65 65 66 66 67 68 68 70-76

7. CONDOM BEHAVIORS: AWARENESS, COLLECTION, BARRIERS, AND USE 70 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8

Awareness and Availability of Condom Reasons for using condom Nearest place to buy condom Sources of getting condom in the locality Condom Affordability Perception of Local People whenYouths Buy Condom Use of Condom Key Findings

Chapter 8

70 70 71 72 73 73 74 76 77-79

8. LIFE-SKILLS AND SELF-EFFICACY IN MANAGING RISK PRACTICES 8.1 8.2 8.3 8.4 8.5 8.6

Confidence to deal with friends/peers Ability to refuse forced sex Ability to ask sex partners to use condom Self-confidence to seek STD services with the nearest clinic Ability to take decision to choose life partner Key Findings

77 77 77 77 77 77 79


Page No. Chapter 9 9. CONCLUSION AND LESSONS LEARNED

80-84 80

References

85-86

Appendix: 1 Sample EAs by rural, urban and SMA by districts Appendix: 2 Prompted Knowledge and Media Exposure on Risks Associated with Multiple Sex Partners and Non-use of Condom Appendix: 3 Summary of Major Indicators for Pre-Intervention Audience Impact Survey 2005

87-91 92-98 99-103


List of Tables:

Page No.

Table 2.1 Allocation of EAs, youths and adolescents and households by divisions Table 2.2 Sample EAs by rural, SMA, and urban areas by division Table 2.3 Sample EAs by rural, urban and SMA by districts Table 2.4 Name of the selected EAs with address Table 2.5 Sample EAs by upazila & district (Urban) Table 3.1 Percent distribution of respondents by selected background characteristics and according to study areas (rural, urban and slum) Table 3.2 Percent distribution of respondents by their occupational background, according to study sites (rural, urban and slum) Table 3.3 Percent distribution of respondents by their possession/ availability of household durables/facilities, according to study sites (rural, urban and slum) Table 4.1 Percentage of newspaper readers by specific daily newspapers Table 5.1 Major Sources of Information on General Awareness of HIV/AIDS Table 5.2 Specific Program Watched Providing Information on General Awareness of HIV/AIDS Table 5.3 Specific Radio Programs Listened Providing Information on general awareness of HIV/AIDS Table 5.4 Spontaneous knowledge on the Routes of HIV Transmission Table 5.5 Specific Program Watched Providing Information on the Routes of HIV Transmission Table 5.6 Specific Sessions when Adolescents andYouths Watch Programs Providing Information on the Routes of HIV Transmission Table 5.7 Specific Radio Programs Listened Providing Information on the Routes of HIV Transmission (Multiple responses permitted) Table 5.8 Specific Sessions when Adolescents andYouths Listened Programs Providing Information on the Routes of HIV Transmission Table 5.9 Spontaneous knowledge on the Perceived Ways of Preventing HIV Transmission Table 5.10 Specific Program Watched Providing Information on the Perceived Ways of Preventing HIV Transmission Table 5.11 Specific Sessions when Adolescents andYouths Watch Programs Providing Information on the Perceived Ways of Preventing HIV Transmission Table 5.12 Specific Radio Programs Listened Providing Information on the Perceived Ways of Preventing HIV Transmission Table 5.13 Specific Sessions when Adolescents andYouths Listened Programs Providing Information on the Perceived Ways of Preventing HIV Transmission Table 5.14 Prompted Knowledge and Media Exposure on HIV-related Risks Practices

15 15 0 0 0 22 23 24 30 33 34 36 39 41 41 42 43 44 46 46 48 48 50


Page No. Table 5.15 Table 5.16 Table 5.17 Table 5.18 Table Table Table Table Table Table Table Table Table

5.19 5.20 5.21 5.22 5.23 6.1 6.2 6.3 7.1

Table 7.2 Table 7.3 Table 8.1

Prompted Knowledge and Media Exposure on Risks Associated with Multiple Sex Partners and Non-use of Condom Prompted Knowledge and Media Exposure on Risks Associated with Un-tested Blood Transfusion Prompted Knowledge and Media Exposure on Risks Associated with Pregnancy of HIV/AIDS Infected Mother Prompted Knowledge and Media Exposure on Perceived Severity of HIV/AIDS Miasmic/Erroneous Beliefs on the Routes of HIV Transmission How to behave with HIV infected person Media Exposure on Programs about HIV/AIDS Targeting Adolescents Whether Perceived Threat of HIV/AIDS in Bangladesh Self-efficacy and Interpersonal Communication on HIV/AIDS Percent distribution of respondents by types of STDs/STIs heard Major Ways of Protection from STDs Availability of STD Services in the Locality Percentage of adolescents and youths according to their Condom related practices Percentage of adolescents and youths according to their Collection of condom Percentage of adolescents and youths according to their use of condom Life-Skills and Self-Efficacy in Managing Risk Practices

92-93 94-95 96-97 98 52 53 57 59 61 65 67 68 72 74 75 78


List of Figures: Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure

2.1 4.1 4.2 4.3 4.4 4.5 4.6 4.7 5.1 5.2 5.3

Figure 5.4 Figure 5.5 Figure 5.6 Figure 5.7 Figure 5.8 Figure 5.9 Figure 5.10 Figure 5.11 Figure 5.12 Figure 5.13 Figure 5.14 Figure 5.15 Figure 5.16 Figure 5.17 Figure 5.18 Figure 5.19 Figure 5.20 Figure 5.21 Figure 5.22

Page No.

Map of Bangladesh: The Spread of the Sample Sites 16 Habits of Listening to Radio 26 Most Frequently Listened Radio Stations 27 Preferred Sessions of Listening Radio 27 Habits of Watching Television 28 Preferred Sessions of Watching Television by the Respondents 28 Most Frequently Watched TV Channels 29 Habits of Reading Newspapers 30 Awareness of HIV/AIDS 32 Awareness of HIV/AIDS by Areas 32 Specific Television Channels Provided Information on General Awareness of HIV/AIDS 34 Specific Sessions when Adolescents andYouths Watched TV Programs Providing Information on General Awareness of HIV/AIDS 35 Specific Radio Stations Provided Information on General Awareness of HIV/AIDS 35 Specific Sessions when Adolescents andYouths Listened Programs Providing Information on General Awareness of HIV/AIDS 36 Specific Newspapers Read on HIV/AIDS 37 Specific News Items Read on HIV/AIDS 37 When have you read/seen this information 38 Major Sources of Information on the Routes of HIV Transmission 40 Specific Television Channels Provided Information on the Routes of HIV Transmission 40 Specific Radio Stations Provided Information on the Routes of HIV Transmission (Multiple responses permitted) 42 Major Sources of Information on the Perceived Ways of HIV Prevention44 Specific Television Channels Provided Information on the Perceived Ways of Preventing HIV Transmission 45 Specific Radio Stations Provided Information on the Perceived Ways of Preventing HIV Transmission 47 Perceived Severity of HIV/AIDS (Consequences) 49 Major Sources of Information on how to behave with an HIV/AIDS Infected Person 54 Whether interested to learn more about HIV/AIDS 55 Whether support providing information on HIV/AIDS through TV, Radio, newspaper and other media 55 Reasons to Diffuse information on HIV/AIDS through TV, Radio, newspaper and other media 56 Appropriateness of the information on HIV/AIDS provided by TV, Radio and other media channels 56 Whether ever watched/listen/seen/read any program about HIV/ AIDS on TV, radio and other media targeting adolescents and youths 57


Page No. Figure

5.23

Figure Figure

5.24 5.25

Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure

5.26 6.1 6.2 6.3 7.1 7.2 7.3 7.4 7.5 7.6 7.7

Whether support the necessity of providing HIV/AIDS information to adolescents More perfected media to diffuse HIV/AIDS information Whether HIV/AIDS infected person should be allowed to mix with general public/un-infected person Whether reproductive and sexual health issues should be discussed at school Whether ever heard of any STDs other then HIV/AIDS Major Ways of Transmitting STDs/STIs More perfected media to diffuse STDs information Whether Ever Heard About Condom Availability of condom in the locality Reasons for using condom Sources of condom in the locality Whether the price of condom is affordable Ever use of any condom by adolescents and youths Reasons of using condom

58 58 59 60 65 66 67 70 71 71 72 73 75 75


Acronyms AIDS BBS BCC BDHS CARE FP FSW CSW GFATM GO HIV ICDDR,B IEC KAP/B MH&FW NAC NASP NGO NGU PIACT RTI SCF-USA SMC STD STI UNAIDS UNFPA UNICEF VD WHO

Acquired Immune Deficiency Syndrome Bangladesh Bureau of Statistics Behavior Change Communication Bangladesh Demographic and Health Survey Cooperative American Relief Agency Family Planning Female Sex Workers Commercial Sex Worker Global Fight to Aids, Tuberculosis, and Malaria Government Organization Human Immunodeficiency Virus International Center for Diarrheal Disease and Research Information, Education and Communication Knowledge, Attitude and Practice/Behavior Ministry of Health and Family Welfare National AIDS Committee National AIDS and STD Program Nongovernment Organization Non-gonococcal Urethritis Program for the Introduction and Adaptation of Contraceptive Technology, Bangladesh Reproductive Tract Infection Save the Children Fund-USA Social Marketing Company Sexually Transmitted Disease Sexually Transmitted Infection Joint United Nations Programme on HIV/AIDS United Nation Fund for Population United Nation International Children Emergency Fund Venereal Disease World Health Organization


EXECUTIVE SUMMARY Background: The Government of the People’s Republic of Bangladesh has received a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) for the Prevention of HIV/AIDS amongYouths and Adolescents in Bangladesh in 2004. The Ministry of Health and Family Welfare (MOHFW) has selected Save the Children-USA as the Management Agency (MA) for the project under the umbrella of National AIDS/STD Program (NASP). Out of five packages under the project, Mattra--PIACT Bangladesh consortium has been awarded to implement the package titled “Provision of HIV Prevention Information to Young People through Mass and Print Media for Campaigns” (Package # GF 901). The major objective of the package is to diffuse HIV/AIDS prevention information to youths and adolescents of Bangladesh through some effective campaigns using various mass media and interpersonal channels. It is expected that the interventions would improve the knowledge of target audiences on transmission and prevention of HIV, so that the young population of this country can avert the risks of being attacked by this deadly pandemic. The pre-intervention audience impact assessment intends to determine the significant changes regarding prevention of HIV/AIDS among youth and adolescents due to broadcasting and disseminating HIV prevention messages for young people through mass and print media. The survey has been planned to compare the post intervention situation with baseline (pre-intervention situation). The present report is based on the pre-intervention survey conducted in recent times. PIACT Bangladesh, in collaboration with the Ministry of Health & Family Welfare of the People’s Republic of Bangladesh and Save the Children-USA, and Mattra has taken this step to conduct a Pre-Intervention Audience Impact Survey among the youths and adolescents age 15-24 years. The Pre-Intervention Audience Impact Survey 2005 is a nationally representative sample survey undertaken in Bangladesh. As expected, the present study among the youths and adolescents examined several sensitive issues such as awareness of HIV/AIDS, mass media channels, necessary life skills to protect youths from HIV and other STDs, source of their information on HIV/AIDS and STDs/STIs, condom use and barriers, and availability of health services. The survey findings are intended to be useful in planning and implementing the country’s HIV/AIDS campaign program under GFATM projects designed to inform young people of the danger of HIV/AIDS, the modes of transmission of the disease, and the ways a person can protect himself/herself from this disease, promote positive behaviors and thereby, combat HIV/AIDS. The Survey was implemented by collecting data from a nationally representative sample of 4105 adolescents and youths chosen from among men and women. The sample was drawn in terms of households by using a multistage sampling design. A structured was used in the survey to collect the data. The fieldwork for data collection started on 23 June 2005 and was completed by 30 July 2005. Media Exposure: Compared to other mass media channels, adolescents and youths of the current survey, irrespective of their locations, had less exposure to radio. On average, 38 percent of adolescents and youths stated their general habits of listening to Radio. In the present survey, availability of television is much higher in urban (69 percent) and slum (47 percent) areas than rural areas (30 percent). Nationally, 86 percent of adolescents and youths acknowledged their general habits of watching television. Urban and slum respondents had significantly greater exposure to television than their rural counterparts. Adolescents and youths mostly watch television during nighttime, attracting the largest percentage of viewers (68 percent) across the sample areas. Nationally, 96 percent of adolescents and youths were found watching BTV, with 99 percent of those in rural areas and a slightly but significantly lower 92 percent in urban and 96 percent in slum areas. 01


Most popular among the available satellite TV channels were the Bangladeshi TV channels, NTV, ATN Bangla and Channel, each watched by 10-18 percent of urban and slum viewers. Few rural (2-3 percent) viewers have the opportunity to watch satellite TV channels. In consistent with other national surveys about 40 percent adolescents and youths stated that they do not usually read newspapers. Of them, as usually, adolescents and youths in urban (53 percent) and slum (45 percent) areas were more likely to read newspapers than those of their rural (32) counterparts. In the pre-intervention audience impact survey, the daily Prothom Alo had the largest readership, read by 32 percent of newspaper readers. Other most read newspapers were the daily Ittefaq (19 percent), the Janakantho (15 percent) and the daily Inquilab (14 percent). Awareness of HIV/AIDS and Major Sources of Information: In the pre-intervention impact audience assessment, an overwhelming majority of respondents (86 percent) had ever heard about HIV/AIDS. Rural adolescents and youths were less aware (15 percentage points) of HIV/AIDS than their urban (95 percent) and slum (91 percent) counterparts. Irrespective of their locations, an overwhelming majority of adolescents and youths stated that they heard about HIV/AIDS from TV (83 percent), followed by radio (22 percent), friends/peers (16 percent), booklet/book (13 percent), and neighbors (13 percent). Only a nominal number of them said that they heard about HIV/AIDS from newspaper/magazines, billboard, health service providers, and NGO workers. Adolescents and youths universally (98 percent) mentioned BTV as their major source of information. Only 5-8 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on general awareness of HIV/AIDS. An overwhelming majority of adolescents and youths (83 percent) mentioned advertisement as their major source of information on general awareness of HIV/AIDS. Adolescents and youths mostly watched programs providing information on general awareness of HIV/AIDS during night (70 percent) and afternoon times (39 percent). Adolescents and youths almost universally (82 percent) mentioned Dhaka Kha radio station as their major source of information on general awareness of HIV/AIDS. Forty percent of adolescents and youths in the study mentioned that they received HIV/AIDS information from the daily Prothom Alo, followed by the daily Ittefaq (17 percent), the daily Janakantho (14 percent), and the daily Inquilab (13 percent). Spontaneous Knowledge on the Perceived Routes of HIV Transmission: About 60 percent of the respondents, of those adolescents and youths who are aware of HIV/AIDS (n=3515), had no idea that HIV could be transmitted through having unsafe sex with HIV/AIDS infected persons. About 80 percent of adolescents and youths had no idea that non-use of condoms during sex with multiple partners could transmit HIV. Likewise, only 26 percent adolescents and youths spontaneously mentioned that unsafe sex with CSWs could transmit the virus. Around half of the adolescents and youths (47-49 percent) knew that HIV could be transmitted through sharing needles and blood transfusion. An overwhelming majority of adolescents and youths heard about perceived routes of HIV transmission through TV (78 percent), followed by radio (19 percent), friends/peers (17 percent), booklet/book (15 percent). Only a nominal number of them said that they heard about routes of HIV transmission from newspaper/magazines, billboard, health service providers, and NGO workers. Adolescents and youths universally (98 percent) mentioned BTV as their major source of information on the routes of HIV transmission. Only 5-7 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on the routes of HIV transmission. Spontaneous Knowledge on the Perceived Ways of Preventing HIV Transmission: Despite their universal general awareness on HIV/AIDS, about 75 percent of the study adolescents and 02


youths had no idea that HIV could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of HIV prevention, more than 90 percent of adolescents and youths stated that they had no idea that consistent usage of condoms during sex with unfaithful partners could prevent HIV. Respondents also had no spontaneous idea that in preventing vertical transmission of HIV (mother-to-fetus), an infected mother should consult doctor before conception. Likewise, 23 percent adolescents and youths mistakenly mentioned that refraining from all sorts of sex could prevent the transmission of the virus. However, around half of the study adolescents and youths (51-53 percent) knew that the transmission of HIV could be prevented through avoiding unsafe sex other than between husband and wife and checking blood before transfusion. Likewise, a remarkable proportion of adolescents and youths (42 percent) had idea that using sterile needles/syringes could prevent the virus. The sources of information on perceived ways of prevention of HIV were almost similar to those of the sources of information on perceived routes of transmission. Prompted Knowledge and Media Exposure on HIV-related Risks Practices: When prompted, using a pre-coded straight question, an overwhelming majority of adolescents and youths (80 percent) mentioned that they were aware about the risk associated with multiple sex partners and non-use of condom. Likewise, when prompted, majority of the adolescents and youths mentioned that HIV could be transmitted through unsafe blood transfusion (88 percent), infected mother to child (82 percent), and during breastfeeding (81 percent). Throughout the sample, respondents were found well aware of the perceived severity of HIV/AIDS. More then 85 percent of adolescents and youths stated that death is the ultimate consequence of an HIV infected person. About 70-75 percent of them also know that a healthy looking person can have HIV/AIDS and the virus can be transmitted through one single unsafe sexual contact. Miasmic/Erroneous Beliefs on the Routes of HIV Transmission: Despite their remarkable general awareness of HIV/AIDS, a considerable number of adolescents and youths were found in the survey who had miasmic or erroneous beliefs on HIV/AIDS. For example, only 44 percent of adolescents and youths believed that HIV couldn’t be transmitted by coughing or sneezing. About half of them (47-52 percent) supported that HIV cannot be passed through sharing drinking/eating utensils and food with someone who had HIV/AIDS. There were also a sizeable proportion of adolescents and youths (43 percent) who though that women could not get HIV if they make sex during their menstruation time. In addition, around 40 percent of the sample had no idea that sharing the same pond with HIV infected person cannot transmit HIV. In the national sample, only 42 percent of respondents believed that a person could not get infected with HIV through ‘mosquito/insect bites’ or by ‘kissing/hugging’ with an infected person. Further, only 38 percent of the entire adolescent and youth sample believed that there was no immunization to prevent HIV transmission. Therefore, it was no surprise that overall 58 percent of the sample had no idea that there is no antibiotic for HIV/AIDS. Remarkably, more than half (54 percent) of the adolescents and youths throughout the study areas believe that AIDS is a curse. A considerable number of them (22 percent) also believe that there is a cure for HIV/AIDS. Across the study areas, adolescents and youths from rural and slum areas were found to have more erroneous beliefs on HIV/AIDS than their urban counterparts. Behave with HIV infected person: Adolescent and youths are mostly in favor of supporting HIV/AIDS infected persons. In response to a question, 36 percent of adolescents and youths mentioned that uninfected persons should take care of an HIV/AIDS infected person. Likewise, about 37 percent of them stated that we should extend our sympathy to an HIV/AIDS infected person. An overwhelming majority of adolescents and youths (73 percent) mentioned advertisement, especially TV advertisement, as their major source of information on how to behave with an HIV/AIDS infected person. 03


Importance of HIV/AIDS related information: More than 90 percent of adolescents and youths, especially in rural and slum areas, mentioned that they were interested to learn more about HIV/AIDS. An overwhelming majority of them (94 percent), irrespective of their locations, stated that they want more information on HIV/AIDS through electronic and print media to make adolescent and youths more aware about HIV/AIDS (73 percent) and to protect them from HIV/AIDS (39 percent). In repose to another question, about 90 percent of adolescents and youths stated that the information on HIV/AIDS provided by TV, Radio and other media are appropriate. Media exposure on programs about HIV/AIDS targeting adolescents and youths: Bangladeshi adolescents and youths usually do not watch/listen programs or read articles/news items in both electronic and print media on HIV/AIDS, specially designed for young audiences. Therefore, in response to a straight question, whether the respondents ever watched/listen/read/seen any program/news item about HIV/AIDS on TV, Radio and other media targeting adolescents, about 80 percent said ‘No’. Adolescent and youths mostly watched/listened/read advertisements, drama and AIDS-related discussion/news. Adolescents and youths, of those who were exposed to programs (n=820), universally (97 percent), acknowledged that the information contained in those programs were necessary for them. In providing suggestions to improve the standard of those programs, more than 35 percent of respondents stated that message/discussion should be detailed, followed by ‘messages should be broadcast frequently’, ‘provide information through drama’, and so on. Necessity of providing HIV/AIDS information to adolescents: Respondents almost universally (95 percent) acknowledged that there is a dire necessity that HIV/AIDS information should be targeting adolescents and youths. In disseminating information on HIV/AIDS to adolescents and youths, electronic mediums, such as television and radio, were found as most appropriate diffusion channels, followed by newspaper, health workers, NGOs, and community functions. Whether Perceived Threat of HIV/AIDS in Bangladesh: Although the study respondents tended to hold commonplace erroneous beliefs about HIV transmission and prevention, the overall findings of this study has demonstrated that the sampled adolescents and youths had perceived the threat of this deadly disease. In response to a question ‘whether HIV/AIDS infected person should be allowed to mix with general public/un-infected persons,’ more than half of the survey adolescents and youths replied positively. HIV/AIDS-related stigma was more prevalent among rural and slum adolescents and youths than their urban counterparts . Self-efficacy and Interpersonal Communication on HIV/AIDS: Overall, adolescents and youths tend to be overly comfortable to discuss HIV/AIDS and STD issues with doctors, paramedics, friends and sex partners as well as with parents and other family members. More importantly, nearly 80 percent of adolescents and youths agreed that HIV/AIDS, reproductive and sexual health issues should be discussed in schools. Awareness and knowledge on other Sexually Transmitted Diseases (STDs): Compared to HIV/AIDS, the awareness of other sexually transmitted diseases (STDs) among the study respondents was low. Overall, only 32 percent of the entire sample reported to have knowledge of major STDs other than HIV/AIDS. However, adolescents and youths (n=1319) did not have clear ideas about the routes of transmission of STDs. In response to a multiple question, only 35 percent of them mentioned that STDs spread through having un-protected sex with STD/STI infected person, followed by non-use of condoms during sex (29 percent), unprotected sex with multiple sex partners (24 percent) and if not maintain personal hygiene (19 percent). Further, they did not have clear ideas about the major ways of protection from STDs. About 80 percent of them had no idea that STDs could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of STD prevention, more than 60 percent of adolescents and youths stated that they had no idea that usage of condoms during sex 04


with partners could prevent STDs. Likewise, only 7 percent adolescents and youths knew that ‘avoiding untested blood transfusion’ or ‘avoiding infected needle/syringe’ could prevent the transmission of STDs. In disseminating information on STDs to adolescents and youths, interpersonal communication through peer education, neighbors, and health service providers were found as most appropriate diffusion channels, followed by television and booklet. Youths were found shy in receiving communication on STDs through electronic and print mediums. More than 47 percent of adolescents and youths said that there are STD services available nearby. Rural youths had less opportunity to avail this service than their urban counterparts. Likewise, more than 46 of them stated that they know STD service providers which provide treatment facilities in suitable time. In reply to a further question, majority of youths (65 percent) mentioned that they did not know whether STD treatment is expensive or not. Condom Awareness and self-efficacy: Adolescents and youths throughout the study areas almost universally (97 percent) acknowledged that they ever heard about condom. Likewise, all of them mentioned that they ever seen a condom. Further, an overwhelming majority of adolescents and youths (88 percent) reported in the survey that condom is available in their locality. Of those adolescents and youths who ever heard about condoms (n=3961), more than 76 percent reported that condoms are used it to avoid pregnancy. More than 40 percent of them also knew that condom is used to prevent HIV transmission. Rural youths had less knowledge on this important link. Adolescents and youths reported in the survey that condom collection was not hard for them. An overwhelming majority of them (83 percent) agreed that there was nearest place to buy condoms in their locality. Respondents obtain condom in their locality from both government and private service providers. In their understanding, Grocery Shops are the common source of getting condoms for adolescents and youths (72 percent), followed by Pharmacy (64 percent), Govt. Hospitals/FP centers (8 percent). Condom is cheap in Bangladesh. Therefore it was no wonder that a remarkable proportion of adolescents and youths (65.4 percent) stated in the survey that condom is affordable to them. In tandem with the above response, 72 percent of them acknowledged that condom is sold to young people. More than half of them believed that the condom sellers maintain confidentiality. However, majority of adolescent and youths (60 percent) mentioned that buying condom by them often create bad impression among local people. Importantly, an overwhelming majority of them (72 percent) stated that they never used any condom. Of those who used condoms (28 percent, N=1120), a very limited number of rural (n=82) and urban (n=46) youths reported using them to prevent HIV/AIDS. Life-Skills and Self-Efficacy in Managing Risk Practices: Adolescents and youths throughout the study areas almost universally mentioned their self-confidence that their friends/peers could not influence them to take drugs. Nearly 90 of adolescent and youths claimed that they could refuse forced sex. Irrespective of their marital status and availability of sex partners, more than 50 percent of adolescent and youths claimed that they could ask their sex partners to use condom. Likewise, only 30 percent of them acknowledged that they were capable to influence their irregular sex partner to use condom. Majority of them (75 percent) also expressed their confidence that they could seek STD services with the nearest clinic/hospitals. Majority of adolescent and youths (76 percent) thought that they have the ability to take decision in selecting their life partners. The primary and immediate users of the findings of this audience survey should be Mattra and other partner NGOs of Global Fund project in Bangladesh and the MOH&FW. Since empirical studies of this type have been largely absent in Bangladesh, the findings of this work should be useful not only to GFATM partners in Bangladesh but to the GoB and different national/international NGOs in designing a socioculturally sustainable HIV/AIDS and STD campaign/strategy, targeting young audiences. The findings of this work should be disseminated widely among government departments and other development partners. 05


1

INTRODUCTION

1.1 Background More than one-third of the worldâ&#x20AC;&#x2122;s population is between 10 to 30 years of age, and four out of five of these young people live in developing countries in vulnerable situation. For example, more than half of the HIV infections worldwide now occur among people younger than age 25 and rates of sexually transmitted diseases (STDs) are higher among adolescents than for any other age groups (UNAIDS/WHO, 2005). HIV/AIDS has been spreading worldwide with ferocious speed. Virtually unknown 20 years ago, the total number of people living with HIV globally rose from 36.6 million in 2002 to 40.3 million by the end of 2005, including 4.9 million people who were newly infected with HIV in the year 2005. In 2005, the global AIDS epidemic killed 3.1 million people. The number of people living with HIV has been rising in every region of the word (UNAIDS/WHO, 2004, 2005). According to the above source, national HIV infection levels in Asia are low compared with some other continents, notably Africa. While Cambodia, Myanmar and Thailand in this region were hit early by the HIV epidemic, the epidemic has been rapidly expanding in countries such as Indonesia, Nepal, Vietnam, India and China. Other countries like Bangladesh, East Timor, Laos, Pakistan, and the Philippines are still experiencing extremely low levels of HIV prevalence. Recent statistics show that the overall prevalence rate of HIV among the high-risk groups (e.g. commercial sex workers (CSWs), injecting drug users/ IDUs) in Bangladesh is < 1 percent. However, the paucity of data calls for a cautious appraisal. Indeed, many factors suggest that HIV may spread rapidly in the near future. These include high rates of sexually transmitted diseases (STDs) that facilitate spread of HIV infection and hepatitis-C; significant numbers of CSWs (over 100, 000); widespread high-risk behaviors (pre- and extra- marital sex, and very low rate of consistent condom use especially in buying sex from CSWs); rising injecting drug use, and sharing of needles by a high proportion of IDUs (70 percent); a large international and national migrant labor force; an essentially unscreened blood supply derived mostly from professional blood donors, approximately 20 percent of whom test positive for hepatitis-B and syphilis (NASP, 2005); and low level of knowledge of HIV among the general population (Amanullah, 2004). The Government of Bangladesh has recognized the above threats of HIV/AIDS and is thus determined to halt its spread among the general population. This is reflected in the various policies/ programs undertaken by the Government in the recent years. The Government of the Peopleâ&#x20AC;&#x2122;s Republic of Bangladesh, with a speedy grant from the Global Fund, has started a comprehensive HIV prevention program targetingYouths and Adolescents in Bangladesh in 2004.

1.2 The Global Fund to Fight AIDS, TB, and Malaria (GFATM) The Global Fund grants are enabling numerous countries to strengthen local public health infrastructure and to dramatically scale up efforts to prevent and treat HIV, Malaria and TB. The Global Fund to Fight AIDS, Tuberculosis and Malaria was created to dramatically increase resources to fight three of the world's most devastating diseases, and to direct those resources to areas of greatest need. As a partnership between governments, civil society, the private sector and affected communities, the Global Fund represents an innovative approach to international health financing.

06


Its objectives are to finance effective programs, balancing the needs for prevention, treatment, care, and support, in order to alleviate suffering, save lives, and help end these diseases and to dramatically increase the global resources dedicated to fighting these diseases. Furthermore, it has a procurement policy that helps guide the purchase of low cost, high quality medicines including antiretroviral for HIV—and other health products necessary to treat the diseases. Nongovernmental organizations and people living with the diseases have welcomed these operational principles. Combined, HIV/AIDS, tuberculosis (TB) and malaria kill an estimated 6 million people a year and affect a greater untold number. Prevention strategies and medications to save lives and ease suffering exist, yet are not accessible to millions infected with these diseases in developing countries. In global terms, these diseases reflect the grave inequalities in access to care and treatment that exist in our world. Wealthy countries, during the G8 Summit and at the UN General Assembly Special Session on HIV/AIDS in 2001, formally acknowledged the gravity of the global AIDS crisis, and made a promise to set up and financially support the Global Fund for AIDS, TB and Malaria. This was an important moment for people living with HIV and health/social advocates around the world, as it demonstrated the recognition by wealthier countries of their responsibilities in helping the global fight against AIDS, TB and malaria. It offered the best hope of providing funds for treating HIV/AIDS and for preventing new infections. The Global Fund also offers a hope to scale up programming that is so urgently required to address the three diseases.

1.3 The Global Fund Project on Prevention of HIV/AIDS among Youth and Adolescents in Bangladesh The Government of the People’s Republic of Bangladesh has received a grant from the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) for the Prevention of HIV/AIDS among Youths and Adolescents in Bangladesh in 2004. The Ministry of Health and Family Welfare (MOHFW) has selected Save the Children-USA as the Management Agency (MA) for the project under the umbrella of National AIDS/STD Program (NASP). Out of five packages under the project, Mattra--PIACT Bangladesh consortium has been awarded to implement the package titled “Provision of HIV Prevention Information to Young People through Mass and Print Media for Campaigns” (Package # GF 901) . The major objective of the package is to diffuse HIV/AIDS prevention information to youths and adolescents of Bangladesh through various mass media and interpersonal channels. One of the specific objectives of the Package is to conduct preintervention and post-intervention audience impact surveys. The present report is based on the pre-intervention survey conducted in recent times.

1.4 HIV/AIDS and Bangladesh Bangladesh is one of the densely populated countries in the world. The relatively young age structure of the population – 45 percent of the population is below 15 years of age -- indicates continued rapid population growth in future (BBS, 1997; 2001). The latest BDHS data indicate that adolescents/young population are less likely to have been visited by the Family Planning (FP) and health workers, and their status of primary health services in rural areas are still very poor (NIPORT et. al., 2005). Bangladesh is under the compounding threat of HIV epidemic and little is known about the number of people living with HIV/AIDS in this country. Since the first diagnosis of AIDS in 1989, up until now, Bangladesh has officially reported only a few number of HIV infections and AIDScases. There is no doubt that these numbers represent an undercounting. Besides, the available surveillance system in Bangladesh does not allow researchers to approximate the HIV-1 07


seroprevalence in this country. Since the transmission of HIV-1 through IDUs and heterosexual contacts are the predominant modes of transmission in Bangladesh, ‘adolescents and youths’ constitute one of the communities at high risk to become infected with and to transmit the HIV-1 virus. National and international experts are suspecting that the actual number of HIV infections in Bangladesh is much higher (Islam et al., 1999; Azim et al., 2000; Amanullah, 2002). According to a WHO estimate, about 20,000 Bangladeshi adults and children were infected with the HIV by the end of 1993 and over 100,000 could have been infected by 1997 (UNAIDS, 1997). Sentinel surveillance system has not been established yet in this country to prove or disprove this estimate and therefore, the experts and policy makers often depend on guessing or inappropriate surveillance in estimating the number of HIV infection.

1.5 Pre-marital Sex Culture in Bangladesh Despite strong religiosity and sociocultural norms, several qualitative and quantitative studies show that promiscuity, illicit sexual behavior, and multiple sex partners are much common among Bangladeshi youths. In an anthropological study, Aziz and Maloney (1985:96) reported that, 50 percent of their subjects (adolescents and youths) had engaged in intercourse before their marriage, adolescents were not punished for their premarital sex, and such acts were related to respondents’ socioeconomic status. Although Islam permits sex only within marriage (Amin and Hossain, 1995:1334-1335), however, Aziz and Maloney observed that families were not worried about pre-marital discreet sexual relationships of their sons (1985:99). In their opinion, social and religious sanctions against pre-marital sexual relation are weak if it happens between a powerful man and a poor woman (1985:97-98). Here, unmarried young are most likely to make sexual relations with their unmarried kin (Caldwell and Pieris, 1999:188; Aziz and Maloney, 1985:92-96; Aziz, 1979:120; Amanullah, 2004). About half of the subjects (Bangladeshi males) stated their experience of premarital sex in a joint study of ICDDR,B and the Health Transition Center of Australian National University. Furthermore, about 50percent of married/unmarried men, who stated premarital relations, had visited sex workers (Caldwell and Pieris, 1999:187-189). In a condom use study (Folmar, Alam and Sharif, 1992), about 30 percent of the respondents stated that they were engaged in premarital sex. Of them, only around a quarter stated using condoms. Researchers opined that, given the sensitivity of issue, these figures are undercounts. In another study (Islam, 1981), abortion practitioners helped hundreds of unmarried girls to do induce abortions. Maloney, Aziz and Sarker (1981) further reported that rigid attitudes to promiscuity/illicit sex are misleading because about half of their study youths were engaged in premarital sex. In a recent study of adolescents, Haider et al. (1997) reported that by the age of 19 years 88percent of urban unmarried males had sexual experience compared to 44 percent of unmarried rural males.

1.6 Extra-marital sex The practice of extra-marital sex is much frequent among male adolescents and youths as well as small professional groups (Amanullah, 2002; OMQ, 1998). Caldwell and Pieris (1999:187-188) reported in their study that 52 percent of married and 47 percent of unmarried men ever had extramarital coitus mostly with their girl friends, sisters-in-law, and prostitutes. In a SMC study on HIV/AIDS, 56 percent truckers mentioned visiting FSWs and other sex partners, and their average age of first sex was 20 (OMQ, 1998). Further, almost all married truckers’ wives did not know that their husband visit SWs. Among truckers, 26 percent stated that they had serial sex with a common SW. The actual incident of condom use with SWs and other kin/sex partners was unregarded. The qualitative part of the study revealed that small traders, tea stall owner/managers, moneychangers, warehouse labors, and police/BDR had extra/pre-marital sex with brothel/floating SWs in bordering areas (OMQ, 1998:1-11). In an earlier national survey, 75 percent of the subjects were found against extra-marital sex (NAC, 1990), which was not supported by the later studies. 08


1.7 Sexually Transmitted Diseases (STDs) It is now well established that the presence of both ulcerative and non-ulcerative STDs increases the risk of HIV transmission as much as 3 to 5 folds. Specifically various genital ulcers, such as herpes simplex II or syphilis and trichomonas vaginalis, chlamydia trachomatis, and neisseria gonococcal infections, have been identified as catalyzing agents in increasing the susceptibility of HIV infection in all over the world (UNAIDS/WHO, 2001, 2005). In absence of a comprehensive and routine screening, a scientific STD prevalence (Islam et al., 1999; Azim et al., 2000) is largely unknown for Bangladeshi population. Gonorrhea, syphilis, genital herpes, and genital warts are the leading STDs among Bangladeshi population (Islam et al., 1999; Azim et al., 2000; Sarkar et al., 1998; Amanullah and Islam, 1996; Khan and Arefeen, 1995). In a situational analysis, Mian and Karim (1993) observed an increased number of STD patients in a Bangladeshi hospital in 1993. In their study, about 41 percent of skin/VD out-door patients had genital tract injection, 14percent had syphilis, 6 percent had nongonococcal urethritis (NGU) infections, 38 percent had some combination of STDs, and the treatment facilities were non-specific and insufficient. Aziz and Maloney (1985) confirmed that the people in their study areas were generally aware that STDs transmit through illicit sex and often from SWs. In 1992, Save the Children (USA) studied 980 women over the age of thirteen and 70 men during a four-day free health clinic conducted in Rangunia, a conservative, predominantly Muslim rural area about 30 km from port city Chittagong. In the study, 54 percent of the women have had a history of present or past STDs, 61 percent, having current symptoms of STDs, had an abnormal vaginal discharge, 5 percent had genital ulcers, 34percent had lower abdominal tenderness, and 4 percent had genital warts. Because of anal intercourse, some women had anal warts. The study warned that in absence of adequate testing and treatment facilities, the high incidence of STDs in such a poor and remote rural community would provide a fertile ground for explosive and unchecked outbreak of HIV (SCF, 1993).

1.8 Usage of condoms HIV spreads fast in absence of condom use and in presence of STDs and other infectious diseases. However, in Bangladesh, condom is not a part of heterosexual and homosexual intercourse. Several national studies show that the awareness and usefulness of condoms have risen in Bangladesh for last few decades among ever-married women/men (Mitra et al., 2001; NIPORT, 2005), adolescents (Mitra, Islam and Amanullah, 1996) and SWs and their clients (Amanullah and Islam, 1996; Jenkins, 1999). However, the most discoursing fact for HIV program planners is that, of those women (49 percent) and men (60 percent) who were currently using FP methods, only 3.9 percent women and 5.7 percent of men stated that they were using condoms and the practice was strikingly related to their education and place of residence (Mitra et al., 2001; NIPORT et. al., 2005). Although the current use of condoms has risen steadily among women, the discontinuation of its usage was highest (65 percent) among all contraceptive methods (1997:67). Besides, consistent use rates of condoms are largely unknown for them. The above national scenario confirms that the condom is not a part of sex culture in Bangladesh. Caldwell and Pieris observed that although ‘…by international standards the recorded levels of nonmarital and commercial sex are not high’ in Bangladesh, ‘…however, most of this sexual activity was reported to be unprotected’ (1999:190). In their study of high-risk behaviors among Bangladeshi married/unmarried males, only about 12 percent of the subjects reported always using condoms with non-marital/causal sexual partners. Their findings are more or less similar to existing condom use rates reported by available condom and prostitution studies in Bangladesh (Amanullah and Islam, 1996; Rich et al., 1997; Jenkins, 1999:218; Amanullah, 2002). 09


1.9 Background of This Project From the experience of the past BCC intervention programs and the above discussion, it has been seen that there is a high occurrence of risk-behaviors among the adolescents and youth population of Bangladesh. Moreover, these people have hardly any access to correct knowledge and information, especially on sexually transmitted diseases (STDs) and HIV/AIDS, which leads them to seek information on sensitive issues from unreliable and inaccurate sources. In the wake of HIV epidemic, it is imperative that the knowledge level and common queries that adolescents have are investigated and addressed through large-scale campaign using mass media campaign and other techniques of interpersonal communication such as workshops and seminars. Hence, the need for a research on adolescents and youth.

1.10 Objectives of the survey The objectives of the pre-intervention audience impact survey were to: o o o

o o o

assess existing level and breadth of knowledge, attitudes, and practices related to HIV/AIDS and other STDs among the adolescents and youths population in Bangladesh assess media exposure of adolescents and youths on HIV/AIDS and other STDs review existing communication channels (electronic and print media and inter-personal communication) and identify the effective diffusion agents/ channels with reasons to justify to use them during large scale campaign assess the awareness, range of experiences, behaviors and self-efficacy with regard to condom use and barriers among adolescents and youths assess the level of life-skills and self-efficacy of adolescents and youths regarding decision making, obtaining STD services, and sex and HIV/AIDS education, and provide baseline measures for evaluating the package GF# 901 (Provision of HIV Prevention Information toYoung People through Mass and Print Media for Campaigns) activities among the adolescents and youths

1.11 Aim of the survey A consortium of MATTRA and PIACT Bangladesh, in collaboration with the Ministry of Health & Family Welfare and Save the Children-USA, has taken this step to conduct a Pre-intervention Audience Impact Assessment among the Youths and Adolescents age 15-24 years. The survey findings will help the sponsors toward designing the media intervention program on HIV/AIDS and find out the current scenario of sexual health of youths and adolescents of Bangladesh. As expected, the present study among the youths and adolescents examined several sensitive issues such as HIV/AIDS, necessary life skills to protect youths from HIV and other STIs, source of their information on HIV/AIDS and STDs/STIs, condom use and barriers, availability of health services, and media habits.

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2

METHODOLOGY AND IMPLEMENTATION OF THE SURVEY

Detailed design of the study including sample size, respondents, process of instrument development, training, data analysis and quality control plan etc. are stated below:

2.1 Methodology 2.1.1 Study Design The audience impact assessment study for package # GF 901 intends to determine the significant changes regarding prevention of HIV/AIDS among youth and adolescents due to broadcasting and disseminating HIV prevention messages for young people through mass and print media. There is no fixed age bracket for the definition of youth and adolescents. Different organizations use different definitions. The Global Fund focuses on population aged between 15 and 24 years. So, in this impact study, we concentrated to the population aged 15-24 years. The 2001 Population Census reveals that the youth and adolescents of age 15-24 comprise 18.5 percent of the total population. Accordingly, the estimated youths and adolescents in 2004 come at 25.57 millions. Therefore, in 100 households, on average, there are 91 youth and adolescents (0.91 youth and adolescents per household). The impact assessment study envisaged to see the changes as a result of interventions. The most commonly design used in operational research of above category is the pre-test â&#x20AC;&#x201C; post-test design. In this design, baseline (the pre-test) situation is assessed by a nationally representative sample. The post-test situation will also be assessed by a nationally representative sample. The outcome in such situation is best if panel sample is used in the post-test case. Let P1 is the knowledge level in baseline situation and P2 is the knowledge level in post intervention situation. Hypotheses: H0 : P2 - P1 > large enough.

2.1.2 Conceptual Framework Although Bangladesh is a low prevalence nation, but risk behaviors are currently facilitating to spread the HIV infection to its general population, particularly young population. It is urgently felt that all out efforts be undertaken to fight against AIDS, STDs, Malaria and Tuberculosis. The GFATM project in Bangladesh has been undertaken to prevent the HIV/AIDS among youths and adolescents. The strategy of package GF # 901 under the project is to increase the knowledge of HIV/AIDS and its consequences and develop awareness of preventive measures among the general youths as well as high-risk groups through some effective campaign. It is expected that the interventions would improve the knowledge of target audiences on transmission and prevention of HIV, so that the young population of this country can avert the risks of being attacked by this deadly pandemic. The audience impact assessment has been planned to compare the post intervention situation with baseline (pre-intervention situation).

11


The following diagram shows the conceptual framework: Before Intervention

Interventions

Low level of knowledge of HIV

Airing HIV/AIDS Related Messages/Information

Low level of awareness about the consequence

u

Low level of knowledge about prevention measure

Educational media spots through TV and Radio channels

u

TV drama serial

High-risks of HIV/AIDS

u

Radio magazines/drama serials

BHDS 2004 Estimated: u

No knowledge HIV=40 percent

about

Percent of people know preventive methods=18 percent

u

HIV/AIDS information through folksongs by TV and Radio Community Theatre Shows

Displaying youth attractive programs through other innovative ways Organizing workshops at national, divisional and local levels

After Intervention High level of knowledge of HIV High level of awareness about the consequences High level of knowledge about preventive measures Low risks of being attacked, particularly of youth people It is expected that after the project percent of knowledgeable youth would go beyond 90 percent and percent of people know preventive measures would exceed 80 percent or even more.

2.1.3 Survey Design and Sampling Plan It is stated that a nationwide estimate is desired to see the impact of the project. In view of the above the sampling design of this pre-intervention audience impact survey has been developed so that all the target groups: the youth and adolescents are represented in the sample.

Target respondents: the Adolescents and Youths The population covered by the pre-intervention audience impact survey was the universe of all the male and female, married or unmarried of age 15-24 (project target group). Thus, the respondents were: o o

Female adolescents and youths aged between 15 and 24 Male adolescents and youths aged between 15 and 24

12


In any HIV/AIDS and sexuality survey, to avoid response biases, it is important to interview respondents individually. It was found better to identify adolescents and youthsâ&#x20AC;&#x2122; free time and make them clear about the content of the questionnaire. To avoid further response biases, one adolescent/youth from each sample household was interviewed. Therefore, the respondents who were interviewed earlier were less likely to influence the responses of those to be interviewed later by discussing the survey questions with them. The technique was found suitable to collect social data in other academic and commissioned studies (Amanullah, 2002). Field supervisor in each team maintained the daily record of successful interview so that the total number of interview is completed within the stipulated time. Field manager strictly monitored the whole process so that the quota per category is maintained. The youths and adolescents in the selected households will be interviewed.

2.1.4 Sampling Frame: An up-dated list of Enumerated Areas (EAs) in six administrative divisions was used as sampling frame for the selection of sample of households. This up-dated list has been developed by BBS for Integrated Multi-purpose Sample (IMPS). In each division, the list of Enumeration Areas (EAs) constituted the initial sample for the pre-intervention audience impact survey.

Sample Size: Rural and urban areas other than slum areas For the selection of youth and adolescents for the whole country, excluding slum areas, the following general formula was used. 2

Z PQ (d.e) e2 = 3538 = 3750, for convenience of allocation to strata n=

o o o

Where Z=1.96, P=Q=0.5, d=2.0 (design effect) for three stage sampling and e = .0233 (margin of error)

Thus, the total adolescents and youth covered equals = 3750 Total male adolescents & youth = 1875 Total female adolescents & youths = 1875

o

Since 0.91 adolescent and youth live on average in one household, the total households covered came at 4121.

o

It was planned to cover 30 youths and adolescents from each selected EA, thus the total EAs selected were 125 (3750 á 30).

o

From each EA 15 boys and 15 girls were interviewed. To cover 30 adolescents and youths it was necessary to cover 33 households on average from each EA.

13


2.1.5 Slum Sample Urban slum is an important domain for this study. It is intended to cover 360 adolescents and youths from the slum areas. Thus, from each slum a total of 30 (15 boys, 15 girls) adolescents and youth were covered. The total slum EAs were 12. These slums were selected from the six divisional headquarters.

2.1.6 Sample Selection The pre-intervention audience impact survey was conducted in all six divisions of Bangladesh. Sampling was done separately for each division. For each stratum, rural and urban stratification was followed. The primary sampling unit was upazila. The secondary sampling unit was Enumeration Area, and households were ultimate sampling units. All the youths and adolescents in the sample households were covered. Thus, the sampling design was a three stage sampling design. At primary and secondary stage probability proportional to size (PPS) scheme and for selection of households, random sampling scheme was used.

Allocation of Strata: The BDHS 2003 used information on sampling errors for six selected variables for the 1996-97 BDHS, and found that the square root allocation provides most efficient estimate. In the impact assessment study we also allocated EAs proportion to square root of the size of strata. The allocation between rural and urban also followed proportion to square root of total dwellings. The allocation of 125 EAs for rural urban, 12 EAs for urban slums is shown in Table-2.1.

Table 2.1 Allocation of EAs, youths and adolescents (Y&A) and households by divisions Division Urban EAs Rural EAs Slum EAs Total EAs UrbanY&A RuralY&A SlumY&A TotalY&A Urban HH Rural HH Slum HH Total HH

Barisal 4 10 1 15 120 300 30 450 132 330 33 495

Chittagong 8 14 2 24 240 420 60 720 264 462 66 792

Dhaka 14 16 3 33 420 480 90 99 462 527 99 1088 14

Khulna 6 13 2 21 180 390 60 630 198 429 66 6931

Rajshahi 7 21 3 31 210 630 90 930 231 692 99 1022

Sylhet 3 9 1 13 90 270 30 390 99 297 33 429

Total 42 83 12 137 1260 2490 360 4110 1386 2737 396 4519


For each division samples were drawn independently for rural and urban areas (metropolitan, municipalities, and urban slums), urban SMA, and other urban areas from the Integrated Multipurpose samples drawn by BBS. Thus, the total youths and adolescents selected for this survey were 4110. Among them, 2055 were male and 2055 were female. In each EA, 15 male youths and adolescents and 15 female youths and adolescents were covered. In order to cover 30 youths, a minimum number of 33 households were required to cover from each enumeration area. Therefore, the total households covered in this survey came at about 4519. For each district, number of upazilas, equal to the number of EAs, one for each upazila, was drawn using PPS (Table 2.3-2.5, attached in Appendix). At the third stage, at least 33 households were covered to obtain 15 male and 15 female adolescents and youths. Table 2.2 Sample EAs by rural, SMA, and urban areas by division Division Total EAs Rural EAs Urban EAs SMA slum*

Barisal 15 10 4 1

Chittagong 24 14 8 2

Dhaka 33 16 14 3

Khulna 21 13 6 2

Rajshahi 31 21 7 3

Sylhet Bangladesh 13 137 9 83 3 42 1 12

* In Bangladesh, the slum population in each SMA is not stable over time, nor within a slum also. It is therefore very difficult to define it geographically. Since we do not have adequate frame to study this population, the selection of slum was done purposively. Selection of household within a slum, however, was done randomly.

15


Figure 2.1: Map of Bangladesh: The Spread of the Sample Sites Pre-intervention Audience Impact Survey for Youth and Adolescents on HIV/AIDS 2005 890

SMA Rural Urban Slum

900

Panchaga 260

Nilphamari

Thakurgaon

920

BANGLADESH 260

Lalmonirhat Kurigram

Rangpur

Dinajpur

910

Rajshahi Division

INDIA

Gaibandha 25

0

Sherpur

Joypurhat Naogaon

Jamalpur Bogra

Nawabganj

Dhaka Division Mymensingh

Rajshahi Natore

Sirajganj

Gazipur

Meherpur

Chuadanga Jhenaida

Jessore

0

Rajbari

Narail

INDIA

Satkhira

Comilla

Gopalganj

Khulna

Bagerhat

Noakhali Barisal Pirojpur Jhalokati

Khagrachuri Feni

Lakshmipur

230

Chittagong Division

Bhola

Rangamati

Barisal Division Patuakhali

Chittagong Bandarban

Barguna

220

240

Narayanganj

Shariatpur Madaripur Chandpur

Khulna Division

INDIA

Munshiganj

Faridpur

Magura

Habiganj

B. Baria Dhaka

0

Sylhet Division

Narshingdi

Manikganj

Kushtia

25

Sylhet

Moulvibazar

Kishoreganj

Tangail

Pabna

240

23

Sunamganj

Netrokona

220

Cox's Bazar

BAY OF BENGAL MYANMAR 210

GEOGRAPHY

210

890

900

910

16

920


2.1.7 Data Description Data have been collected from male and female youths and adolescents. The topics within the questionnaire include: o o o o o o o o

o o o o o o o o

Demographic background Household information Exposure to Media Exposure to HIV/AIDS-related communication program messages Knowledge on HIV/AIDS Knowledge on other STDs/STIs Awareness on the ways of avoiding HIV/AIDS and other STIs Interpersonal communication with peers, parents, and others regarding HIV/AIDS and other STDs Life skills Obtaining condoms Barriers related to condom Condom use Perceived ability to effectively manage oneâ&#x20AC;&#x2122;s sexual activities Perceptions and use of sexual health services in community Discussion with parents and others on such topics as sexuality, HIV/AIDS, condom use, etc. The importance of HIV/AIDS education for adolescent and youths at schools/colleges etc.

2.2 Implementation of the survey 2.2.1 Survey Tools Questionnaire was developed in consultation with SC-USA and Mattra. After developing the draft questionnaire, it was sent to SC-USA and Mattra for their comment. After getting approval from them, the final questionnaire was translated into Bangla, the local lingua franca, and then retranslated into English to use them in the study. The contents of the questionnaire were same for all categories of respondents. All questions/sections are likely to be answered by only a few respondents. Questions pertaining to the sources of HIV/AIDS were not asked of a subject if she/he had not heard about HIV/AIDS. Thus, the total number of responses is not the same for all questions/sections.

2.2.2 Pretest and Finalization of Questionnaire We organized a pretest of the draft questionnaire both in urban and rural areas. A group of 24 male and female interviewers, 6 field supervisors, 6 quality control supervisors, 1 field manager were recruited and trained for a week to conduct this pretest for checking the translation, consistency and integrity of the study tool. The study tool was finalized based on the results of this pretest. The supervisors were provided with Grameen Mobile Phones to facilitate communication and monitoring. We did the pilot testing in non-sample point locations. The pretest fieldwork was lasted for 2 days. 17


During pre-testing the questionnaire, following issues were considered: o o o o o

The probing techniques The language necessary to administer sensitive issues The sequencing of questions The techniques/methods/options for documenting responses Providing appropriate skips in the questionnaire, etc.

The sites for pre testing of questionnaire were selected along with the SC-USA and Mattra.

2.2.3 Administering Survey PIACT Bangladesh administered the survey to respondents according to the sampling plan discussed above. Considering the sensitivity of the information required, special attention was given to minimize the reluctance of the respondents to talk about their experience or behavior which may be embarrassing or socially disapproved. The following approaches were followed to minimize the reluctance of the respondents: o o o

o o

Establishing proper rapport with the respondents and gaining their trust on the interviewers Minimizing social distance between the interviewers and the respondents The interviews were conducted in privacy. As the individuals feel more free to talk on sexual behavior when interviewed away from the domestic settings, questionnaires were administered at isolated places and sometimes away from home In some cases, repeated visits were occurred to some of the respondents to break down the barriers Each interviewer made at least three attempts to call each assigned respondent before he/she is considered unavailable

2.2.4 Number of Teams for Data Collection There were six teams -- consisting 2 male and 2 female interviewers, 1 field supervisor and 1 quality control officer -- responsible for six divisions. Required number of field personnel (interviewers, quality control officers, and field supervisors) for the study were recruited from our panel of experienced interviewers and supervisors. After preliminary selection, the investigators, quality control officers, and field supervisors were trained on data collection mechanism, art of data collection, briefing on the questionnaire etc. After the training sessions, these personnel went to the field to administer questionnaire. This gives a practical knowledge about the whole process to them. Before final selection, they had to face a â&#x20AC;&#x153;mock testâ&#x20AC;?. Female interviewers were used to collect data from the female respondents. Almost all the field personnel were graduate or above. For four field interviewers, we had one field supervisor.

2.2.5 Fieldwork for the Survey The fieldwork for present survey was conducted for 30 days between June and July 2005. The survey was based on an exclusive fieldwork in various pre-selected sample sites in Bangladesh. About 40 field personnel consisting of male/female interviewers, quality controllers, supervisors, and filed managers were involved in the filed operation. The research teamsâ&#x20AC;&#x2122; previous study experiences with similar subjects helped in collecting personalized information pertaining to their knowledge, attitude and practices relating to HIV/AIDS and STDs, as well as in building rapport with such young and sensitive study communities. Therefore, the successful completion of the present survey was possible within a relatively short time. Although the quantitative data were collected from individual respondents, an attempt had been made in the subsequent analysis to correlate the individual experiences with their wider socioeconomic and cultural contexts. 18


A Central Control Room was based at our Dhaka Office, which was managed by the Field Operations Manager. All teams were provided with Grameen Mobile Phones and were in direct contact with the Control Room. They reported their daily progress as well as any other information to the Control Room. The Field Operations Manager is a senior staff member of PIACT Bangladesh and was responsible for providing logistics to the survey teams and quality control teams under his jurisdiction. He also implemented the overall monitoring and supervision of fieldwork, after discussions with the Team Leader/Consultants. For successful completion of the fieldwork of this pre-intervention audience impact survey, the team leader made several field visits throughout the country. The team leader also coordinated with SC-USA and Mattra, Dhaka. In order to ensure the quality, each investigator was allowed to do a maximum of 6 completed interviews in a day. The allocation of households to different investigators was made in such a manner that they were closed to each other to facilitate monitoring by the field supervisors and quality controllers officers.

2.2.6 Non Response There were cases of non-response from respondents including cases of non-availability of members/respondents in selected households. In this situation, the interviewers selected respondents from the alternative household so that the overall sample size is achieved. Every effort was made to interview all the sample households. If the sample respondent was not available at the time of interview then at least two revisits were made to interview the sample respondents. Therefore the overall non-response rate in this study is virtually nil.

2.2.7 Data Processing/Analysis Data processing work involved the following stages under the guidance of the Analysis Manager who worked in close co-ordination with the Team Leader and Statistical Advisor: o o o o o o o o o o

o o

o o o

Questionnaire registration and editing Edit verification Listing of open-ended responses and classification Coding and code transfer Verification of coding and code transfer Development of data entry structure Data entry and entry verification Enter data as per questionnaire structure in SAS Editing data Verifying the logic and accuracy of the data as per filled up questionnaire (in Clipper 5.3 version-language programming and C language programming) Keeping and maintaining data backups Tabulating as per objective and requirement in Quantum (an upgraded version of SPSS), also tabulating data in SPSS 11.0 version (latest version of SPSS package) Development of analysis plan Program development as per the analysis plan Program running and report generation.

19


Different statistical tests were carried out to test the level of significance, some of the relevant ones are Chi-square test to measure variation within indicators and observe all cross analysis and Z-test to measure rural-urban variations.

2.2.8 Ethical Issues Following HIV/AIDS related ethical principle (UNAIDS, 1997), the team leader and PIACT Bangladesh has taken every possible steps to ensure the ethical standard in completing this baseline study. Since PIACT Bangladesh is a member of several professional bodies, adequate measures were taken toward maintaining ethical standards at all the stages. Measures were taken to protect the rights of people participating in the study, explaining the purposes of the study before collecting information from them. Some of the steps are stated below: Introduction and Explaining the Purpose: It was mandatory to all the investigators to introduce themselves and explaining the purposes of the study before collecting information from adolescents and youths. They had to indicate the respondents that their participation was voluntary. The investigators also had to brief about the organization. Confidentiality: The respondents were informed clearly that the information they provide during the interviews would be kept strictly confidential. Only the interviewer and the researcher would have access to the questionnaires and these questionnaires would be destroyed on completion of the analysis and cross-tabulation. The name and address of the respondents would not be recorded any where in the database. Privacy: Furthermore, privacy during the interview process was safeguarded. The interview was held under conditions wherein the respondents felt most comfortable in responding. Also their identity will not be linked to the study at any point of time or stages of the study. All documents, questionnaire, photographs etc. are kept under lock & key in a separate room at PIACT Bangladesh. Primarily, it was respondentsâ&#x20AC;&#x2122; discretion to participate in the interview. The study registered oral consent from all interviewees. Any form of coercion on the study subjects was strictly avoided in either getting their consent or interview.

2.2.9 Limitations Despite of all positive initiatives taken to conduct this pre-intervention audience impact survey properly, the findings of the survey had a number of limitations. First, the survey had to rely on convenience samples in selecting slums. Because of time and resource constraints, the samples of adolescents and youths from slum areas may not be fully representative. Therefore, the generalization of slum findings is somewhat limited in relation to the greater adolescents and youth population living in other slum areas of Bangladesh. On the other hand, KAP-based quantitative findings of the study may be generalized but in some instances, they are not selfexplanatory and descriptive. To overcome this problem, this study has not tried to examine HIV/AIDS and STDs related KAP variables of adolescents and youths by employing both quantitative and qualitative survey techniques and by integrating a cultural study perspective. Further documentation and systematic replicable studies should verify the findings of this initial study. 20


Second, a major portion of data in this study has relied on respondent’s self-reports and these might not be free from unintentional/intentional response biases or deliberate concealment. However, based on the team leader and consultant’s long experience, the study used several techniques to overcome the above difficulties and to get accurate and honest responses from the study samples. We believe that because of our rigorous training, both adolescents and youths did not try to please the interviewers by providing socially desirable answers. Third, the results reported in the study are mostly based on cross-sectional data and are preliminary in nature. They may be affected by the confounding factors, and therefore the relationships described between various study variables cannot be viewed as exclusively causal. Fourth, there was a limitation of observing the real practices of knowledge. In most of the cases, the investigators had to rely on respondents’ statements. Finally, the study could construct a few simple scales in measuring the subjects’ levels of perceived knowledge, attitude and practices pertaining to HIV/AIDS and STDs. Besides, to ascertain the influences of the extraneous variables on study subjects’ HIV/AIDS and STD related perception and practices should be one of the primary goals of this study. In the study, extraneous variables that are likely to influence the HIV/AIDS and STDs related KAP variables were not classified. Using bivariate and multivariate analysis, the influences of extraneous variables on dependent variables, especially on knowledge, perception and practice pertaining to HIV/AIDS and STDs should be examined later. Due to shortage of time, the study could not attempt those measures. However, considering the above limitations, the study fulfilled all the steps required to conduct this pre-intervention audience impact survey scientifically and effectively. The findings are indicative and could be confidently used for future decision-making processes.

2.2.10 Usefulness The primary and immediate users of the evaluation will be the Mattra and other partner NGOs of Global Fund project in Bangladesh and the Ministry of Health and Family Welfare. With its widespread coverage, partners outside of GFATM would also no doubt be interested in the findings. The evaluation will inform the decisions on next steps of HIV/AIDS and STDs/STIs education through using various mass, interpersonal and traditional communication channels targeting Bangladeshi adolescents and youths. The evaluation provided a baseline against which the effects of any new campaign approaches, tools and programs -- that might be introduced as a result of the evaluation -- can be measured in a few months time. Since empirical studies of this type have been largely absent in Bangladesh, the quantitative findings of this work should also be useful to the GoB and different national/international NGOs in designing a socioculturally sustainable HIV/AIDS campaign program/strategy, targeting adolescents and youths. This study also highlights the future direction of communication and education to achieve effective Information, Education and Communication (IEC) exposures and diffusion by spreading different HIV/AIDS and STD related messages to the maximum among youths and adolescents in Bangladesh and other developing countries.

21


3

SOCIO-DEMOGRAPHIC CHARACTARICTICS RESPONDENTS

Socio-demographic findings pertaining to adolescents and youths, included in this pre-intervention audience impact survey, cover: their age, civil status, ever and current attendance of school, major occupation, household income and possession/availability of household durables/facilities, etc.

3.1 Age In total, 4105 adolescents and youths ranging from ages 15 to 24 were interviewed in this preintervention audience impact survey. The male-female ratio among the respondents was almost equal. In the overall sample, the mean age was recorded as 20 years. No significant variation was observed among the mean ages of the respondents across the study areas.

Table 3.1 Percent distribution of respondents by selected background characteristics and according to study areas (rural, urban and slum) Gender Male Female Age 15-19 20-24 Mean Age Ever attendance in school Yes No Current attendance in school Yes No Highest class attended No study Primary Secondary College/University Civil status Married Unmarried Widow/Divorced/ Separated Total N'

Rural 50.0 50.0

Urban 49.6 50.4

Slum 50.1 49.9

National 49.9 50.1

46.4 53.6 19.8

42.2 57.8 20.2

51.0 49.0 19.6

45.6 54.4 19.9

85.5 14.5

91.1 8.9

76.7 23.3

86.4 13.6

23.6 76.4

30.3 69.7

13.3 86.4

24.4 75.3

14.5 27.4 50.8 7.3

8.9 23.0 50.0 18.2

23.3 41.3 33.0 2.5

13.6 27.3 49.0 10.1

49.5 49.8 0.7

47.9 51.1 1.0

49.0 50.4 0.6

49.0 50.3 0.7

100.0 2551

100.0 1193

100.0 361

100.0 4105

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey.

22


3.2 Educational background Ever attendance in school among adolescents and youths was very high with 86 percent of adolescents and youths in rural areas and more than 91 percent of them in urban areas had ever attended in school. In the slum areas, roughly 77 percent of adolescents and youths had ever attended school. However, a much lower percentage of respondents were found currently attending in school. Roughly 24 percent of rural, 30 percent of urban, and only 14 percent of slum respondents stated that they were currently attending in schools (Table 3.1). About 14 percent of respondents in the overall sample had no education. The percentage of respondents with no education was significantly higher in slum areas (23.3 percent) than in urban areas (9 percent) and rural areas (15 percent). In terms of secondary education, the percentage of adolescents and youths that attained their secondary school certificate (SSC) was around 50 percent in both rural and urban areas. The percentage of adolescents and youths completing their SSC was significantly lower at 33 percent in slum areas. In the survey, only 10 percent of adolescents and youths stated attending college/university education. Respondents from rural and slum areas are much lagging behind in attending tertiary education than their urban counterparts.

3.3 Civil status In the overall sample, 49 percent of respondents were currently married while more than half were (50.3 percent) were never married. Few of the adolescents and youths were widowed, divorced or separated. There were no variations in the civil status composition of respondents across the study sites.

Table 3.2 Percent distribution of respondents by their occupational background, according to study sites (rural, urban and slum) Major Occupations Service (Govt/Private) Student/Tuition Unemployed Housewife Agriculture Business Others N'

Rural 4.3 23.3 13.8 23.7 13.6 7.7 4.2 2551

Urban 11.5 29.3 10.0 21.8 0.8 11.6 4.4 1193

Slum 13.9 13.0 11.9 21.9 0.8 14.1 5.3 361

National 7.3 24.1 12.5 23.0 8.7 9.4 4.4 4105

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey.

3.4 Occupational background The overall unemployment rate is moderate across the study sample (12.5 percent). Compared to rural (14 percent) and slum (12 percent) areas, adolescents and youths in urban areas were less likely to be unemployed (10 percent). Adolescents and youths were mostly found to be involved in study (24 percent), followed by housewife (23 percent), business (9.4 percent), agriculture (8.7 percent), and some sort of service (7.3 percent) (Table 3.2). 23


3.5 Possession/availability of household durables/facilities In the survey, 60 percent of the households had access to electricity. Compared to urban (90 percent) and slum areas (77 percent), availability of electricity in the rural households was much lower (44 percent). Possession of television sets in households is still limited in rural Bangladesh. Compared to urban (69 percent) and slum areas (47 percent), only 30 percent of the rural households were found to have television sets. However, compared to urban (37 percent) and slum areas (30 percent), possession of radio sets was found higher among rural households (40 percent). In the survey, only 8 percent of households were found subscribing newspapers. Subscription of newspapers was much lower in rural and slum areas (4 percent respectively) than those of urban households (16 percent). In the survey, 29 percent of households had motorcycles. A considerable number of study audiences had mobile phones (29 percent) and refrigerators (7 percent). More than 40 percent of households in the overall sample had average monthly income BD Taka <3000, followed by BD Taka 3001-5000 and 5000+ (around 30 percent respectively) (Table 3.3). These findings are consistent with the finding of latest BDHS.

Table 3.3 Percent distribution of respondents by their possession/ availability of household durables/facilities, according to study sites (rural, urban and slum) Possession/availability of household durables/facilities* Electricity Radio Television Newspaper Bicycle Motor cycle Car/Truck/Van Mobile/Land phone Refrigerator Others Average monthly income (HHs.) < 3000 3001-5000 5001+ Total N'

Rural 43.6 39.9 30.1 4.3 30.4 2.7 4.9 11.5 2.4 3.7 Rural 46.2 29.8 24.0 100.0 2551

Urban 90.2 37.4 68.7 16.3 28.2 5.5 4.9 33.9 19.5 6.0 Urban 25.2 25.6 49.1 100.0 1193

Slum 76.7 29.9 46.5 4.2 22.2 0.3 5.3 10.2 1.9 3.6 Slum 50.1 33.2 16.6 100.0 361

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey.

24

National 60.0 38.3 42.8 7.8 29.0 3.3 4.9 17.9 7.3 4.3 National 40.4 28.9 30.6 100.0 4105


3.6 Key Findings In total, 4105 adolescents and youths ranging from ages 15 to 24 were interviewed in this preintervention audience impact survey. The male-female ratio among the respondents was almost equal. In the overall sample, the mean age was recorded as 20 years. Ever attendance in school among adolescents and youths was very high with 86 percent of adolescents and youths in rural areas and more than 91 percent of them in urban areas had ever attended in school. In the slum areas, roughly 77 percent of adolescents and youths had ever attended school. However, roughly 24 percent of rural, 30 percent of urban, and only 14 percent of slum respondents stated that they were currently attending in schools. In the overall sample, 49 percent of respondents were currently married while more than half were (50.3 percent) were never married. The overall unemployment rate is moderate across the study sample (12.5 percent). In the survey, 60 percent of the households had access to electricity. Compared to urban (69 percent) and slum areas (47 percent), only 30 percent of the rural households were found to have television sets. However, compared to urban (37 percent) and slum areas (30 percent), possession of radio sets was found higher among rural households (40 percent). In the survey, only 8 percent of households were found subscribing newspapers. A considerable number of study audiences had mobile phones (29 percent). More than 40 percent of households in the overall sample had average monthly income BD Taka <3000, followed by BD Taka 3001-5000 and 5000+ (around 30 percent respectively).

25


4

MASS MEDIA EXPOSURE

Mass media campaign under package 901 of the Global Fund projects in Bangladesh is intended to help disseminate HIV/AIDS related information rapidly, create interest in the minds of the young audience and provide a credible identity to the campaign. Carefully designed mass media communication is a major component of any health campaign targeting varied young audiences. Implementation and success of any sensitive health campaign depends, to a large extent, on the uses of the diffusion channels by the intended audiences. Therefore, a primary objective of the pre-intervention audience impact survey was to determine the extent of use of different mass media channels among the youths and adolescents included in this survey.

4.1 General Habits of Listening to Radio Radio is an important electronic medium in Bangladesh. According to 2004 BDHS and other national media surveys, nationally 32-38 percent of households own a radio set (Hasan and Amanullah, 2004; Hasan 1998a, 1998c, Amanullah, 1996; Mitra et al., 2001). The findings of the above national surveys show that the availability of radio is higher in urban and metropolitan areas than rural areas. Besides, although the accessibility of radio is much higher than its availability, its audience among young generation is still limited (Mitra, Islam and Amanullah, 1996). Following the above national trend, compared to other mass media channels, adolescents and youths of the current survey, irrespective of their locations, had less exposure to radio. In this audience impact survey, on average, 38 percent of adolescents and youths stated their general habits of listening to Radio. Thus, irrespective of their locations, an overwhelming majority of the study adolescents and youths (62 percent) generally do not listen to radio (Figure 4.1).

Figure: 4.1 Habits of Listening to Radio 100

N = 3545

80 60 40

43 29

35

38

Slum

National

20 0 Rural

Urban

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

26


Adolescents and youths in rural (43 percent) and slum (35 percent) areas had more exposure to radio than those in urban (29 percent) areas (Figure 4.1). This difference in radio listening is statistically significant in 5 percent confidence level. An overwhelming majority of adolescents and youths were found listening to Dhaka KA mostly (86 percent), followed by Khulna (24 percent), Rajshahi (13 percent) and Chittagonj (12 percent) radio stations (Figure 4.2). Adolescents and youths usually listen to radio during noon (41 percent) and night times (34 percent). Respondents were less likely to listen to radio during the early morning (19 percent) and afternoon times (7 percent) (Figure 4.3).

Figure: 4.2 Most Frequently Listened Radio Stations 100 80 60 60 20 0

86

N = 1349

Dhaka

24

12

7

13

Chittagong

Sylhet

Rajshahi

Khulna

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Figure: 4.3 Preferred Sessions of Listening Radio 60 41

40 20

34 23

16

7

0 Morning

Noon

Afternoon

Evening

Night

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

4.2 General Habits of Watching Television Television is considered as an important and popular electronic medium for all age groups in Bangladesh. Nationally, its availability has been increased significantly during the last few years (Hasan and Amanullah, 2004; Mitra et al., 2001; BCCP, 2005; Hasan 1998a, 1998c; Amanullah, 1997).

27


In the present survey, availability of television is much higher in urban (69 percent) and slum (47 percent) areas than rural areas (30 percent) (Table 3.3). Therefore, the mediumâ&#x20AC;&#x2122;s accessibility is much higher in urban and slum areas. However, the survey findings clearly show that, irrespective of locations, televisionâ&#x20AC;&#x2122;s audience and appeal among young generation is quite impressive.

Figure: 4.4 Habits of Watching Television National

86

Slum

91

Urban 97 Rural

80 0

20

40

60

80

100

N = 3545 Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Nationally, 86 percent of adolescents and youths acknowledged their general habits of watching television. Urban and slum respondents had significantly greater exposure to television than their rural counterparts. The viewership was 17 percentage point higher in urban (97 percent) areas than in rural (80 percent) areas. This difference in viewership is statistically significant in 5 percent confidence level (Figure 4.4).

Figure: 4.5 Preferred Sessions of Watching Television by the Respondents

100 80

N = 3062 68

60 40

30

20 0

2 Morning

11

8 Noon

Afternoon

Evening

Night

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

28


Adolescents and youths mostly watch television during night-time, attracting the largest percentage of viewers (68 percent) across the sample areas. About 30 percent of viewers reported usually watching television during afternoon time. The proportion of viewers watching television during any other time of the day (morning, noon and early evening times) was insignificant (Figure 4.5). Figure 4.6 shows the percentage of viewers watching a specific TV channels. BTV (Bangladesh Television) is the only TV channels accessible to TV viewers across the country without cable connection. Nationally, 96 percent of adolescents and youths were found watching BTV, with 99 percent of those in rural areas and a slightly but significantly lower 92 percent in urban and 96 percent in slum areas. All other TV channels available in the country were non-terrestrial channels accessible only through cable connection. As such their use was limited to small proportion of viewers, and mostly in large urban centers.

Figure 4.6 Most Frequently Watched TV Channels 100

96

N = 3062

80 60 40 20

9

7

8

ATN

NTV

Channel-i

4

0

BTV

Others

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

As shown in Figure 4.6, most popular among the available satellite TV channels were the Bangladeshi TV channels, NTV, ATN Bangla and Channel I, each watched by 10-18 percent of urban and slum viewers. Few rural (2-3 percent) viewers have the opportunity to watch satellite TV channels. The above findings are consistent with other national studies (Hasan and Amanullah, 2004; Hasan 1998c; Amanullah, 1997; Mitra, Islam and Amanullah, 1996; BCCP, 2005).

4.3 General Habits of Reading Newspaper Compared to other electronic mediums, newspapers have limited appeal among Bangladeshi adolescents and youths (Hasan and Amanullah, 2004; ACPR, 2002; Amanullah and Daniel, 1998; Mitra, Islam and Amanullah, 1996). Figure 4.7 shows the percentage distribution of respondents by frequency of reading newspaper. In consistent with other national surveys about 40 percent adolescents and youths stated that they do not usually read newspapers. Of them, as usually, adolescents and youths in urban (53 percent) and slum (45 percent) areas were more likely to read newspapers than those of their rural (32) counterparts. Newspapers emerged to be an important print media for urban youths. There was statistically significant difference in the readership among the study areas. 29


Figure 4.7 Habits of Reading Newspapers 100 80

N = 3545 53

60 40

45

39

32

20 0 Rural

Urban

Slum

National

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

In the pre-intervention audience impact survey, the daily Prothom Alo had the largest readership, read by 32 percent of newspaper readers. Other most read newspapers were the daily Ittefaq (19 percent), the Janakantho (15 percent) and the daily Inquilab (14 percent). The daily Prothom Alo appeared to be significantly more popular among urban than rural adolescents and youths. The reverse was true for the percentage of respondents who read the Ittefaq and the Inquilab. There was a substantial group of newspaper readers who reported reading the daily Jugantor, the daily Noya Digantho and other local newspapers (Table 4.1).

Table 4.1 Percentage of newspaper readers by specific daily newspapers Newspaper Read Daily Ittefaq Daily Inquilab Daily Sangbad Daily Janakantha Daily Protom Alo Daily Bhorer Kagos Others N

Rural 22.1 (153) 17.7 (122) 1.9 (13) 16.1 (111) 26.3 (182) 3.6 (25) 54.7 (378) 691

Urban 15.2 (88) 10.5 (61) 1.9 (11) 15.7 (91) 37.3 (216) 5.2 (30) 56.8 (329) 579

Slum 16.8 (21) 8.0 (10) 0.8 (10) 10.4 (13) 32.8 (41) 2.4 (03) 69.6 (87) 125

National 18.8 (262) 13.8 (193) 1.8 (25) 15.4 (215) 31.5 (439) 4.2 (58) 56.9 (794) 1395

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

30


4.4 Key Findings General Habits of Listening to Radio: Compared to other mass media channels, adolescents and youths of the current survey, irrespective of their locations, had less exposure to radio. On average, 38 percent of adolescents and youths stated their general habits of listening to Radio. They mostly listened Dhaka KA (86 percent), followed by Khulna (24 percent), Rajshahi (13 percent) and Chittagonj (12 percent) radio stations. Adolescents and youths usually listen to radio during noon (41 percent) and night times (34 percent). Respondents were less likely to listen to radio during morning (19 percent) and afternoon times (7 percent). General Habits of Watching Television: In the present survey, availability of television is much higher in urban (69 percent) and slum (47 percent) areas than rural areas (30 percent). Therefore, the mediumâ&#x20AC;&#x2122;s accessibility is much higher in urban and slum areas. Nationally, 86 percent of adolescents and youths acknowledged their general habits of watching television. Urban and slum respondents had significantly greater exposure to television than their rural counterparts. Adolescents and youths mostly watch television during nighttime, attracting the largest percentage of viewers (68 percent) across the sample areas. About 30 percent of viewers reported usually watching television during afternoon time. Nationally, 96 percent of adolescents and youths were found watching BTV, with 99 percent of those in rural areas and a slightly but significantly lower 92 percent in urban and 96 percent in slum areas. All other TV channels available in the country were non-terrestrial channels accessible only through cable connection. As such their use was limited to small proportion of viewers, and mostly in large urban centers. Most popular among the available satellite TV channels were the Bangladeshi TV channels, NTV, ATN Bangla and Channel, each watched by 10-18 percent of urban and slum viewers. Few rural (2-3 percent) viewers have the opportunity to watch satellite TV channels. General Habits of Reading Newspaper: In consistent with other national surveys, about 40 percent adolescents and youths stated that they do not usually read newspapers. Of them, as usually, adolescents and youths in urban (53 percent) and slum (45 percent) areas were more likely to read newspapers than those of their rural (32) counterparts. In the pre-intervention audience impact survey, the daily Prothom Alo had the largest readership, read by 32 percent of newspaper readers. Other most read newspapers were the daily Ittefaq (19 percent), the Janakantho (15 percent) and the daily Inquilab (14 percent). The daily Prothom Alo appeared to be significantly more popular among urban than rural adolescents and youths. The reverse was true for the percentage of respondents who read the Ittefaq and the Inquilab. There was a substantial group of newspaper readers who reported reading the daily Jugantor, the daily Noya Digantho and other local newspapers.

31


5

KNOWLEDGE ON HIV / AIDS

During the interview, both urban and rural adolescents and youths were asked if they had heard of HIV/AIDS and other STDs (spontaneous and prompted), and if they had, they were asked a series of questions about the sources and their understanding of HIV/AIDS messages; how HIV and STDs are transmitted, how they can be prevented, perceived susceptibility, lay/miasmic beliefs toward them, interpersonal communication and so on.

5.1 Awareness of HIV/AIDS In the pre-intervention impact audience assessment, an overwhelming majority of respondents (86 percent) had ever heard about HIV/AIDS (Figure 5.1).

Figure 5.1 Awareness of HIV/AIDS (N=4105)

NotAware of HIV/AIDS 14% Aware of HIV/AIDS 86%

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Rural adolescents and youths were less aware (15 percentage points) of HIV/AIDS than their urban (95 percent) and slum (91 percent) counterparts (Figure 5.2).

Figure 5.2 Awareness of HIV/AIDS by Areas 100 80

95

91

80

86

60 40 20 0 Rural

Urban

Slum

N = 4105

32

National


5.2 Major Sources of Information on General Awareness of HIV/AIDS Irrespective of their locations, an overwhelming majority of adolescents and youths stated that they heard about HIV/AIDS from TV (83 percent), followed by radio (22 percent), friends/peers (16 percent), booklet/book (13 percent), and neighbors (13 percent). Only a nominal number of them said that they heard about HIV/AIDS from newspaper/magazines, billboard, health service providers, and NGO workers (Table 5.1).

Table 5.1 Major Sources of Information on General Awareness of HIV/AIDS Diffusion agents Radio TV Newspaper Billboard Poster Magazine Booklet/Book Friends/Peers School Teacher Neighbours Relative Parents Husband/Wife Health service providers Hospital NGOs Pharmacy Community function Others N

Rural 27.1 (555) 78.5 (1609) 6.8 (139) 5.2 (107) 3.6 (74) 0.9 (18) 13.3 (273) 16.1 (329) 3.8 (77) 13.9 (284) 3.2 (65) 0.2 (05) 0.5 (11) 4.9 (101) 3.1 (64) 2.9 (59) 0.5 (11) 3.0 (62) 4.8 (99) 2049

Urban 12.1 (138) 91.7 (1042) 16.6 (189) 13.1 (149) 6.8 (77) 2.6 (30) 15.1 (171) 17.7 (201) 4.0 (46) 9.4 (107) 2.0 (23) 0.3 (03) 0.6 (07) 5.1 (58) 2.9 (33) 5.1 (58) 0.4 (05) 3.5 (40) 4.7 (53) 1136

Slum 20.6 (68) 83.0 (274) 8.5 (28) 7.6 (25) 4.8 (16) 0.0 (00) 5.2 (17) 13.6 (45) 4.8 (16) 17.0 (56) 2.1 (07) 0.0 (00) 0.9 (03) 13.6 (45) 3.9 (13) 17.9 (59) 0.3 (01) 10.6 (35) 6.7 (22) 330

National 21.7 (761) 83.2 (2925) 10.1 (356) 8.0 (281) 4.8 (167) 1.4 (48) 13.1 (461) 16.4 (575) 4.0 (139) 12.7 (447) 2.7 (95) 0.2 (08) 0.6 (21) 5.8 (204) 3.1 (110) 5.0 (176) 0.5 (17) 3.9 (137) 5.0 (174) 3515

Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.3 Specific Media Channels, Sessions, and Programs as Major Sources of Information on General Awareness of HIV/AIDS 5.3.1 Specific Television Channels Providing Information on General Awareness of HIV/AIDS As reflected in Figure 5.3 for the overall sample, adolescents and youths universally (98 percent) mentioned BTV as their major source of information on general awareness of HIV/AIDS. Only 5-8 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on general awareness of HIV/AIDS. 33


Figure 5.3 Specific Television Channels Provided Information on General Awareness of HIV/AIDS 100

98

N = 2925

80 60 40 20

8

5

6

ATN

NTV

Channel-i

1

0

BTV

Others

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.3.2 Specific Television Programs Watched on General Awareness of HIV/AIDS Table 5.2 shows, by different areas of the impact assessment, the percentage of TV viewers watching specific programs providing information on general awareness of HIV/AIDS. An overwhelming majority of adolescents and youths (83 percent) mentioned advertisement as their major source of information on general awareness of HIV/AIDS. Only 13-15 percent of them acknowledged other AIDS-related programs, various AIDS-related discussions and dramas as their sources on general awareness of HIV/AIDS.

Table 5.2 Specific Program Watched Providing Information on General Awareness of HIV/AIDS Specific Program Watched AIDS Related Program Discussion Advertisement Drama Movie News Others N

Rural 9.4(152) 12.7 (205) 83.4 (1342) 12.9 (208) 1.2 (20) 1.1 (17) 1.9 (30) 1609

Urban 15.9 (166) 15.5 (162) 83.1 (866) 14.7 (153) 3.0 (31) 0.8 (080 1.6 (17) 1042

Slum 21.5 (59) 24.5 (67) 74.5 (204) 19.7 (54) 3.6 (10) 2.2 (06) 2.2 (06) 274

National 12.9 (377) 14.8 (434) 82.5 (2412) 14.2 (415) 2.1 (61) 1.1 (31) 1.8 (53) 2925

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.3.3 Specific Sessions of Watching Television Programs on General Awareness of HIV/AIDS Adolescents and youths, as Figure 5.4 shows, mostly watched programs providing information on general awareness of HIV/AIDS during night (70 percent) and afternoon sessions (39 percent). They were less likely to watch programs on general awareness of HIV/AIDS at other times of the 34


Figure 5.4 Specific Sessions when Adolescents and Youths Watched TV Programs Providing Information on General Awareness of HIV/AIDS 100

N = 2925

80

70

60 40

39

20 4

0

16

14

Morning

Noon

Afternoon

Evening

Night

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.3.4 Specific Radio Stations Providing Information on General Awareness of HIV/AIDS As reflected in Figure 5.5 for the overall sample, adolescents and youths almost universally (82 percent) mentioned Dhaka Kha as their major source of information on general awareness of HIV/AIDS. Only 10 and 18 percent adolescents and youths acknowledged Khulna, Chittagong and Rajshahi as their preferred radio stations broadcasting information on general awareness of HIV/AIDS. Sylhet and Barisal radio stations had few audiences in this regard.

Figure 5.5 Specific Radio Stations Provided Information on General Awareness of HIV/AIDS 100 80

82.3

N = 761

60 40 20 0

10.4 Dhaka Kha

Chittagong

10

3 Sylhet

Rajshahi

18

Khulna

1

3

Barisal

Others

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

35


5.3.5 Specific Radio Programs Listened Table 5.3 shows, by different areas of the impact assessment, the percentage of radio listeners listening specific programs providing information on general awareness of HIV/AIDS. Nationally, 32-39 percent of adolescents and youths mentioned advertisements, health messages, and AIDSrelated discussions as their major source of information from radio on general awareness of HIV/AIDS. Only 11 percent of them acknowledged dramas/life story on radio as their source on general awareness of HIV/AIDS. Rural audiences were more likely to listen to advertisements and urban audiences were in favor of discussions (Table 5.3).

Table 5.3 Specific Radio Programs Listened Providing Information on general awareness of HIV/AIDS Specific Radio Programs Drama/Life story AIDS related discussion Health message/discussion Advertisement News Others N

Rural 11.5 (64) 28.5 (158) 39.8 (221) 38.7 (215) 0.5 (03) 6.1 (34) 555

Urban 10.1 (14) 43.5 (60) 39.1 (54) 31.2 (43) 0.7 (01) 4.3 (06) 138

Slum 7.4 (05) 36.8 (75) 29.4 (20) 38.2 (26) 1.5 (01) 8.8 (06) 68

National 10.9 (83) 31.9 (243) 38.8 (295) 27.3 (284) 0.7 (05) 6.0 (46) 761

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.3.6 Specific Sessions of Listening Radio Programs on General Awareness of HIV/AIDS Adolescents and youths, as Figure 5.6 shows, mostly listened programs providing information on general awareness of HIV/AIDS during noon (46 percent), night (33 percent) and afternoon sessions (29 percent). They were less likely to listen programs on general awareness of HIV/AIDS at other times of the day (Figure 5.6).

Figure 5.6 Specific Sessions when Adolescents and Youths Listened Programs Providing Information on General Awareness of HIV/AIDS 100

N = 761

80 60 46.3

40 20

33

29

19.4

15

0 Morning

Noon

Afternoon

Evening

Night

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) 36


5.3.7 Specific Newspapers Providing Information on General Awareness of HIV/AIDS Compared to electronic mediums, adolescents and youths had less exposure to newspapers in receiving information on general awareness of HIV/AIDS. Respondents, who mentioned newspapers as their sources of information on general awareness of HIV/AIDS, were asked to name their preferred newspapers in this regard. In reply, 40 percent adolescents and youths mentioned that they received HIV/AIDS information from the daily Prothom Alo, followed by the daily Ittefaq (17 percent), the daily Janakantho (14 percent), and the daily Inquilab (13 percent). A sizeable proportion of adolescents and youths received HIV/AIDS-related information from the daily Jugantor and other local dailies (Figure 5.7).

Figure 5.7 Specific Newspapers Read on HIV/AIDS 60

N = 483

50

42

40

40 30 17

20

13

14

10 0 Ittefaq

Inqilab

Janakantha

Prothom Alo

Others (Jugantor, Local Dailies)

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.3.8 Specific News Items Read on General Awareness of HIV/AIDS Figure 5.8 shows the percentage of newspaper readers reading specific news items providing information on general awareness of HIV/AIDS. Forty-two percent of adolescents and youths mentioned that they read information on ‘infection and prevention of HIV/AIDS’, followed by the ‘deadliness of AIDS’ (33 percent) and ‘possibility of spreading HIV in Bangladesh’ (22 percent).

Figure 5.8 Specific News Items Read on HIV/AIDS 60 50 40 30

42 33 22

20 9

10 0

15

Information about infection and prevention AIDS is a deadly disease Possibility of spreading AIDS IN Bangladesh Many people are dying due to AIDS Cann't recall

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) 37


In consistent with other national surveys (BCCP, 2005; Hasan and Amanullah, 2004; Mitra, Islam and Amanullah, 1996), rural audiences were found less exposed to the information on deadliness of AIDS and the vulnerability of Bangladesh for possible AIDS pandemic (Figure 5.8). In reply to another question, about half of the adolescents and youths said that they read/seen this information ‘long time ago’, followed by ‘a few days ago’ (39 percent) (Figure 5.9).

Figure 5.9 When have you read/seen this information? 60

40

N = 483

47

50

39

30 20 10

4

8

0

Few days ago

Long time ago

Yesterday/today

Don't know

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.4 Spontaneous Knowledge on the Perceived Routes of HIV Transmission About 60 percent of the respondents, of those adolescents and youths who are aware of HIV/AIDS (n=3515), had no idea that HIV could be transmitted through having unsafe sex with HIV/AIDS infected persons. About 80 percent of adolescents and youths had no idea that non-use of condoms during sex with multiple partners could transmit HIV. Likewise, only 26 percent adolescents and youths spontaneously mentioned that unsafe sex with CSWs could transmit the virus. Around half of the adolescents and youths (47-49 percent) knew that HIV could be transmitted through sharing needles and blood transfusion. Only a limited proportion of adolescents and youths (9 percent) also had idea about the neo-natal and pre-natal transmission of HIV (mother to child contraction of HIV). It is important to note here that respondents had universal correct knowledge that the causal transmission of HIV is not possible through mosquito bites, sharing latrines/bed/clothes, and in absence of cleanliness/personal hygiene. In the survey 18 percent of adolescents and youths were found who heard about HIV/AIDS but did not know anything about the routes of HIV transmission (Table 5.4).

38


Table 5.4 Spontaneous knowledge on the Routes of HIV Transmission HIV could be transmitted through: Having un-safe sex with HIV/AIDS infected person Through HIV infected blood Through HIV infected syringe/needle HIV/AIDS infected mother-to-child Through breast feeding Un-safe sex with CSWs Un-safe sex with multiple partners Through using others Underwear/Towel Through using un-cleaned latrine If not maintain personal hygiene/cleanliness Through using public/shared bed Through insect/mosquito bites Others Donâ&#x20AC;&#x2122;t know N

Rural

Urban

Slum

National

39.0 (800)

46.0 (522)

48.8 (161)

42.2 (1483)

41.9 (858) 44.9 (920)

49.0 (557) 56.2 (638)

45.8 (151) 51.5 (170)

44.6 (1566) 49.2 (1728)

9.2 (189)

9.9 (113)

5.8 (19)

9.1 (321)

7.3 (149) 22.4 (460) 19.5 (400)

6.9 (78) 29.9 (340) 22.1 (251)

7.3 (24) 34.5 (114) 17.6 (58)

7.1 (251) 26.0 (914) 20.2 (709)

0.2 (04)

0.3 (03)

0.3 (01)

0.2 (08)

0.1 (03)

0.2 (02)

0.6 (02)

0.2 (07)

1.1 (22)

0.4 (05)

1.2 (04)

0.9 (31)

0.1 (03)

0.0 (0)

0.6 (02)

0.1 (05)

0.4 (08) 3.4 (70) 21.2 (435) 2049

0.1 (01) 3.7 (42) 14.1 (160) 1136

0.6 (02) 6.4 (21) 11.2 (37) 330

0.3 (11) 3.8 (133) 18.0 (632) 3515

5.5 Major Sources of information on Perceived Routes of HIV Transmission An overwhelming majority of adolescents and youths heard about perceived routes of HIV transmission through TV (78 percent), followed by radio (19 percent), friends/peers (17 percent), booklet/book (15 percent). Only a nominal number of them said that they heard about routes of HIV transmission from newspaper/magazines, billboard, health service providers, and NGO workers (Figure 5.10).

39


Figure 5.10 Major Sources of Information on the Routes of HIV Transmission (Multiple responses permitted)

100 90

N = 2251

78

80 70 60 50 40 30

19

20

9

10

15

8

17 9

7

5

0 Radio

TV

Newspaper

Billboard

Booklet

Peers

Neighbors

Health Service Providers

NGO's

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.6 Specific Media Channels, Sessions, and Programs as Major Sources of Information on Perceived Routes of HIV Transmission 5.6.1 Specific Television Channels As reflected in Figure 5.11 for the overall sample, adolescents and youths universally (98 percent) mentioned BTV as their major source of information on the routes of HIV transmission. Only 5-7 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on the routes of HIV transmission.

Figure 5.11 Specific Television Channels Provided Information on the Routes of HIV Transmission (Multiple responses permitted) 100

98

80 60 40 20

7

5

5

1

ATN

NTV

Channel-i

Others

0 BTV

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) 40


5.6.2 Specific Television Programs Watched Table 5.5 shows, by different areas of the impact assessment, the percentage of TV viewers watching specific programs providing information on the routes of HIV transmission. An overwhelming majority of adolescents and youths (81 percent) mentioned advertisement as their major source of information on the routes of HIV transmission. Only 15-16 percent of them acknowledged other AIDS-related programs, various AIDS-related discussions and Dramas as their sources on the routes of HIV transmission.

Table 5.5 Specific Program Watched Providing Information on the Routes of HIV Transmission Specific programs watched AIDS Related Program Discussion Advertisement Drama Movie News Others N

Rural 10.8 (131) 15.1 (183) 82.3 (995) 14.0 (169) 0.7 (08) 1.1 (13) 1.0 (12) 1209

Urban 18.8 (154) 15.6 (128) 80.7 (660) 14.7 (120) 3.2 (26) 0.6 (05) 0.1 (01) 818

Slum 22.8 (51) 21.9 (49) 70.5 (158) 23.7 (53) 4.9 (11) 0.9 (02) 0.9 (02) 224

National 14.9 (336) 16.0 (360) 80.5 (1813) 15.2 (342) 2.0 (45) 0.9 (20) 0.7 (15) 2251

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.6.3 Specific Sessions of Watching Television Programs on the Routes of HIV Transmission Adolescents and youths, as Table 5.6 shows, mostly watched programs providing information on the routes of HIV transmission during night (68 percent) and afternoon sessions (37 percent). They were less likely to watch programs on the routes of HIV transmission at other times of the day (Table 5.6).

Table 5.6 Specific Sessions when Adolescents and Youths Watch Programs Providing Information on the Routes of HIV Transmission Specific sessions Morning Noon Afternoon Evening Night N

Rural 1.7 (20) 14.1 (171) 40.2 (486) 15.8 (191) 65.1 (787) 1209

Urban 2.1 (17) 14.4 (118) 33.6 (275) 18.8 (154) 71.8 (587) 818

Slum 3.6 (08) 20.5 (46) 35.7 (80) 17.0 (38) 68.3 (153) 224

National 2.0 (45) 14.9 (335) 37.4 (841) 17.0 (383) 67.8 (1527) 2251

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

41


5.6.4 Specific Radio Stations As reflected in Figure 5.12 for the overall sample, adolescents and youths almost universally (83 percent) mentioned Dhaka Kha as their major source of information on the routes of HIV transmission. Only 16 and 13 percent adolescents and youths acknowledged Khulna and Chittagong respectively as their major radio sources on the routes of HIV transmission. Sylhet, Barisal, and Rajshahi Radio stations attracted only a few audiences in this regard.

Figure 5.12 Specific Radio Stations Provided Information on the Routes of HIV Transmission (Multiple responses permitted) 100

83

N = 540

80 60 40 13

20

2

ng go tta hi C

a

ak

Dh

Sy

a

Kh

h js

i

a

R

2

1 na

ah

lh et

0

16

8

l hu

K

B

al

is

ar

O

s

er

th

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.6.5 Specific Radio Programs Listened Table 5.7 shows, by different areas of the impact assessment, the percentage of radio listeners listening specific programs providing information on the routes of HIV transmission. Nationally, 3337 percent of adolescents and youths mentioned advertisements, health messages, and AIDSrelated discussions as their major source of information from radio on the routes of HIV transmission. Only 14 percent of them acknowledged dramas on radio as their source on the routes of HIV transmission. Rural audiences were more likely to listen to advertisements and urban audiences were in favor of discussions and health messages.

Table 5.7 Specific Radio Programs Listened Providing Information on the Routes of HIV Transmission (Multiple responses permitted) Specific Radio Programs Listened Drama/Life story AIDS related discussion Health message/discussion Advertisement News Others N

Rural 13.3 (55) 31.7 (131) 34.4 (142) 37.3 (154) 0.5 (02) 3.1 (13) 413

Urban 16.5 (15) 38.5 (35) 39.6 (36) 31.9 (29) 0.0 (00) 1.1 (01) 91

Slum 8.3 (03) 38.9 (14) 38.9 (14) 38.9 (14) 0.0 (00) 5.6 (02) 36

National 13.5 (73) 33.3 (180) 35.6 (192) 36.5 (197) 0.4 (02) 3.0 (16) 540

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) 42


5.6.6 Specific Sessions of Listening Radio Programs on the Routes of HIV Transmission Adolescents and youths, as Table 5.8 shows, mostly listened programs providing information on the routes of HIV transmission during noon (42 percent), night (37 percent) and afternoon sessions (28 percent). They were less likely to listen programs on the routes of HIV transmission at other times of the day (Table 5.8).

Table 5.8 Specific Sessions when Adolescents and Youths Listened Programs Providing Information on the Routes of HIV Transmission Specific sessions Morning Noon Afternoon Evening Night N

Rural 21.5 (89) 40.9 (169) 27.8 (115) 15.3 (63) 37.3 (154) 413

Urban 13.2 (12) 47.3 (43) 31.9 (29) 7.7 (07) 39.6 (36) 91

Slum 33.3 (12) 47.2 (17) 22.2 (08) 8.3 (03) 30.6 (11) 36

National 20.9 (113) 42.4 (229) 28.1 (151) 13.5 (73) 37.2 (201) 540

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.7 Spontaneous Knowledge on the Perceived Ways of Preventing HIV Transmission Despite their universal general awareness on HIV/AIDS, about 75 percent of the study adolescents and youths had no idea that HIV could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of HIV prevention, more than 90 percent of adolescents and youths stated that they had no idea that consistent usage of condoms during sex with unfaithful partners could prevent HIV. Respondents also had no spontaneous idea that in preventing vertical transmission of HIV (mother-to-fetus), an infected mother should consult doctor before conception. Likewise, 23 percent adolescents and youths mistakenly mentioned that refraining from all sorts of sex could prevent the transmission of the virus (Table 5.9). However, around half of the study adolescents and youths (51-53 percent) knew that the transmission of HIV could be prevented through avoiding unsafe sex other than between husband and wife and checking blood before transfusion. Likewise, a remarkable proportion of adolescents and youths (42 percent) had idea that using sterile needles/syringes could prevent the virus. Across the study areas, rural respondents were slightly lagging behind in perceiving the major ways of preventing HIV transmission. In the survey, more than 14 percent of adolescents and youths were found who heard about HIV/AIDS but could not tell anything about the ways of HIV prevention (Table 5.9).

43


Table 5.9 Spontaneous knowledge on the Perceived Ways of Preventing HIV Transmission Ways of Preventing HIV Transmission Refraining from all sorts of sex Following religious and social rules Refraining from having unsafe sex with CSWs Avoiding unsafe sex other than between husband and wife Checking blood before transfusion Using sterile needles/syringes AIDS infected mother should consult doctor before conception Using condoms with unfaithful partners consistently Others Donâ&#x20AC;&#x2122;t know N

Rural 20.9 (428) 8.0 (164)

Urban 23.5 (267) 11.7 (133)

Slum 32.7 (108) 10.3 (34)

National 22.8 (803) 9.4 (331)

22.5 (4610)

27.9 (317)

31.2 (103)

25.1 (881)

49.3 (1010) 47.3 (969) 38.9 (797)

57.7 (655) 56.9 (646) 46.6 (529)

55.8 (184) 50.9 (168) 45.2 (149)

52.6 (1849) 50.7 (1783) 42.0 (1475)

2.6 (53)

1.9 (22)

1.5 (05)

2.3 (80)

9.9 (202) 4.2 (86) 17.1 (350) 2049

10.7 (121) 4.0 (46) 11.4 (129) 1136

10.9 (36) 8.2 (27) 6.7 (22) 330

10.2 (359) 4.5 (159) 14.3 (501) 3515

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.8 Major Sources of Information on the Perceived Ways of Preventing HIV Transmission An overwhelming majority of adolescents and youths heard about the perceived ways of HIV prevention through TV (72 percent), followed by radio (16 percent), friends/peers (16 percent), booklet/book (14 percent). Only a nominal number of them said that they heard about the ways of HIV prevention from newspaper/magazines, billboard, health service providers, and health service providers (7-8 percent) (Figure 5.13).

Figure 5.13 Major Sources of Information on the Perceived Ways of HIV Prevention (Multiple responses permitted)

* Multiple responses permitted 44

ce Se rvi

lth

ee rs

He a

nd s/P

Fri e

/Bo ok let

Bo ok

lbo ard Bil

sp ap ers

TV

Ne w

Ra d

io

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%


5.9 Specific Media Channels, Sessions, and Programs as Major Sources of Information on the Perceived Ways of Preventing HIV Transmission 5.9.1 Specific Television Channels Providing Information on the Perceived Ways of Preventing HIV Transmission As reflected in Figure 5.14 for the overall sample, adolescents and youths universally (98 percent) mentioned BTV as their major source of information on the perceived ways of preventing HIV transmission. Only 5-7 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on the perceived ways of preventing HIV transmission.

Figure 5.14 Specific Television Channels Provided Information on the Perceived Ways of Preventing HIV Transmission 100 98

80 60 40 20

7

5

5

ATN

NTV

Channel-i

0 BTV

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.9.2 Specific Television Programs Watched Providing Information on the Perceived Ways of Preventing HIV Transmission Table 5.10 shows, by different areas of the impact assessment, the percentage of TV viewers watching specific programs providing information on the perceived ways of preventing HIV transmission. An overwhelming majority of adolescents and youths (80 percent) mentioned advertisement as their major source of information on the perceived ways of preventing HIV transmission. Only 16-17 percent of them acknowledged other AIDS-related programs, various AIDS-related discussions/messages and dramas as their sources on the perceived ways of preventing HIV transmission.

45


Table 5.10 Specific Program Watched Providing Information on the Perceived Ways of Preventing HIV Transmission Specific programs watched AIDS Related Program Discussion/messages Advertisement Drama Movie News Others N

Rural 13.2 (156) 14.9 (176) 81.8 (968) 14.8 (167) 1.6 (19) 1.2 (14) 1.3 (15) 1183

Urban 21.5 (166) 18.1 (140) 79.8 (617) 15.9 (123) 3.8 929) 0.6 (05) 0.4 (03) 773

Slum 25.6 (51) 28.1 (56) 68.8 (137) 26.1 (52) 26.1 (52) 0.5 (01) 0.5 (01) 199

National 17.3 (373) 17.3 (372) 79.9 (1722) 15.9 )342) 15.9 (342) 0.9 (20) 0.9 (19) 2155

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.9.3 Specific Sessions of Watching Television Programs on the Perceived Ways of Preventing HIV Transmission Adolescents and youths, as Table 5.11 shows, mostly watched programs providing information on the perceived ways of preventing HIV transmission during night (68 percent) and afternoon sessions (38 percent). They were less likely to watch programs on the perceived ways of preventing HIV transmission at other times of the day (Table 5.11).

Table 5.11 Specific Sessions when Adolescents and Youths Watch Programs Providing Information on the Perceived Ways of Preventing HIV Transmission Specific sessions Morning Noon Afternoon Evening Night N

Rural 1.8 (21) 14.9 (176) 40.6 (480) 16.6 (196) 65.8 (778) 1183

Urban 1.8 (14) 15.5 (120) 33.9 (262) 19.3 (149) 71.0 (549) 773

Slum National 2.5 (05) 1.9 (40) 21.1 (42) 15.7 (338) 39.2 (78) 38.1 (820) 21.1 (42) 18.0 (387) 68.8 (137) 67.9 (1464) 199 2155

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

46


5.9.4 Specific Radio Stations Providing Information on the Perceived Ways of Preventing HIV Transmission As reflected in Figure 5.15 for the overall sample, adolescents and youths almost universally (84 percent) mentioned Dhaka Kha as their major source of information on the perceived ways of preventing HIV transmission. Only 15 percent adolescents and youths acknowledged Khulna and Chittagong as their major radio sources of information on the perceived ways of preventing HIV transmission. Sylhet, Barisal, and Rajshahi Radio stations attracted only a few audiences in this regard.

Figure 5.15 Specific Radio Stations Provided Information on the Perceived Ways of Preventing HIV Transmission 100

84

N = 485

80 60 40 15

20

7

4

15

0 Dhaka Kha

Chittagong

Sylhet

Rajshahi

Khulna

1

2

Barisal

Others

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.9.5 Specific Radio Programs Listened Table 5.12 shows, by different areas of the impact assessment, the percentage of radio listeners listening specific programs providing information on the perceived ways of preventing HIV transmission. Nationally, 31-43 percent of adolescents and youths mentioned advertisements, health messages, and AIDS-related discussions as their major sources of information from radio on the perceived ways of preventing HIV transmission. Only 13 percent of them acknowledged dramas on radio as their sources of information on the perceived ways of preventing HIV transmission. Rural audiences were more likely to listen to advertisements and urban audiences were in favor of discussions and health messages.

47


Table 5.12 Specific Radio Programs Listened Providing Information on the Perceived Ways of Preventing HIV Transmission Specific Radio Programs Listened Drama/Life story AIDS related discussion Health message/discussion Advertisement News Others N

Rural 11.6 (43) 29.5 (109) 40.0 (148) 41.9 (155) 0.8 (03) 3.2 (12) 370

Urban 20.0 (18) 34.4 (31) 48.9 (44) 27.8 (25) 1.1 (01) 2.2 (02) 90

Slum 8.0 (02) 32.0 (08) 56.0 (14) 40.0 (10) 4.0 (01) 4.0 (01) 25

National 13.0 (63) 30.5 (148) 42.5 (206) 39.2 (190) 1.0 (05) 3.1 (15) 485

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.9.6 Specific Sessions of Listening Radio Programs on the Perceived Ways of Preventing HIV Transmission Adolescents and youths, as Table 5.13 shows, mostly listened programs providing information on the perceived ways of preventing HIV transmission during noon (43 percent), night (42 percent) and afternoon sessions (29 percent). In this regard, they were less likely to listen programs at other times of the day (Table 5.13).

Table 5.13 Specific Sessions when Adolescents and Youths Listened Programs Providing Information on the Perceived Ways of Preventing HIV Transmission Specific sessions Morning Noon Afternoon Evening Night N

Rural 19.2 (71) 44.6 (165) 28.6 (106) 15.7 (58) 43.5 (161) 370

Urban 18.9 (17) 34.4 (31) 28.9 (26) 10.0 (09) 42.2 (38) 90

Slum 40.0 (10) 44.0 (11) 36.0 (09) 8.0 (02) 24.0 (06) 25

National 20.2 (98) 42.7 (207) 29.1 (141) 14.2 (69) 42.3 (205) 485

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.10 Prompted Knowledge and Media Exposure on HIV-related Risks Practices In providing spontaneous responses, about 20 percent of adolescents and youths, of those who are aware of HIV/AIDS (n=3515), stated that they had idea that non-use of condoms during sex with multiple partners could transmit HIV. However, when prompted using a pre-coded straight question, an overwhelming majority of them (80 percent) mentioned that they were aware about the risk associated with multiple sex partners and non-use of condom. Likewise, when prompted, majority of the adolescents and youths mentioned that HIV can be transmitted through unsafe blood transfusion (88 percent), infected mother to child (82 percent), and during breast feeding (81 percent) (Table 5.14). 48


Throughout the sample, respondents were found well aware of the perceived severity of HIV/AIDS. More then 85 percent of adolescents and youths stated that death is the ultimate consequence of an HIV infected person (Figure 5.16). About 70-75 percent of them also know that a healthy looking person can have HIV/AIDS and the virus can be transmitted through one single unsafe sexual contact. However, compared to other dominant routes of transmission, adolescents and youths were found less aware that HIV could be transmitted through unprotected oral and anal sex (Table 5.14).

Figure 5.16 Perceived Severity of HIV/AIDS (Consequences) 100%

85%

N = 3515

80% 60% 40% 20%

1.40%

0% Infected person will die

12%

Cann't protect other diseases

Don't know

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.11 Media Exposure on HIV-related Risks Practices 5.11.1 Television An overwhelming majority of adolescents and youths stated that the original sources of their prompted knowledge on various HIV-related Risks Practices were television, followed by radio, friends/peers, and booklet/book. Only a few of them said that they heard about various HIVrelated Risks Practices from newspaper/magazines, billboard, health service providers, and NGO workers (Tables 5.15-5.18) (attached in appendix). As reflected in Tables 5.15 â&#x20AC;&#x201C;5.18 (attached in appendix) for the overall sample, adolescents and youths almost universally mentioned BTV as their major source of information on various HIVrelated Risks Practices. Therefore, only a limited number of viewers, mostly in urban areas, acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on various HIV-related Risks Practices. An overwhelming majority of adolescents and youths mentioned advertisement as their major source of information on various HIV-related Risks Practices. However, some of them acknowledged other AIDS-related programs, various AIDS-related discussions and dramas as their sources of information. Adolescents and youths, as Tables 5.15 â&#x20AC;&#x201C;5.18 show, mostly watched programs providing information on various HIV-related Risks Practices during night and afternoon sessions. They were less likely to watch such programs at other times of the day.

49


Table 5.14 Prompted Knowledge and Media Exposure on HIV-related Risks Practices Risk Associated with multiple sex Rural partners and Non-use of condom* Can be infected with HIV/AIDS 76.9 Possibility of having different STDs 2.9 Don’t know 19.7 Risk Associated with un-tested blood transfusion* Can be infected with HIV/AIDS 85.5 Don’t know 12.6 Risk Associated with pregnancy of HIV/AIDS infected mother* The Child can be infected with HIV/AIDS 80.0 Don’t know 18.1 Risk Associated with breastfeeding by HIV/AIDS infected mother* The Child can be infected with HIV/AIDS 80.8 Don’t know 16.9 A healthy looking person can have HIV/AIDS Correct knowledge 67.6 Incorrect knowledge 17.6 No knowledge 14.7 HIV can be transmitted through one single unsafe sexual contact* Correct knowledge 72.4 Incorrect knowledge 10.6 No knowledge 17.0 HIV can be transmitted through unprotected oral sex* Correct knowledge 47.8 Incorrect knowledge 11.3 No knowledge 40.9 HIV can be transmitted through un-safe anal sex* Correct knowledge 62.8 Incorrect knowledge 7.1 No knowledge 30.1 TOTAL 100.0 N 2049

Urban

Slum

National

85.1 5.0 11.9

83.0 8.2 12.7

80.1 4.1 16.5

91.5 7.4

88.2 8.8

87.7 10.6

86.8 11.7

80.6 14.5

82.3 15.7

81.7 15.8

81.5 16.4

81.2 16.5

72.1 19.8 8.1

64.5 23.0 12.4

68.8 18.8 12.4

79.0 10.3 10.7

71.5 14.2 14.2

74.4 10.9 14.7

45.1 15.1 39.9

44.5 14.5 40.9

46.6 12.8 40.6

61.9 6.8 31.3 100.0 1136

60.3 9.1 30.6 100.0 330

62.3 7.2 30.6 100.0 3515

* Multiple responses were permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

50


5.11.2 Radio As reflected in Tables 5.15 –5.18 (attached in appendix) for the overall sample, adolescents and youths almost universally mentioned Dhaka Kha as their major source of information on various HIV-related Risks Practices. In this regard, only a small number of listeners acknowledged Khulna and Chittagong as their major radio sources of information. Nationally, more than one-third of adolescents and youths mentioned advertisements, health messages, and AIDS-related discussions as their major sources of information from radio on various HIV-related Risks Practices. As usually, adolescents and youths, as Tables 5.15-5.18 show, mostly listened programs providing information on various HIV-related Risks Practices during noon, night, and afternoon times.

5.12 Miasmic/Erroneous Beliefs on the Routes of HIV Transmission Despite their remarkable general awareness of HIV/AIDS, a considerable number of adolescents and youths were found in the survey who had miasmic or erroneous beliefs on HIV/AIDS. For example, only 44 percent of adolescents and youths believed that HIV couldn’t be transmitted by coughing or sneezing. About half of them (47-52 percent) supported that HIV cannot be passed through sharing drinking/eating utensils and food with someone who had HIV/AIDS. Fourteen percent of adolescents and youths mentioned that they had no idea in this regard (Table 5.19). There were also a sizeable proportion of adolescents and youths (43 percent) who though that women could not get HIV if they make sex during their menstruation time. Only 23 percent of them provided the correct answer in this regard. In addition, around 40 percent of the sample had no idea that sharing the same pond with HIV infected person cannot transmit HIV (Table 5.19). In the national sample, only 42 percent of respondents believed that a person could not get infected with HIV through ‘mosquito/insect bites’ or by ‘kissing/hugging’ with an infected person (Table 5.19). Further, only 38 percent of the entire adolescent and youth sample believed that there was no immunization to prevent HIV transmission. Therefore, it was no surprise that overall 58 of the sample had no idea that there is no antibiotic for HIV/AIDS (Table 5.19). Remarkably, more than half (54 percent) of the adolescents and youths throughout the study areas believe that AIDS is a curse. A considerable number of them (22 percent) also believe that there is a cure for HIV/AIDS (Table 5.19). Across the study areas, adolescents and youths from rural and slum areas were found to have more erroneous beliefs on HIV/AIDS than their urban counterparts.

51


Table 5.19 Miasmic/Erroneous Beliefs on the Routes of HIV Transmission HIV Can be transmitted by coughing or sneezing Rura Urban Correct knowledge 39.3 51.6 Incorrect knowledge 32.2 25.4 No knowledge 28.5 23.0 Sharing drinking with infected person Correct knowledge 42.0 55.8 Incorrect knowledge 42.5 33.2 No knowledge 15.5 11.0 There is immunization for HIV/AIDS Correct knowledge 34.8 45.2 Incorrect knowledge 25.3 19.2 No knowledge 40.9 35.7 HIV can be transmitted by kissing/hugging Correct knowledge 42.8 41.7 Incorrect knowledge 28.7 36.3 No knowledge 28.5 22.0 Women can not get HIV if make sex during menstruation Correct knowledge 22.7 23.7 Incorrect knowledge 44.2 42.6 No knowledge 33.1 33.7 Sharing the same pond with HIV infected person can transmit the HIV Correct knowledge 55.4 68.0 Incorrect knowledge 24.9 16.8 No knowledge 19.6 15.2 A healthy looking person can have HIV/AIDS Correct knowledge 67.6 72.1 Incorrect knowledge 17.6 19.8 No knowledge 14.7 8.1 HIV can be transmitted through sharing eating utensils with HIV infected person Correct knowledge 47.1 62.3 Incorrect knowledge 37.4 27.4 No knowledge 15.5 10.3 HIV can be transmitted by mosquito/insect bites Correct knowledge 37.2 49.8 Incorrect knowledge 34.2 25.9 No knowledge 28.6 4.3 A person canĂ­t get HIV if he/she takes antibiotics Correct knowledge 39.1 47.4 Incorrect knowledge 19.2 14.9 No knowledge 41.7 7.8 There is a cure for HIV/AIDS Correct knowledge 62.7 67.3 Incorrect knowledge 22.4 20.4 No knowledge 14.9 2.2 AIDS is a curse Correct knowledge 54.1 51.3 Incorrect knowledge 35.0 40.8 No knowledge 10.9 7.8 TOTAL 100.0 100.0 N1 2049 1136 Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents who ever heard about HIV/AIDS.

52

Slum 41.8 30.0 28.2

National 43.5 29.8 26.7

43.3 43.3 13.3

46.6 39.6 13.9

37.0 21.5 41.5

38.3 22.4 39.3

35.8 35.5 28.8

41.8 31.8 26.4

25.2 38.8 36.1

23.2 43.2 33.6

57.3 23.3 19.4

59.7 22.2 18.2

64.5 23.0 12.4

68.8 18.8 12.4

50.9 36.1 13.0

52.4 34.0 13.6

47.6 24.8 27.6

42.2 30.6 27.1

40.6 15.8 3.6

41.9 17.5 40.6

58.2 27.3 114.5

63.8 22.2 14.0

59.4 32.4 8.2 100.0 330

53.7 36.7 9.6 100.0 3515


5.13 How to behave with HIV infected person Adolescent and youths are mostly in favor of supporting HIV/AIDS infected persons. In response to a question, 36 percent of adolescents and youths mentioned that uninfected persons should take care of an HIV/AIDS infected person. Likewise, about 37 percent of them stated that we should extend our sympathy to an HIV/AIDS infected person. Only 16 percent of adolescents and youths opined that it is better to stay away from a person with HIV/AIDS. This misconception is significantly more prevalent among rural and slum adolescents and youths than their urban counterparts (Table 5.20).

Table 5.20 How to behave with HIV infected person How to behave with an HIV infected person Should take care Should extend our sympathy Should extend our all support Keep distance Should hate him Others Donâ&#x20AC;&#x2122;t know N Specific Television Channel Watched BTV ATN NTV Channel 1 Program watched AIDS Related Program Discussion Advertisement Drama N Specific Radio station listened Dhaka Chittagong Khulna Program listened Drama/Life story AIDS related discussion Health message/discussion Advertisement N

Rural 33.8 (693) 32.8 (672) 11.5 (235) 18.6 (381) 3.6 (74) 6.1 (124) 13.0 (267) 2049 Rural 99.2 (767) 1.0 (08) 0.4 (03) 0.6 (05) Rural 9.7 (75) 18.8 (145) 77.6 (600) 14.7 (114) 773 Rural 80.8 (185) 12.2 (28) 12.2 (28) Rural 17.5 (40) 26.6 (61) 41.0 (94) 30.1 (69) 229

Urban 36.7 (417) 41.7 (474) 18.7 (212) 11.5 (131) 2.2 (25) 7.0 (79) 9.8 (111) 1136 Urban 94.1(530) 11.2 (63) 9.6 (54) 8.3 (47) Urban 17.8 (100) 16.2 (91) 68.9 (388) 20.4 (115) 563 Urban 62.5 (35) 25.0 (14) 14.3 (08) Urban 19.6 (11) 26.8 (15) 48.2 (27) 23.2 (13) 56

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

53

Slum 48.5 (160) 41.5 (137) 21.5(71) 16.7 (55) 5.2 (17) 9.7 (32) 4.8 (16) 330 Slum 96.5 (136) 8.5 (12) 5.7 (08) 9.9 (14) Slum 23.4 (33) 24.1 (34) 64.5 (91) 25.5 (36) 141 Slum 72.2 (13) 11.1 (02) 22.2 (04) Slum 5.6 (01) 38.9 (07) 55.6 (10) 44.4 (08) 18

National 36.1 (1270) 36.5 (1283) 14.7 (518) 16.1 (567) 3.3 (116) 6.7 (235) 11.2 (394) 3515 National 97.0 (1433) 5.6 (83) 4.4 (65) 4.5 (66) National 14.1 (208) 18.3 (270) 73.1 (1079) 17.9 (256) 1477 National 76.9 (233) 14.5 (44) 13.2 (40) National 17.2 (52) 27.4 (83) 43.2 (131) 29.7 (90) 303


5.14 Major Sources of Information on How to Behave with HIV Infected Person About half of the adolescents and youths stated that the sources of their information on how to behave with an HIV/AIDS infected person were television (47 percent), followed by friends/peers (12 percent), radio and booklet/book (8 percent respectively). Only a few of them said that they heard about this from newspaper/magazines, billboard, health service providers, and NGO workers (Figure 5.17).

Figure 5.17 Major Sources of Information on how to behave with an HIV/AIDS Infected Person 100 80 60

47

40 20

10

8

12

8

Peers

Neighbors

0 Radio

TV

BOOKLET/BOOK

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Adolescents and youths almost universally mentioned BTV (97 percent) as their major source of information on how to behave with an HIV/AIDS infected person. Therefore, only a limited number of viewers, mostly in urban areas, acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on how to behave with an HIV/AIDS infected person. An overwhelming majority of adolescents and youths (73 percent) mentioned advertisement as their major source of information on how to behave with an HIV/AIDS infected person. However, some of them (14-18 percent) acknowledged other AIDSrelated programs, various AIDS-related discussions and dramas as their sources of information (Table 5.20). As reflected in Tables 5.20 for the overall sample, adolescents and youths almost universally (77 percent) mentioned Dhaka Kha as their major source of information on how to behave with an HIV/AIDS infected person. In this regard, only a small number of listeners acknowledged Khulna and Chittagong as their major radio sources of information. Nationally, more than 40 percent of adolescents and youths mentioned health messages, as their major source of information, followed by advertisements and AIDS-related discussions from radio on how to behave with an HIV/AIDS infected person (Table 5.20).

5.15 Importance of HIV/AIDS related information More than 90 percent of adolescents and youths, especially in rural and slum areas, mentioned that they were interested to learn more about HIV/AIDS (Figure 5.18).

54


Figure 5.18 Whether interested to learn more about HIV/AIDS 6.3

0.7

93

Yes

No

Don't know

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

An overwhelming majority of them (94 percent), irrespective of their locations, stated that they want more information on HIV/AIDS through electronic and print media (Figure 5.19) to make adolescent and youths more aware about HIV/AIDS (73 percent) and to protect them from HIV/AIDS (39 percent) (Figure 5.20). In repose to another question, about 90 percent of adolescents and youths stated that the information on HIV/AIDS provided by TV, Radio and other media are appropriate (Figure 5.21).

Figure 5.19 Whether support providing information on HIV/AIDS through TV, Radio, newspaper and other media 5.7

0.3

94.1

Yes

No

Don't know

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

55


Figure 5.20 Reasons to Diffuse information on HIV/AIDS through TV, Radio, newspaper and other media 100 73.2

80 60

39.3

40 20

4

2.5

0 To make them aware about HIV/AIDS To influence others

To protect them from HIV/AIDS Don't know

* Multiple responses were permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Figure 5.21 Appropriateness of the information on HIV/AIDS provided by TV, Radio and other media channels 11.7

1.3

87 Appropriate

Not Appropriate

Don't know

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.16 Media Exposure on Programs About HIV/AIDS Targeting Adolescents and Youths Bangladeshi adolescents and youths usually do not watch/listen programs or read articles/news items in both electronic and print media on HIV/AIDS specially made for young audiences. Therefore, in response to a straight question, whether the respondents ever watched/listen/read/seen any program about HIV/AIDS on TV, Radio and other media targeting adolescents, about 80 percent said â&#x20AC;&#x2DC;Noâ&#x20AC;&#x2122; (Figure 5.22). Only about one-fifth of them acknowledged that they ever watched/listen or read such programs. Adolescent and youths 56


mostly watched/listened/read advertisements, drama and AIDS-related discussion/news. Adolescents and youths, of those who were exposed to programs (n=820), universally (97 percent), acknowledged that the information contained in those programs were necessary for them. In providing suggestions to improve the standard of those programs, more than 35 percent of respondents stated that message/discussion should be detailed, followed by ‘messages should be broadcast frequently’, ‘provide information through drama’, and so on. Only 3 percent of them mentioned that current programs are alright (Table 5.21)

Figure 5.22 Whether ever watched/listen/seen/read any program about HIV/AIDS on TV, radio and other media targeting adolescents and youths 60 40 20

17.1

28.4

29.9

Urban

Slum

21.5

0 Rural

National

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Table 5.21 Media Exposure on Programs about HIV/AIDS Targeting Adolescents Types of programs ever watched/ listened/ seen/read about HIV/AIDS targeting adolescents* Rural Urban Slum National AIDS-related programs 20.0 28.8 31.3 24.8 AIDS-related discussion/messages 17.6 14.4 24.0 17.1 Advertisement 47.5 36.3 17.7 39.6 Drama 18.3 24.1 36.5 22.7 Movies 0.4 1.6 4.2 2.7 Others Whether the information were necessary for you Yes 95.5 98.1 96.9 96.7 No 2.7 1.3 0.0 1.8 Don’t know 1.7 0.6 3.1 1.5 What is your suggestions to improve the standard of those programs?* No suggestions 16.1 14.4 15.6 15.4 Broadcast messages frequently 27.0 23.8 25.0 25.5 Provide information through drama 12.9 12.8 28.1 14.6 Message/Discussion should be detailed 33.9 41.6 20.8 35.4 Current programs are alright 3.2 1.9 4.2 2.8 N 404 320 96 820 * Multiple responses were permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

57


5.16.1 Necessity of providing HIV/AIDS information to adolescents Respondents almost universally (95 percent) acknowledged that there is a dire necessity that these information should be targeting adolescents and youths. In this regard, there was no difference in views among the study samples (Figure 5. 23).

Figure 5.23 Whether support the necessity of providing HIV/AIDS information to adolescents 2.7

2.7

94.6 Yes

No

Don't know

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.16.2 More perfected media to diffuse HIV/AIDS information In disseminating information on HIV/AIDS to adolescents and youths, electronic mediums, such as television and radio, were found as most appropriate diffusion channels, followed by newspaper, health workers, NGOs, and community functions (Figure 5.24).

Figure 5.24 More perfected media to diffuse HIV/AIDS information 100

87.2

80 60

56.4

40

22.5

20 0

8.6 Radio Nawspaper Booklet NGOs

8.1

18.4

10.6

10.8

TV Billboard/sign board Health service providers Community functions/drama/rally

* Multiple responses were permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

58


5.16.3 Whether Perceived Threat of HIV/AIDS in Bangladesh Although the study respondents tended to hold commonplace erroneous beliefs about HIV transmission and prevention, the overall findings of this study has demonstrated that the sampled adolescents and youths had perceived the threat of this deadly disease. Other available national survey findings also support this finding (Table 5.22).

Table 5.22 Whether Perceived Threat of HIV/AIDS in Bangladesh Whether HIV/AIDS would be a serious problem for Bangladesh Yes No Don’t know TOTAL N

Rural 91.6 1.6 6.9 100.0 2369

Urban 94.4 1.4 4.2 100.0 1127

Slum 92.5 0.6 6.9 100.0 321

National 92.5 1.4 6.1 100.0 3817

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

5.16.4 HIV/AIDS-related Stigma Although sociocultural stigmas are the major barriers to HIV/AIDS prevention program in developing countries, it is a hope for the Bangladeshi policy planners involved in HIV/AIDS prevention that the ice of stigma is breaking among the adolescents and youths of this country. In response to a question ‘whether HIV/AIDS infected person should be allowed to mix with general public/un-infected persons,’ more than half of the survey adolescents and youths replied positively. However, a significant difference in the response of rural, slum, and urban audiences was revealed. HIV/AIDS-related stigma was more prevalent among rural and slum adolescents and youths than their urban counterparts (Figure 5.25).

Figure 5.25 Whether HIV/AIDS infected person should be allowed to mix with general public/un-infected person* N = 3817

80 60

62.2 48.4

42.7

40

52

20 0 Rural

Urban

Slum

National

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) * Multiple responses permitted

59


5.16.5 Self-efficacy and Interpersonal Communication on HIV/AIDS Overall, adolescents and youths tend to be overly comfortable to discuss HIV/AIDS and STD issues with doctors and paramedics. Nationally, more than 73 percent adolescents and youths agreed that that they would feel comfortable in discussing HIV/AIDS and STD issues with local health professionals (Table 5.23). Likewise, interpersonal communication on HIV/AIDS and STDs among friends and sex partners is also dominant among the study audiences. Seventy six percent of adolescent and youths mentioned that they would feel comfortable in discussing HIV/AIDS and STD issues with their friends and sex partners. Surprisingly, majority of them (66 percent) agreed that HIV/AIDS, reproductive and sexual health issues should be discussed with parents and other family members. In this regard, respondents in rural and slum areas were slightly lagging behind (Table 5.23). More importantly, nearly 80 percent of adolescents and youths agreed that HIV/AIDS, reproductive and sexual health issues should be discussed in schools (Figure 5.26).

Figure 5.26 Whether reproductive and sexual health issues should be discussed at school (N'= 4105)

National

78

Slum

77

Urban

82

Rural

76 0

20

40

60

80

Yes Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey.

60

100


Table 5.23 Self-efficacy and Interpersonal Communication on HIV/AIDS Whether feel comfortable in discussing HIV/AIDS and STDs with doctor/paramedics Rural Feel comfortable 71.5 Don’t feel comfortable 17.4 Don’t know/Cannot tell 11.1 Whether feel comfortable in discussing HIV/AIDS and STDs with friends/sex partners Feel comfortable 75.2 Don’t feel comfortable 15.7 Don’t know/Can’t tell 9.1 Whether HIV/AIDS, reproductive and sexual health issues should be discussed with parents or other family members Yes 63.9 No 32.3 Don’t know 3.8 Whether HIV/AIDS, reproductive and sexual health issues should be discussed in school Yes 76.0 No 19.3 Don’t know 4.6 TOTAL 100.0 N' 2551

Urban 78.7 14.6 6.7

Slum 68.1 16.3 15.5

National 73.3 16.5 10.2

79.0 15.7 5.4

72.3 14.1 13.6

76.0 15.6 8.4

70.5 27.0 2.5

66.5 29.4 4.2

66.0 30.6 3.5

82.1 15.3 2.5 100.0 1193

76.5 17.2 6.4 100.0 361

77.9 18.9 4.2 100.0 4105

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey.

5.17 Key Findings Awareness of HIV/AIDS: In the pre-intervention impact audience assessment, an overwhelming majority of respondents (86 percent) had ever heard about HIV/AIDS. Rural adolescents and youths were less aware (15 percentage points) of HIV/AIDS than their urban (95 percent) and slum (91 percent) counterparts. Major Sources of Information: Irrespective of their locations, an overwhelming majority of adolescents and youths stated that they heard about HIV/AIDS from TV (83 percent), followed by radio (22 percent), friends/peers (16 percent), booklet/book (13 percent), and neighbors (13 percent). Only a nominal number of them said that they heard about HIV/AIDS from newspaper /magazines, billboard, health service providers, and NGO workers. Adolescents and youths universally (98 percent) mentioned BTV as their major source of information. Only 5-8 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on general awareness of HIV/AIDS. An overwhelming majority of adolescents and youths (83 percent) mentioned advertisement as their major source of information on general awareness of HIV/AIDS. Adolescents and youths mostly watched programs providing information on general awareness of HIV/AIDS during night (70 percent) and afternoon times (39 percent). 61


Forty percent of adolescents and youths in the study mentioned that they received HIV/AIDS information from the daily Prothom Alo, followed by the daily Ittefaq (17 percent), the daily Janakantho (14 percent), and the daily Inquilab (13 percent). A sizeable proportion of adolescents and youths received HIV/AIDS-related information from the daily Jugantor and other local dailies. Spontaneous Knowledge on the Perceived Routes of HIV Transmission: About 60 percent of the respondents, of those adolescents and youths who are aware of HIV/AIDS (n=3515), had no idea that HIV could be transmitted through having unsafe sex with HIV/AIDS infected persons. About 80 percent of adolescents and youths had no idea that non-use of condoms during sex with multiple partners could transmit HIV. Likewise, only 26 percent adolescents and youths spontaneously mentioned that unsafe sex with CSWs could transmit the virus. Around half of the adolescents and youths (47-49 percent) knew that HIV could be transmitted through sharing needles and blood transfusion. Major Sources of information on Perceived Routes of HIV Transmission: An overwhelming majority of adolescents and youths heard about perceived routes of HIV transmission through TV (78 percent), followed by radio (19 percent), friends/peers (17 percent), booklet/book (15 percent). Only a nominal number of them said that they heard about routes of HIV transmission from newspaper/magazines, billboard, health service providers, and NGO workers. Adolescents and youths universally (98 percent) mentioned BTV as their major source of information on the routes of HIV transmission. Only 5-7 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on the routes of HIV transmission. An overwhelming majority of adolescents and youths (81 percent) mentioned advertisement as their major source of information on the routes of HIV transmission. Adolescents and youths mostly watched programs providing information on the routes of HIV transmission during night (68 percent) and afternoon sessions (37 percent). Spontaneous Knowledge on the Perceived Ways of Preventing HIV Transmission: Despite their universal general awareness on HIV/AIDS, about 75 percent of the study adolescents and youths had no idea that HIV could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of HIV prevention, more than 90 percent of adolescents and youths stated that they had no idea that consistent usage of condoms during sex with unfaithful partners could prevent HIV. Respondents also had no spontaneous idea that in preventing vertical transmission of HIV (mother-to-fetus), an infected mother should consult doctor before conception. Likewise, 23 percent adolescents and youths mistakenly mentioned that refraining from all sorts of sex could prevent the transmission of the virus. However, around half of the study adolescents and youths (51-53 percent) knew that the transmission of HIV could be prevented through avoiding unsafe sex other than between husband and wife and checking blood before transfusion. Likewise, a remarkable proportion of adolescents and youths (42 percent) had idea that using sterile needles/syringes could prevent the virus. Across the study areas, rural respondents were slightly lagging behind in perceiving the major ways of preventing HIV transmission. In the survey, more than 14 percent of adolescents and youths were found who heard about HIV/AIDS but could not tell anything about the ways of HIV prevention. Prompted Knowledge and Media Exposure on HIV-related Risks Practices: When prompted, using a pre-coded straight question, an overwhelming majority of adolescents and youths (80 percent) mentioned that they were aware about the risk associated with multiple sex partners and non-use of condom. Likewise, when prompted, majority of the adolescents and youths mentioned that HIV can be transmitted through unsafe blood transfusion (88 percent), infected mother to child (82 percent), and during breastfeeding (81 percent).

62


Throughout the sample, respondents were found well aware of the perceived severity of HIV/AIDS. More then 85 percent of adolescents and youths stated that death is the ultimate consequence of an HIV infected person. About 70-75 percent of them also know that a healthy looking person can have HIV/AIDS and the virus can be transmitted through one single unsafe sexual contact. Media Exposure on HIV-related Risks Practices: An overwhelming majority of adolescents and youths stated that the original sources of their prompted knowledge on various HIV-related risks practices were television, followed by radio, friends/peers, and booklet/book. Only a few of them said that they heard about various HIV-related Risks Practices from newspaper/magazines, billboard, health service providers, and NGO workers. For the overall sample, adolescents and youths almost universally mentioned BTV as their major source of information on various HIVrelated Risks Practices. Miasmic/Erroneous Beliefs on the Routes of HIV Transmission: Despite their remarkable general awareness of HIV/AIDS, a considerable number of adolescents and youths were found in the survey who had miasmic or erroneous beliefs on HIV/AIDS. For example, only 44 percent of adolescents and youths believed that HIV cannot be transmitted by coughing or sneezing. About half of them (47-52 percent) supported that HIV cannot be passed through sharing drinking/eating utensils and food with someone who had HIV/AIDS. There were also a sizeable proportion of adolescents and youths (43 percent) who though that women could not get HIV if they make sex during their menstruation time. In addition, around 40 percent of the sample had no idea that sharing the same pond with HIV infected person cannot transmit HIV. In the national sample, only 42 percent of respondents believed that a person could not get infected with HIV through ‘mosquito/insect bites’ or by ‘kissing/hugging’ with an infected person. Further, only 38 percent of the entire adolescent and youth sample believed that there was no immunization to prevent HIV transmission. Therefore, it was no surprise that overall 58 of the sample had no idea that there is no antibiotic for HIV/AIDS. Remarkably, more than half (54 percent) of the adolescents and youths throughout the study areas believe that AIDS is a curse. A considerable number of them (22 percent) also believe that there is a cure for HIV/AIDS. Across the study areas, adolescents and youths from rural and slum areas were found to have more erroneous beliefs on HIV/AIDS than their urban counterparts. Adolescent and youths are mostly in favor of supporting HIV/AIDS infected persons. Importance of HIV/AIDS related information: More than 90 percent of adolescents and youths, especially in rural and slum areas, mentioned that they were interested to learn more about HIV/AIDS. Media exposure on programs about HIV/AIDS targeting adolescents and youths: Bangladeshi adolescents and youths usually do not watch/listen programs or read articles/news items in both electronic and print media on HIV/AIDS, specially designed for young audiences. Therefore, in response to a straight question, whether the respondents ever watched/listen/read/seen any program/news item about HIV/AIDS on TV, Radio and other media targeting adolescents, about 80 percent said ‘No’. Necessity of providing HIV/AIDS information to adolescents: Respondents almost universally (95 percent) acknowledged that there is a dire necessity that HIV/AIDS information should be targeting adolescents and youths. In disseminating information on HIV/AIDS to adolescents and youths, electronic mediums, such as television and radio, were found as most appropriate diffusion channels, followed by newspaper, health workers, NGOs, and community functions.

63


Whether Perceived Threat of HIV/AIDS in Bangladesh: Although the study respondents tended to hold commonplace erroneous beliefs about HIV transmission and prevention, the overall findings of this study has demonstrated that the sampled adolescents and youths had perceived the threat of this deadly disease. In response to a question â&#x20AC;&#x2DC;whether HIV/AIDS infected person should be allowed to mix with general public/un-infected persons,â&#x20AC;&#x2122; more than half of the survey adolescents and youths replied positively. HIV/AIDS-related stigma was more prevalent among rural and slum adolescents and youths than their urban counterparts. Self-efficacy and Interpersonal Communication on HIV/AIDS: Overall, adolescents and youths tend to be overly comfortable to discuss HIV/AIDS and STD issues with doctors and paramedics. More importantly, nearly 80 percent of adolescents and youths agreed that HIV/AIDS, reproductive and sexual health issues should be discussed in schools.

64


6

KNOWLEDGE ON STDs/STIs

6.1 Awareness of other Sexually Transmitted Diseases (STDs) Compared to HIV/AIDS, the awareness of other sexually transmitted diseases (STDs) among the study respondents was low. Overall, only 32 percent of the entire adolescent sample reported to have knowledge of major STDs other than HIV/AIDS. Adolescents and youths in slum areas were more likely to know about STDs than their urban and rural counterparts (Figure 6.1). In response to a separate question, Genital Ulcers/Warts (60 percent), Syphilis (48 percent) and Gonorrhea (40 percent) were identified as major STDs by the respondents. Adolescents and youths did not know much about Chlamydia or other STDs. Adolescents and youths in rural areas had more knowledge on Genital Ulcers/Warts. This data should be interpreted cautiously because a considerable number of respondents from the study areas stated that they only heard the name of STDs and do not know much of them (Table 6.1).

Figure 6.1 Whether ever heard of any STDs other then HIV/AIDS 100

N = 4105

80 60 40

27.9

42.7

38

32.1

20 0 Rural

Urban

Slum

National

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Table 6.1 Percent distribution of respondents by types of STDs/STIs heard Types of STDs/STIs heard Syphilis Gonorrhea Chlamydia Genital Ulcers/warts N'

Rural 44.7 37.5 1.3 61.9 712

Urban 50.1 42.6 3.1 59.2 453

Slum 60.4 40.3 .6 51.3 154

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents who ever heard about STD/STIs.

65

National 48.4 39.6 1.8 59.7 1319


6.2 Knowledge on Major Ways of Transmitting STDs Adolescents and youths (n=1319) did not have clear ideas about the routes of transmission of STDs. In response to a multiple question, only 35 percent of them mentioned that STDs spread through having un-protected sex with STD/STI infected person, followed by non-use of condoms during sex (29 percent), unprotected sex with multiple sex partners (24 percent) and if not maintain personal hygiene (19 percent). About 10 percent adolescents and youths believed that STDs could be transmitted through using used underwear/towel or using un-cleaned toilets. In this regard, rural adolescents and youths had much erroneous beliefs than their urban counterparts.

Figure 6.2 Major Ways of Transmitting STDs/STIs 100 90 80 70 60 50 40 30 20 10 0

N = 1319

35

29

24

19

Having un-protected sex with STD/STI infected person Unprotected sex with multiple person Non use of condom during sex If not maintain personal hyghiene * Multiple responses were permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

6.3 Major Ways of Protection from STDs/STIs Adolescents and youths (n=1319) did not have clear ideas about the major ways of protection from STDs. About 80 percent of them had no idea that STDs could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of STD prevention, more than 60 percent of adolescents and youths stated that they had no idea that usage of condoms during sex with partners could prevent STDs. Only 16-18 percent of them had idea that ‘having sex with a faithful partner’ or ‘limiting sex between husband and wife’ could prevent STDs. Likewise, only 7 percent adolescents and youths knew that ‘avoiding untested blood transfusion’ or ‘avoiding infected needle/syringe’ could prevent the transmission of STDs (Table 6.2). Across the study areas, rural respondents were slightly lagging behind in perceiving the major ways of preventing STD transmission than their urban counterparts. In the survey, about one-third of adolescents and youths were found who heard about STDs but could not tell anything about the ways of prevention (Table 6.2). 66


Table 6.2 Major Ways of Protection from STDs Ways of protection from STDs/STIs (MRP) Having sex with a faithful partner Limiting sex between husband and wife Using condom during sex Avoiding untested blood transfusion Avoiding using infected needle/syringe Avoiding sex with CSWs Others Donâ&#x20AC;&#x2122;t know N

Rural 15.0

Urban 19.0

Slum 14.3

National 16.3

16.2 32.4

18.8 40.4

20.8 51.9

17.6 37.5

6.3

7.1

11.0

7.1

4.9 19.4 9.3 31.0 712

7.5 18.5 13.7 25.2 453

14.3 11.0 22.7 14.3 154

6.9 18.1 12.4 27.1 1319

* Multiple responses were permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

6.4 More perfected media to diffuse STDs information In disseminating information on STDs to adolescents and youths, interpersonal communication through peer education, neighbors, and health service providers were found as most appropriate diffusion channels, followed by television and booklet. Youths were found shy in receiving communication on STDs through electronic and print mediums (Figure 6.3).

Figure 6.3 More perfected media to diffuse STDs information 60 N = 1319

40 20

28 5.2

12.4

6.1

9.2

21.4

12.4

14.2

0 Radio Newspaper Peer education Relative

TV Booklet Neighbors Health service providers

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

67


6.5 Availability of STD Services in the Locality In response to a question, more than 47 percent of adolescents and youths said that there are STD services available nearby. Rural youths had less opportunity to avail this service than their urban counterparts. Likewise, more than 46 of them stated that they know STD service providers which provide treatment facilities in suitable time. In this regard, there was no significant difference between two groups of urban study respondents. In reply to a further question, majority of youths (65 percent) mentioned that they did not know whether STD treatment is expensive or not (Table 6.3).

Table 6.3 Availability of STD Services in the Locality Availability of STD services (Hospital/ Pharmacy/doctorís chamber) nearby Yes No Don’t know Whether know any STD service providers which provide service in suitable time Yes No Don’t know Whether STD treatment is expensive Yes No Don’t know TOTAL N'

Rura 41.4 30.4 28.1

Urban 57.0 14.0 29.0

Slum 56.2 13.3 30.5

National 47.3 24.1 28.6

Rural 42.8 26.9 30.2 Rural 17.0 16.0 67.1 100.0 2551

Urban 52.1 14.2 33.7 Urban 15.6 19.7 64.7 100.0 1193

Slum 52.6 12.7 34.6 Slum 23.8 21.1 55.1 100.0 361

National 46.4 22.0 31.6 National 17.2 17.5 65.3 100.0 4105

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey.

6.6 Key Findings Awareness and knowledge on other Sexually Transmitted Diseases (STDs): Compared to HIV/AIDS, the awareness of other sexually transmitted diseases (STDs) among the study respondents was low. Overall, only 32 percent of the entire adolescent sample reported to have knowledge of major STDs other than HIV/AIDS. In response to a separate question, Genital Ulcers/Warts (60 percent), Syphilis (48 percent) and Gonorrhea (40 percent) were identified as major STDs by the respondents. Adolescents and youths (n=1319) did not have clear ideas about the routes of transmission of STDs. In response to a multiple question, only 35 percent of them mentioned that STDs spread through having un-protected sex with STD/STI infected person, followed by non-use of condoms during sex (29 percent), unprotected sex with multiple sex partners (24 percent) and if not maintain personal hygiene (19 percent). Adolescents and youths (n=1319) did not have clear ideas about the major ways of protection from STDs. 68


About 80 percent of them had no idea that STDs could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of STD prevention, more than 60 percent of adolescents and youths stated that they had no idea that usage of condoms during sex with partners could prevent STDs. Only 16-18 percent of them had idea that ‘having sex with a faithful partner’ or ‘limiting sex between husband and wife’ could prevent STDs. Likewise, only 7 percent adolescents and youths knew that ‘avoiding untested blood transfusion’ or ‘avoiding infected needle/syringe’ could prevent the transmission of STDs. In disseminating information on STDs to adolescents and youths, interpersonal communication through peer education, neighbors, and health service providers were found as most appropriate diffusion channels, followed by television and booklet. Youths were found shy in receiving communication on STDs through electronic and print mediums. More than 47 percent of adolescents and youths said that there are STD services available nearby. Rural youths had less opportunity to avail this service than their urban counterparts. Likewise, more than 46 of them stated that they know STD service providers which provide treatment facilities in suitable time. In reply to a further question, majority of youths (65 percent) mentioned that they did not know whether STD treatment is expensive or not.

69


7

CONDOM BEHAVIORS: AWARENESS, COLLECTION, BARRIERS, AND USE

A major focus in the pre-intervention audience impact survey was on investigating condom efficacy of the study audiences, specifically to ascertain whether they ever heard about condom, collection of condom, purpose of using condom, barriers to collect and use condom, and the availability of condoms in the locality.

7.1 Awareness and Availability of Condom Table 7.1 shows the percent distribution of adolescents and youths by their awareness and availability of condom. In reply to a question, whether they had ever heard about condom, adolescents and youths throughout the study areas almost universally (97 percent) acknowledged that they ever heard about condom (Figure 7.1). Likewise, all of them mentioned that they ever seen a condom (Table 7.1). No, 3%

Yes, 97% N = 4105

Figure 7.1 Whether Ever Heard About Condom Further, an overwhelming majority of adolescents and youths (88 percent) reported in the survey that condom is available in their locality. There was little variation in reporting condom awareness and obtaining practices between rural and urban youths (Figure 7.2).

7.2 Reasons for using condom Of those adolescents and youths who ever heard about condoms (n=3961), more than 76 percent reported that condoms are used it to avoid pregnancy. More than 40 percent of them also knew that condom is used to prevent HIV transmission (Figure 7.3). However, there was huge variation in reporting the positive relationship of condom use and HIV prevention between the rural and urban youths. Rural youths had less knowledge on this important link (Table 7.1).

70


Figure 7.2 Availability of condom in the locality

Not Available 9%

Don't know 9%

Available 88%

Source: Table 7.1 Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Figure 7.3 Reasons for using condom 100 80

76.2

60 40.3

40 20

6.3

8.1

0 For family planning

To prevent HIV transmission

To prevent STD/STIs

Don't know

Source: Table 7.1 Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

7.3 Nearest place to buy condom Adolescents and youths reported in the survey that condom collection was not hard for them. An overwhelming majority of them (83 percent) agreed that there was nearest place to buy condoms in their locality. There was little variation in reporting condom collection practices between the rural and urban youths (Table 7.2).

71


Table 7.1 Percentage of adolescents and youths according to their Condom related practices Whether heard about condom Yes No TOTAL N' Whether ever seen condom Yes No Why condom is used?* For family planning To prevent HIV transmission To prevent STDs/STIs Others Donâ&#x20AC;&#x2122;t know Availability of condom in the locality Available Not available Donâ&#x20AC;&#x2122;t know TOTAL N2

Rural 96.0 4.0 100.0 2551 Rural 93.3 6.6 Rural 76.5 33.7 4.9 3.7 9.1 Rural 88.5 3.8 7.7 100.0 2448

Urban 98.2 1.8 100.0 1193 Urban 91.8 8.2 Urban 78.1 48.1 8.7 1.9 6.2 Urban 87.1 1.5 11.4 100.0 1171

Slum 94.7 5.3 100.0 361 Slum 91.5 8.5 Slum 68.1 60.8 8.8 2.3 7.3 Slum 89.8 1.8 8.5 100.0 342

National 96.5 3.5 100.0 4105 National 92.7 7.3 National 76.2 40.3 6.3 3.1 8.1 National 88.2 3.0 8.9 100.0 3961

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey. N is the weighted number of respondents who ever heard/seen any condom.

7.4 Sources of getting condom in the locality Respondents obtain condom in their locality from both government and private service providers. In their understanding, Grocery Shops are the common source of getting condoms for adolescents and youths (72 percent), followed by Pharmacy (64 percent), Govt. Hospitals and FP centers (8 percent respectively). Urban adolescents and youths were more likely to obtain condoms from pharmacy and rural respondents usually buy condoms from grocery shops (Figure 7.4).

Figure 7.4 Sources of condom in the locality 100 80 60

N = 3610

64.2

71.9

40 20

8.4

0 Govt. hospital

5.4

NGO clinic

7.7 FP centre

Pharmacy

Grocery shop

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

72


7.5 Condom Affordability Condom is cheap in Bangladesh. Therefore it was no wonder that a remarkable proportion of adolescents and youths (65.4 percent) stated in the survey that condom is affordable to them. In tandem with the above response, 72 percent of them acknowledged that condom is sold to young people. More than half of them believed that confidentiality is maintained by the condom sellers.

Figure 7.5 Whether the price of condom is affordable

N = 4105

30.5

65.4 4.1

Yes

No

Don't know

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

7.6 Perception of Local People when Youths Buy Condom Local people do not take it easy when youths buy condoms. In reply to a multiple question, majority of adolescent and youths (60 percent) replied that buying condom by adolescents and youths creates bad impression among local people. There was insignificant variation in reporting the above condom collection practices between the rural and urban youths (Table 7.2).

73


Table 7.2 Percentage of adolescents and youths according to their Collection of condom Whether any nearest place to buy condoms Yes No Don’t know N Whether condom is affordable Yes No Don’t know Whether condom is sold to young people Yes No Don’t know Whether confidentiality is maintained by the condom sellers Yes No Don’t know TOTAL N Perception of local people if you buy condoms* Nothing/Don’t mind It creates bad impression Don’t Know Married/No Problem N'

Rural 82.1 6.8 11.1 2260 Rural 65.8 4.4 29.9 Rural 71.7 8.3 20.0

Urban 85.3 2.2 12.5 1037 Urban 67.7 2.8 29.4 Urban 74.3 7.7 18.0

Slum 83.4 2.8 13.9 313 Slum 54.8 6.4 38.8 Slum 64.0 10.8 25.2

National 83.2 5.1 11.8 3610 National 65.4 4.1 30.5 National 71.7 8.3 19.9

Rural 54.7 9.8 35.5 100.0 2551

Urban 54.1 11.8 34.0 100.0 1193

Slum 51.8 9.4 38.8 100.0 361

National 54.3 10.4 35.4 100.0 4105

Rural 20.3 60.2 12.4 3.8 2551

Urban 19.2 59.9 12.1 6.0 1193

Slum 24.9 60.7 6.9 6.4 361

National 20.4 60.1 11.8 4.7 4105

* Multiple responses permitted Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey.

7.7 Use of Condom Condom is not a part of sex culture among Bangladeshi adolescents and youths. Of those adolescents and youths who ever heard or seen any condoms (n=3961) were asked about their usage of condoms. In reply, an overwhelming majority of them (72 percent) stated that they never used any condom (Figure 7.6). Of those who used condoms (28 percent, N=1120), a very limited number of rural (n=82) and urban (n=46) youths reported using condoms to prevent HIV/AIDS (Figure 7.7). It seems that the slum populations are more aware (35 percent) that condom prevents HIV (Table 7.3). 74


Figure 7.6 Ever use of any condom by adolescents and youths (N = 3961) 28.3

71.7

Yes

No

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Figure 7.7 Reasons of using condom 100 80

92.6

N = 1120

60 40 14.6

20 0

3.8

FP/check pregnancy To prevent STDs/STIs

2.6

To prevent HIV/AIDS Others

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901)

Table 7.3 Percentage of adolescents and youths according to their use of condom Whether ever used any condom Yes No TOTAL N' Reasons for using condom* To prevent pregnancy To prevent HIV/AIDS To prevent STDs/STIs Others N2

Rural 25.7 74.3 100.0 2448 Rural 93.5 (588) 13.0 (82) 3.5 (220 2.9 (18) 629

Urban Slu National 33.1 30.1 28.3 66.9 69.9 71.7 100.0 100.0 100.0 1171 342 3961 Urban Slum National 94.1 (365) 81.6 (84) 92.6 (1037) 11.9 (46) 35.0 (36) 14.6 (164) 3.6 (14) 5.8 (6) 3.8 (42) 1.8 (7) 3.9 (4) 2.6 (29) 388 103 1120

* Percentage do not add-up to 100 percent due to multiple responses. Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents who had ever heard/seen a condom

75


7.8 Key Findings Condom Awareness and self-efficacy: Adolescents and youths throughout the study areas almost universally (97 percent) acknowledged that they ever heard about condom. Likewise, all of them mentioned that they ever seen a condom. Further, an overwhelming majority of adolescents and youths (88 percent) reported in the survey that condom is available in their locality. Of those adolescents and youths who ever heard about condoms (n=3961), more than 76 percent reported that condoms are used it to avoid pregnancy. More than 40 percent of them also knew that condoms are used to prevent HIV transmission. Rural youths had less knowledge on this important link. Adolescents and youths reported in the survey that condom collection was not hard for them. An overwhelming majority of them (83 percent) agreed that there was nearest place to buy condoms in their locality. Respondents obtain condom in their locality from both government and private service providers. In their understanding, Grocery Shops are the common source of getting condoms for adolescents and youths (72 percent), followed by Pharmacy (64 percent), Govt. Hospitals and FP centers (8 percent respectively). Condom is cheap in Bangladesh. Therefore it was no wonder that a remarkable proportion of adolescents and youths (65.4 percent) stated in the survey that condom is affordable to them. In tandem with the above response, 72 percent of them acknowledged that condom is sold to young people. More than half of them believed that confidentiality is maintained by the condom sellers. Local people do not take it easy when youths buy condoms. Majority of adolescent and youths (60 percent) mentioned that buying condom by them creates bad impression among local people. However, an overwhelming majority of them (72 percent) stated that they never used any condom. Of those who used condoms (28 percent, N=1120), a very limited number of rural (n=82) and urban (n=46) youths reported using condoms to prevent HIV/AIDS.

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8

LIFE-SKILLS AND SELF-EFFICACY IN MANAGING RISK PRACTICES

Another major focus in the pre-intervention audience impact survey was on investigating life-skills and self-efficacy of adolescents and youths in managing their risk practices, specifically to ascertain whether their friends/peers could influence them to take drug, ability to ask sex partners to use condom, self-confidence to refuse forced sex and so on.

8.1 Confidence to deal with friends/peers Adolescents and youths throughout the study areas almost universally mentioned their selfconfidence that their friends/peers could not influence them to take drugs. A slight variation was observed among the respondents in slum areas. Compared to rural (92 percent) and urban (93 percent) areas, adolescents and youths in slum areas were found less self-confident (84 percent) in this regard (Table 8.1).

8.2 Ability to refuse forced sex Nearly 90 of adolescent and youths claimed that they could refuse forced sex. In this matter, only 12 percent of them mentioned that they are uncertain. There was insignificant variation in reporting the above answer between the rural and urban youths (Table 8.1).

8.3 Ability to ask sex partners to use condom Irrespective of their marital status and availability of sex partners, adolescents and youths were asked in the survey to provide information on their use of condoms with sex partners. In reply, more than 50 percent of adolescent and youths claimed that they could ask their sex partners to use condom. Only 11 percent of them said that they were unable to motivate their sex partners to use condom. Likewise, only 30 percent of them acknowledged that they were capable to influence their irregular sex partner to use condom (Table 8.1).

8.4 Self-confidence to seek STD services with the nearest clinic In reply to a question, majority of the respondents (75 percent) expressed their confidence that they could seek STD services with the nearest clinic/hospitals. Slum respondents (68 percent) were less likely to seek STD services with the nearest clinic than that of other urban and rural respondents. In reply to a separate question, some 14 percent of adolescents and youths stated that they have the possibility of contacting STDs, like syphilis and gonorrhea (Table 8.1).

8.5 Ability to take decision to choose life partner Majority of adolescent and youths (76 percent) thought that they have the ability to take decision in selecting their life partners. Only 11 percent of them replied that they were not confident in this regard (Table 8.1).

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Table 8.1 Life-Skills and Self-Efficacy in Managing Risk Practices Whether the friends/peers can influence in taking drug Yes, they can No they can’t Uncertain Whether able to ask sex partners to use condom Yes, I can No, I can’t Uncertain Not applicable Whether capable to influence irregular sex partner to use condom Yes, I can No, I cannot Uncertain Not applicable Whether confident to seek STD services with the nearest clinic Yes, confident Not confident Uncertain Whether confident to refuse forced sex Yes, confident Not confident Uncertain Whether self confident to take decision in selecting life partner Yes, confident Not confident Uncertain Possibility of contacting STDs, like syphilis and gonorrhea Yes, possible Not possible Don’t know TOTAL N'

Rural 4.7 91.8 3.5 Rural 51.6 11.3 3.1 33.9

Urban 4.0 93.2 2.8 Urban 55.9 8.5 3.4 32.2

Slum 10.8 83.9 5.3 Slum 56.0 12.2 2.2 29.6

National 5.0 91.5 3.4 National 53.3 10.6 3.1 33.1

Rural 27.6 10.0 4.2 58.3

Urban 32.3 7.0 4.8 55.9

Slum 35.7 6.9 4.7 52.6

National 29.6 8.8 4.4 57.1

Rural 74.0 13.4 12.5 Rural 82.6 10.9 6.5

Urban 78.8 12.5 8.7 Urban 82.5 12.7 4.8

Slum 68.4 14.4 17.2 Slum 83.9 11.6 4.4

National 74.9 13.5 11.6 National 82.7 11.5 5.8

Rural 75.5 10.5 14.0

Urban 75.9 11.5 12.6

Slum 77.3 11.1 11.6

National 75.8 10.9 13.4

Rural 13.9 53.2 33.0 100.0 2551

Urban 12.7 59.4 27.9 100.0 1193

Slum 18.6 48.5 33.0 100.0 361

National 13.9 54.6 31.5 100.0 4105

Source: Pre-Intervention Audience Impact Survey 2005 (Package GF # 901) N' is the weighted number of respondents in the survey. 78


8.6 Key Findings Life-Skills and Self-Efficacy in Managing Risk Practices: Adolescents and youths throughout the study areas almost universally mentioned their self-confidence that their friends/peers could not influence them to take drugs. Nearly 90 of adolescent and youths claimed that they could refuse forced sex. Irrespective of their marital status and availability of sex partners, more than 50 percent of adolescent and youths claimed that they could ask their sex partners to use condom. Likewise, only 30 percent of them acknowledged that they were capable to influence their irregular sex partner to use condom. Majority of them (75 percent) also expressed their confidence that they could seek STD services with the nearest clinic/hospitals. Some 14 percent of adolescents and youths stated that they have the possibility of contacting STDs, like syphilis and gonorrhea. Majority of adolescent and youths (76 percent) thought that they have the ability to take decision in selecting their life partners.

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9

CONCLUSION AND LESSONS LEARNED

PIACT Bangladesh, in collaboration with the Ministry of Health & Family Welfare of the Peopleâ&#x20AC;&#x2122;s Republic of Bangladesh and Save the Children-USA, and Mattra has taken this step to conduct a Pre-Intervention Audience Impact Survey among the youths and adolescents age 15-24 years. The Pre-Intervention Audience Impact Survey 2005 is a nationally representative survey undertaken in Bangladesh. As expected, the present study among the youths and adolescents examined several sensitive issues such as awareness of HIV/AIDS, mass media channels, necessary life skills to protect youths from HIV and other STDs, source of their information on HIV/AIDS and STDs/STIs, condom use and barriers, and availability of health services. The survey findings are intended to be useful in planning and implementing the countryâ&#x20AC;&#x2122;s HIV/AIDS campaign program under GFATM projects designed to inform young people of the danger of HIV/AIDS, the modes of transmission of the disease, and the ways a person can protect himself/herself from this disease, promote positive behaviors and thereby, combat HIV/AIDS. The Survey was implemented by collecting data from a nationally representative sample of 4105 adolescents and youths chosen from among men and women. The sample was drawn in terms of households by using a multistage sampling design. A structured was used in the survey to collect the data. The fieldwork for data collection started on 23 June 2005 and was completed by 30 July 2005. Media Exposure: Compared to other mass media channels, adolescents and youths of the current survey, irrespective of their locations, had less exposure to radio. On average, 38 percent of adolescents and youths stated their general habits of listening to Radio. Nationally, 86 percent of adolescents and youths acknowledged their general habits of watching television. Adolescents and youths mostly watch television during nighttime, attracting the largest percentage of viewers (68 percent) across the sample areas. Nationally, 96 percent of adolescents and youths were found watching BTV, with 99 percent of those in rural areas and a slightly but significantly lower 92 percent in urban and 96 percent in slum areas. In consistent with other national surveys about 40 percent adolescents and youths stated that they do not usually read newspapers. Awareness of HIV/AIDS and Major Sources of Information: In the pre-intervention impact audience assessment, an overwhelming majority of respondents (86 percent) had ever heard about HIV/AIDS. Rural adolescents and youths were less aware (15 percentage points) of HIV/AIDS than their urban (95 percent) and slum (91 percent) counterparts. Irrespective of their locations, an overwhelming majority of adolescents and youths stated that they heard about HIV/AIDS from TV (83 percent), followed by radio (22 percent), friends/peers (16 percent), booklet/book (13 percent), and neighbors (13 percent). Only a nominal number of them said that they heard about HIV/AIDS from newspaper/magazines, billboard, health service providers, and NGO workers. Adolescents and youths universally (98 percent) mentioned BTV as their major source of information. Only 5-8 percent adolescents and youths acknowledged other Bangladeshi satellite channels such as NTV, ATN Bangla and Channel I as their major electronic source on general awareness of HIV/AIDS. Spontaneous Knowledge on the Perceived Routes of HIV Transmission: About 60 percent of the respondents, of those adolescents and youths who are aware of HIV/AIDS (n=3515), had no idea that HIV could be transmitted through having unsafe sex with HIV/AIDS infected persons. About 80 percent of adolescents and youths had no idea that non-use of condoms during sex with multiple partners could transmit HIV. 80


Likewise, only 26 percent adolescents and youths spontaneously mentioned that unsafe sex with CSWs could transmit the virus. Around half of the adolescents and youths (47-49 percent) knew that HIV could be transmitted through sharing needles and blood transfusion. Spontaneous Knowledge on the Perceived Ways of Preventing HIV Transmission: Despite their universal general awareness on HIV/AIDS, about 75 percent of the study adolescents and youths had no idea that HIV could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of HIV prevention, more than 90 percent of adolescents and youths stated that they had no idea that consistent usage of condoms during sex with unfaithful partners could prevent HIV. However, around half of the study adolescents and youths (51-53 percent) knew that the transmission of HIV could be prevented through avoiding unsafe sex other than between husband and wife and checking blood before transfusion. Likewise, a remarkable proportion of adolescents and youths (42 percent) had idea that using sterile needles/syringes could prevent the virus. The sources of information on perceived ways of prevention of HIV was almost similar to those of the sources of information on perceived routes of transmission. Prompted Knowledge and Media Exposure on HIV-related Risks Practices: When prompted, using a pre-coded straight question, an overwhelming majority of adolescents and youths (80 percent) mentioned that they were aware about the risk associated with multiple sex partners and non-use of condom. Likewise, when prompted, majority of the adolescents and youths mentioned that HIV could be transmitted through unsafe blood transfusion (88 percent), infected mother to child (82 percent), and during breastfeeding (81 percent). Miasmic/Erroneous Beliefs on the Routes of HIV Transmission: Despite their remarkable general awareness of HIV/AIDS, a considerable number of adolescents and youths were found in the survey who had miasmic or erroneous beliefs on HIV/AIDS. For example, only 44 percent of adolescents and youths believed that HIV cannot be transmitted by coughing or sneezing. About half of them (47-52 percent) supported that HIV cannot be passed through sharing drinking/eating utensils and food with someone who had HIV/AIDS. There were also a sizeable proportion of adolescents and youths (43 percent) who though that women could not get HIV if they make sex during their menstruation time. In addition, around 40 percent of the sample had no idea that sharing the same pond with HIV infected person cannot transmit HIV. In the national sample, only 42 percent of respondents believed that a person could not get infected with HIV through ‘mosquito/insect bites’ or by ‘kissing/hugging’ with an infected person. Further, only 38 percent of the entire adolescent and youth sample believed that there was no immunization to prevent HIV transmission. Therefore, it was no surprise that overall 58 of the sample had no idea that there is no antibiotic for HIV/AIDS. Remarkably, more than half (54 percent) of the adolescents and youths throughout the study areas believe that AIDS is a curse. A considerable number of them (22 percent) also believe that there is a cure for HIV/AIDS. Across the study areas, adolescents and youths from rural and slum areas were found to have more erroneous beliefs on HIV/AIDS than their urban counterparts. Behave with HIV infected person: Adolescent and youths are mostly in favor of supporting HIV/AIDS infected persons. In response to a question, 36 percent of adolescents and youths mentioned that uninfected persons should take care of an HIV/AIDS infected person. Likewise, about 37 percent of them stated that we should extend our sympathy to an HIV/AIDS infected person. 81


Importance of HIV/AIDS related information: More than 90 percent of adolescents and youths, especially in rural and slum areas, mentioned that they were interested to learn more about HIV/AIDS. An overwhelming majority of them (94 percent), irrespective of their locations, stated that they want more information on HIV/AIDS through electronic and print media to make adolescent and youths more aware about HIV/AIDS (73 percent) and to protect them from HIV/AIDS (39 percent). In repose to another question, about 90 percent of adolescents and youths stated that the information on HIV/AIDS provided by TV, Radio and other media are appropriate. Media exposure on programs about HIV/AIDS targeting adolescents and youths: Bangladeshi adolescents and youths usually do not watch/listen programs or read articles/news items in both electronic and print media on HIV/AIDS, specially designed for young audiences. Therefore, in response to a straight question, whether the respondents ever watched/listen/read/seen any program/news item about HIV/AIDS on TV, Radio and other media targeting adolescents, about 80 percent said ‘No’. Adolescent and youths mostly watched/listened/read advertisements, drama and AIDS-related discussion/news. Adolescents and youths, of those who were exposed to programs (n=820), universally (97 percent), acknowledged that the information contained in those programs were necessary for them. In providing suggestions to improve the standard of those programs, more than 35 percent of respondents stated that message/discussion should be detailed, followed by ‘messages should be broadcast frequently’, ‘provide information through drama’, and so on. Necessity of providing HIV/AIDS information to adolescents: Respondents almost universally (95 percent) acknowledged that there is a dire necessity that HIV/AIDS information should be targeting adolescents and youths. In disseminating information on HIV/AIDS to adolescents and youths, electronic mediums, such as television and radio, were found as most appropriate diffusion channels, followed by newspaper, health workers, NGOs, and community functions. Whether Perceived Threat of HIV/AIDS in Bangladesh: Although the study respondents tended to hold commonplace erroneous beliefs about HIV transmission and prevention, the overall findings of this study has demonstrated that the sampled adolescents and youths had perceived the threat of this deadly disease. In response to a question ‘whether HIV/AIDS infected person should be allowed to mix with general public/un-infected persons,’ more than half of the survey adolescents and youths replied positively. HIV/AIDS-related stigma was more prevalent among rural and slum adolescents and youths than their urban counterparts . Self-efficacy and Interpersonal Communication on HIV/AIDS: Overall, adolescents and youths tend to be overly comfortable to discuss HIV/AIDS and STD issues with doctors, paramedics, friends and sex partners as well as with parents and other family members. More importantly, nearly 80 percent of adolescents and youths agreed that HIV/AIDS, reproductive and sexual health issues should be discussed in schools. Awareness and knowledge on other Sexually Transmitted Diseases (STDs): Compared to HIV/AIDS, the awareness of other sexually transmitted diseases (STDs) among the study respondents was low. Overall, only 32 percent of the entire sample reported to have knowledge of major STDs other than HIV/AIDS.

82


However, adolescents and youths (n=1319) did not have clear ideas about the routes of transmission of STDs. In response to a multiple question, only 35 percent of them mentioned that STDs spread through having un-protected sex with STD/STI infected person, followed by non-use of condoms during sex (29 percent), unprotected sex with multiple sex partners (24 percent) and if not maintain personal hygiene (19 percent). Further, they did not have clear ideas about the major ways of protection from STDs. About 80 percent of them had no idea that STDs could be prevented through refraining from having unsafe sex with CSWs. In reply to a series of questions on the ways of STD prevention, more than 60 percent of adolescents and youths stated that they had no idea that usage of condoms during sex with partners could prevent STDs. In disseminating information on STDs to adolescents and youths, interpersonal communication through peer education, neighbors, and health service providers were found as most appropriate diffusion channels, followed by television and booklet. Youths were found shy in receiving communication on STDs through electronic and print mediums. More than 47 percent of adolescents and youths said that there are STD services available nearby. Rural youths had less opportunity to avail this service than their urban counterparts. Likewise, more than 46 of them stated that they know STD service providers which provide treatment facilities in suitable time. In reply to a further question, majority of youths (65 percent) mentioned that they did not know whether STD treatment is expensive or not. Condom Awareness and self-efficacy: Adolescents and youths throughout the study areas almost universally (97 percent) acknowledged that they ever heard about condom. Likewise, all of them mentioned that they ever seen a condom. Further, an overwhelming majority of adolescents and youths (88 percent) reported in the survey that condom is available in their locality. Of those adolescents and youths who ever heard about condoms (n=3961), more than 76 percent reported that condoms are used it to avoid pregnancy. More than 40 percent of them also knew those condoms are used to prevent HIV transmission. Rural youths had less knowledge on this important link. Adolescents and youths reported in the survey that condom collection was not hard for them. An overwhelming majority of them (83 percent) agreed that there was nearest place to buy condoms in their locality. Respondents obtain condom in their locality from both government and private service providers. In their understanding, Grocery Shops are the common source of getting condoms for adolescents and youths (72 percent), followed by Pharmacy (64 percent), Govt. Hospitals/FP centers (8 percent). Condom is cheap in Bangladesh. Therefore it was no wonder that a remarkable proportion of adolescents and youths (65.4 percent) stated in the survey that condom is affordable to them. In tandem with the above response, 72 percent of them acknowledged that condom is sold to young people. More than half of them believed that confidentiality is maintained by the condom sellers. However, majority of adolescent and youths (60 percent) mentioned that buying condom by them often create bad impression among local people. Importantly, an overwhelming majority of them (72 percent) stated that they never used any condom. Of those who used condoms (28 percent, N=1120), a very limited number of rural (n=82) and urban (n=46) youths reported using them to prevent HIV/AIDS. Life-Skills and Self-Efficacy in Managing Risk Practices: Adolescents and youths throughout the study areas almost universally mentioned their self-confidence that their friends/peers could not influence them to take drugs. Nearly 90 of adolescent and youths claimed that they could refuse forced sex. Irrespective of their marital status and availability of sex partners, more than 50 percent of adolescent and youths claimed that they could ask their sex partners to use condom. Likewise, only 30 percent of them acknowledged that they were capable to influence their irregular sex partner to use condom. Majority of them (75 percent) also expressed their confidence that they could seek STD services with the nearest clinic/hospitals. Majority of adolescent and youths (76 percent) thought that they have the ability to take decision in selecting their life partners. 83


This study has addressed a series of issues in relation to HIV/AIDS and other STDs. It has reported some dramatic findings at variance with conventional Bangladeshi and other international studies. These may have implications for future HIV/AIDS prevention efforts in lessresourced communities targeting both adolescents and youths. Although the study respondents tended to hold commonplace erroneous beliefs about HIV transmission and prevention, the overall findings of this study has demonstrated that awareness of HIV/AIDS is moderately high among the sampled population, and an overwhelming majority of them had knowledge of the benefits of condom use and had perceived the threat of this deadly disease. Other available national survey findings also suggest that adolescents and youths had knowledge about the most common routes of transmission, and the link between non-use of condoms and the chance of contracting HIV. Some of the study respondents used condoms to protect pregnancy rather than to counter HIV/STDs. The overall attitudes of the respondents in this study were positive to minimize HIV-related risk practices. Although sociocultural stigmas were the major barriers to sensitive sexual messages and condom use in the general population, its extensive promotion through existing media campaign may not be offensive to the adolescents and young audiences of Bangladesh. Before designing such a promotion some cultural factors should be taken into account. To avoid any counterproductive reaction, it is also necessary to undertake ethnographic research in order to understand the sex cultures and power dynamics among adolescents, youths, parents, and other stakeholders of the society. After analyzing the media habits of the study audiences, it was found that radio, television, sensitization workshops, school and college curriculum, small group communications, health workers, and opinion leaders could play a significant role in diffusing credible safe-sex messages among Bangladeshi youths. The successes achieved in Thailand and many other African countries such as Senegal, Zimbabwe and Uganda reveals that, despite structural and cultural barriers such as poverty, illiteracy, stigma and male dominance, there is still some hope to increase safe sex practices through culturally sustainable mass media campaign. The primary and immediate users of the findings of this audience survey should be Mattra and other partner NGOs of Global Fund project in Bangladesh and the MOH&FW. Since empirical studies of this type have been largely absent in Bangladesh, the findings of this work should be useful not only to GFATM partners in Bangladesh but to the GoB and different national/international NGOs in designing a socioculturally sustainable HIV/AIDS and STD campaign/strategy, targeting young audiences. The findings of this work should be disseminated widely among government departments and other development partners.

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Appendix: 1

Table 2.3: Sample EAS by rural, urban and SMA by districts District Barguna Barisal Bhola Jhalokati Patuakhali Pirojpur Barisal Division Bandarban B. Baria Chandpur Chittagong Comilla Cox's Bazar Feni Khagrachuri Lakshmipur Noakhali Rangamati Chittagong Division Dhaka Faridpur Gazipur Gopalganj Jamalpur Kishoreganj Madaripur Manikganj Munshiganj Mymensingh Narayanganj Narshingdi Netrokona Rajbari Shariatpur Sherpur Tangail Dhaka Division

Rural 1 2 2 1 2 2 10

Urban 1 1 1 -1 -4

SMA --------

Total 2 3 3 1 3 3 14

-2 1 1 2 1 1 1 2 2 1 14

1 --1 1 ------3

---5 -------5

1 2 1 7 3 1 1 1 2 2 1 22

1 1 -1 1 1 1 1 1 1 1 1 1 1 1 1 1 16

1 1 --1 ----1 -------4

7 -1 -------2 ------10

9 2 1 1 1 1 1 1 1 2 3 1 1 1 1 1 1 30

District Bagerhat Chuadanga Jessore Jhenaida Khulna Kushtia Magura Meherpur Narail Satkhira Khulna Division Bogra Dinajpur Gaibandha Joypurhat Kurigram Lalmonirhat Naogaon Natore Nawabganj Nilphamari Pabna Panchaga Rajshahi Rangpur Sirajganj Thakurgaon Rajshahi Division Habiganj Moulvibazar Sunamganj Sylhet Sylhet Vivision Bangladesh

87

Rural 1 1 2 1 2 2 1 1 1 1 13

Urban --1 --1 ---1 3

SMA ----3 -----3

Total 1 1 3 1 5 3 1 1 1 2 19

2 1 1 1 1 1 1 2 1 1 2 1 2 1 1 2 21

1 -----1 -1 ----1 --4

------------3 ---3

3 1 1 1 1 1 2 2 2 1 1 1 5 2 1 2 28

3 3 2 1 9

1 1 -1 3

------

4 4 2 2 12


Table 2.4: Name of the selected EAs with address Barisal Division (Rural) District Barguna

Thana Amtali

Barisal

Babuganj

Bhola Jhalokathi Patuakhali Pirojpur

Muladi Burhanuddin Lalmohan Rajapur Bauphal Galachipa Bhandaria Nesarabad (Sadar)

Union Barabagi

Mauza Bara Nishanbaria Cha Kedarpur Dakshin Bhutardia Nazirpur Ramarpol Bara Manika Bara Manika Lord Hardinje Char Lord Hardinje Mathbari Indrapasha Keshabpur Mominpur Dakua Atkhali Gauripur Dakshin Charail Atghar Kuriana Khanyerkati

Village Kabiraj Para

PSU 0039

Dakshin Bhutardia

0002

Ramarpol Bara Manika Lord Handinje Paschim Indrapasha Mominpur Purba Atkhali Dakshin Charail Hospital Para

0011 0015 0021 0029 0048 0051 0031 0037

Union Salimabad gOKARNA

Baghmara Kaiarbil Mithachhar Yakubpur Ramgarh Uttar Hamchadi Sonapur Eklashpur Mohammadpur Chandraghona

Mauza Salimabad Gokarna Char Barali Geramara Ranichara Jamalnagar Khojakhali Mithachhar Chandipur Ramgarh Shyamganj Baga Rakhalia Anantapur Mohammadpur Chandraghona

Village Kamalpur Gokarba Char Barali Geramara Ranichara Jamalnagar Khojakhali

PSU 0114 0121 0125 0097 0137 0146 0106

Madhya Chandipur Com Para Shyamganj Baga Rakhalia Anantapur Mohammadpur Limon Type

0163 0160 0171 0173 0178 0185 0192

Union Sutipara Kalamridha Kushla Sharifpur Maij Char Rajoir Baliati Hasail Banari Mallikbari Kanchpur Shukundi Tiasree Kalimahar Naodoba Nunni Hatibandha

Mauza Chhota Kalampur Deora Tuparia Mrizapur Naohata Chauaribari Baliati Banari Mallikbari Kanchpur Shukundi Saidpur Tarttipur Paschim Naodoba Nunni Hatibandha

Village Chhota Kalampur Deora Tuparia Mrizapur Boali Chauaribari Char Para Noadha Nayanpur, 0383 Kanchpur Shukundi Saidpur Tarttipur Alim Uddin Mallik Ka Nunni Hatibandha

PSU 0263 0310 0323 0356 0371 0332 0280 0291

Chittagong Division (Rural) District B. Baria Chandpur Chittagong Comilla Coxâ&#x20AC;&#x2122;s Bazar Feni Khagrachuri Lakshmipur Noakhali Rangamati

Thana Banchharampur Nasirnagar Faridganj Mirsharai Chandina Laksam Chakaria Daganbhuiyan Ramgarh Lakshmipur Roypur Begumganj Senbagh Kaptai

Dakshin Faridganj

Karerhat Dollai Nowababapur

Dhaka Division (Rural) District Dhaka Faridpur Gopalganj Jamalpur Kishoreganj Madaripur Manikganj Munshiganj Mymensingh Narayanganj Narshingdi Netrokona Rajbari Shariatpur Sherpur Tangail

Thana Dhamrai Bhanga Kotalipara Jamalpur Sadar Bajitpur Rajoir Saturia Tongibari Bhaluka Sonargaon Manohardi Madan Pangsha Zanjira Nalitabari Sakhipur

88

0295 0302 0411 0338 0350 0364 0429


Khulna Division (Rural) District Jessore Jhenaidah Magura Narail Bagerhat Khulna Satkhira Chuadanga Kushtia Meherpur

Thana Abhaynagar Keshabpur Kaliganj Sreepur Kalia Chitalmari Dacope Paikgachha Satkhira Sadar Alamdanga Daulatpur Kumarkhali Mujib Nagar

Union Payra Panjia Bara Bazar Dariapur Joynagar Char Baniari Chalna Lata Banshdaha Jehala Boalia Nandalalpur Dariapur

Mauza Dattagati Sagar Dattakati Thikdanga Dariapur Gachhbaria Durgapur Pankhali Sankardana Banshdaha Garcha Para Sarishaduli Chak Raghua Parandarpur

Village Dattagati Sagar Dattakati Thikdanga Baraichara Gachhbaria Durgapur Chalna Sankardana Kuliadanga Garcha Para Sarishaduli Chak Raghua Parandarpur

PSU 0549 0554 0564 0576 0578 0587 0595 0600 0607 0613 0621 0625 0634

Union Lahiri Para Naruamala Aymarasulpur Saintara Salbahan Bakua Nonduar Chhaikhola Manikhat Chalitadanga Agra Digun Bahadurpur Gopalpur Kasba Jogi Para Maugachhi Gazaria Bara Bhita Kuchlibari Shimulbari Barabala

Mauza Bathuabari Prathamar Cheo Koria Dakshin Palashbari Khirkidangi Barampur Jaogaon Katenga Ulath Chandipur Hatsira Kauti Adampur Gamati Ranibari Kasba Bajekola Basanta Kedar Gazaria Baralai Panbari Rajbari Hasia Saran

Village Bathuabari Prathamar Cheo Satbaria Palashbari Chhota Daluagachh Barampur Jaogaon Uttar Katenga Para Ulath Chandipur Hatsira Kauti Adampur Gamati Ranibari Kasba Bajekola Basanta Kedar Baushi Para Char Baralai Panbari Rajbari Hasia Saran

PSU 0697 0702 0717 0724 0739 0741 0744 0750 0757 0761 0773 0779 0785 0796 0804 0809 0812 0826 0841 0846 0857

Union Uabahata Bagasura Kalair Banga Routhgaon Kamar Chak Rajghat Jawar Bazar Duhalia Beanibazar

Mauza Uabhata Kalikapur Kharia Mukundapur Maricha Udnachhara T.G. Deorgaon Bhabanipur Kasba

Village Uabhata Ratanpur Kharia Lalpur Abdulpur Maulvir Chak Udnachhara T.G. Deorgaon Bhabanipur Kasba

PSU 0950 0952 0954 0959 0961 0963 0965 0968 0975

Rajshahi Division (Rural) District Bogra Joypurhat Dinajpur Panchagar Thakurgaon Pabna Sirajganj Naogaon Natore Nawabganj Rajshahi Gaibandha Kurigram Lalmonirhat Nilphamari Rangpur

Thana Bogra Sadar Gabtali Panchbibi Chirirbandar Tentulia Haripur Ranisankail Chatmohar Sujanagar Kazipur Dhamoirhat Niamatpur Baraigram Nachole Baghmara Mohanpur Fulchhari Phulbari Patgram Jaldhaka Mitha Pukur

Sylhet Division (Rural) District Habiganj Moulvibazar Sunamganj Sylhet

Thana Chunarughat Madhabpur Nabiganj Kulaura Rajnagar Sreemangal Chhatak Dowarabazar Beanibazar

89


Table 2.5 Sample EAs by upazila & district (Urban) Barisal Division (Urban) District Barisal Bhola Barguna Patuakhali

Thana Barisal Sadar Bhola Sadar Amtali Patuakhali Sadar

Union Ward No. 17 Ward No. 07 Ward No. 04 Ward No. 04

Mauza

Arambagh (Sahapara)

Village -----

PSU 0059 0062 0073 007

Union Ward No. 05 Ward No. 02 Ward No. 02

Mauza Ujanipara Sonapahar (Part) Chotara (Part)

Village ----

PSU 0198 0201 0221

Union Ward No. 02 Ward No. 27 Ward No. 16 Ward No. 41 Kumira

Mauza Jalalabad C.D.A. Chandanpura Dakshin Patenga Uttar Sonichhari

Village ----Uttar Sonichhari

PSU 246 250 254 258 259

Union Ward No. 08 Ward No. 03 Ward No. 06 Ward No. 12

Mauza Dohar Paschim Khabaspur Majumdar Para R.K. Mission Road

Village -----

PSU 0435 0452 0472 0489

Union Dhaka C.C./ Ward No. 1 Ward No. 52 Kamrangir Char (Part) Ward No. 60 (Part) Ward No. 03 (Part) Ward No. 35 Ward No. 56 Ward No. 06 Musapur Sumil Para

Mauza Kuril (Madhya & Daks) Elephant Road Bagchand Kha

Village --

PSU 0505

-Bagchand Kha

0508 0510

Shahidnagar

--

0514

Pirerbagh

--

0516

Malibagh Eng. University

---Langalbanda Bazar Char Sumil Para

0518 0520 0529 0539 0548

Dakshin Alekanda (PA) Paschim Ukil Para (PA)

Sadarpara

Chittagong Division (Urban) District Bandarban Chittagong Comilla

Thana Bandarban Sadar Mirsharai Comilla Sadar

Chittagong Division SMA District Chittagong

Thana Bayejid Bostami Double Mooring Kotwali Patenga Sitakunda

Chittagong Division (Urban) District Dhaka Faridpur Jamalpur Mymensingh

Thana Dohar Faridpur Sadar Jamalpur Sadar Mymensingh Sadar

Dhaka Division SMA District Dhaka

Thana Badda Dhanmondi Kamrangir Char Lalbabgh Mirpur

Gazipur Narayanganj

Motijheel Ramna Gazipur Sadar Bandar Narayanganj Sadar

Paschim Arispur (Part)

Langalbanda Siddirganj (Part)

90


Khulna Division (Urban) District Jessore

Thana Kotwali

Union Ward No. 01

Village --

PSU 0641

Ward No. 04 Ward No. 04

Mauza Mollah Para Gorastan Sultanpur Court Para North

Satkhira Kushtia

Satkhira Sadar Kushtia Sadar

---

0667 0676

Union Ward No. 12 Ward No. 26 Ghatbhogh

Mauza Khalishpur HE Jora Gate Alaipur

Village --Alaipur

PSU 0686 0688 0691

Union Ward No. 03 Ward No. 03 Ward No. 09 Ward No. 03

Mauza Chalo Para Madhya Durgapur Abu Rajpara Munsipara

Village -----

PSU 0867 0899 0908 0933

Chittagong Division SMA District Khulna

Thana Khalishpur Khulna Sadar Rupsa

Rajshahi Division (Urban) District Bogra Naogaon Nawabganj Rangpur

Thana Bogra Sadar Naogaon Sadar Nawabganj Sadar Rangpur Sadar

Rajshahi Division SMA District Rajshahi

Thana Boalia Paba Shah Makhdum

Union Ward No. 25 Haragram

Mauza Ramchandrapur Kashiadanga (Part-B) Ward No. 20 (Part) Paba Para

Village -Adharia Chithalkul

PSU 0937 0940

--

0945

Union Ward No. 03 Ward No. 07 Ward No. 22

Village ----

PSU 0986 0989 1000

Sylhet Division (Urban) District Habiganj Moulvibazar Sylhet

Thana Habiganj Sadar Kulaura Kotwali

Mauza Railway Colony Dattarmuri Bangladesh Bank Colony

91


Appendix: 2 Table 5.15 Prompted Knowledge and Media Exposure on Risks Associated with Multiple Sex Partners and Non-use of Condom Risk Associated with multiple sex partners and Non-use of condom Can be infected with HIV/AIDS Possibility of having different STDs Nothing with happen Others Donâ&#x20AC;&#x2122;t know N Major sources of information Radio TV Newspaper Billboard Poster Booklet/Book Peers School Teacher Neighbours Relative Health service providers Hospital NGOs Others N Specific Television Channels provided information BTV ATN NTV Channel I Others N When you watched this program Morning Noon Afternoon Evening Night N Program watched AIDS Related Program Discussion Advertisement Drama Movie News Others N

Rural

Urban

Slum

National

76.9(1575) 2.9(60) 0.4(09) 2.0(40) 19.7(404) 2049 Rural 20.9(343) 65.1(1071) 4.9(81) 4.3(70) 2.3(38) 12.6(207) 17.1(282) 2.9(47) 9.0(148) 2.7(44) 4.6(76) 2.7(45) 2.7(45) 7.2(118) 1645 Rural

85.1(967) 5.0(57) 0.2(02) 1.7(19) 11.9(135) 1136 Urban 8.3(83) 75.5(756) 9.1(91) 9.5(95) 3.6(36) 14.9(149) 18.1(181) 2.1(21) 5.9(59) 1.5(15) 6.7(67) 2.7(27) 4.1(41) 6.0(60) 1001 Urban

83.0(274) 8.2(27) 0.9(03) 3.6(12) 12.7(42) 330 Slum 11.5(33) 66.7(192) 2.1(06) 5.6(16) 1.7(05) 3.1(09) 15.3(44) 5.6(16) 11.5(33) 1.4(04) 17.4(50) 3.8(11) 13.2(38) 8.0(23) 288 Slum

80.1(2816) 4.1(144) 0.4(14) 2.0(71) 16.5(581) 3515 National 15.6(459) 68.8(2019) 6.1(178) 6.2(181) 2.7(79) 12.4(365) 17.3(507) 2.9(84) 8.2(240 2.1(63) 6.6(193) 2.8(83) 4.2(124) 6.9(201) 2934 National

98.8(1058) 1.9(20) 0.6(06) 1.0(11) 0.3(03) 1071 Rural 1.9(20) 14.6(156) 38.5(412) 18.1(194) 61.5(659) 1071 Rural 9.6(103) 14.9(160) 80.2(859) 12.4(133) 0.7(08) 0.7(07) 1.3(14) 1071

93.8(709) 13.1(99) 9.7(73) 8.6(65) 0.7(05) 756 Urban 2.6(20) 14.3(108) 33.7(255) 18.5(140) 66.8(505) 765 Urban 18.0(136) 15.5(117) 76.6(579) 13.2(100) 2.1(16) 0.5(04) 0.3(02) 756

96.9(186) 12.0(23) 7.8(15) 12.0(23) 1.0(02) 192 Slum 4.2(08) 18.2(35) 35.9(69) 18.8(36) 64.6(124) 192 Slum 22.4(43) 24.0(46) 66.1(127) 22.4(43) 2.6(05) 1.6(03) 0.0(00) 192

96.7(1953) 7.0(142) 4.7(94) 4.9(99) 0.5(10) 2019 National 2.4(48) 14.8(299) 36.5(736) 18.3(370) 63.8(1288) 2019 National 14.0(282) 16.0(323) 77.5(1565) 13.7(276) 1.4(29) 0.7(14) 0.8(16) 2019

92


Table 5.15 Contd. Radio station you listened Dhaka Chittagong Sylhet Rajshahi Khulna Barishal Others N Program listened Drama/Life story AIDS related discussion Health message/discussion Advertisement News Others N Time of listening program Morning Noon Afternoon Evening Night N

Rural 83.7(287) 11.4(39) 3.5(12) 7.9(27) 16.0(55) 0.9(03) 0.9(03) 343 Rural 12.2(42) 29.4(101) 37.6(129) 35.6(122) 1.5(05) 2.9(10) 343 Rural 9.5(67) 42.0(144) 30.0(105) 14.9(51) 37.9(130) 343

93

Urban 67.5(56) 20.5(17) 7.2(06) 12.0(10) 15.7(13) 0.0(00) 1.2(01) 83 Urban 10.8(09) 36.1(30) 44.6(37) 28.9(24) 2.4(02) 1.2(01) 83 Urban 16.9(14) 44.6(37) 28.9(24) 7.2(06) 37.3(31) 83

Slum 69.7(23) 9.1(03) 0.0(00) 21.2(07) 18.2(06) 6.1(02) 6.1(02) 33 Slum 12.1(04) 42.4(14) 51.5(17) 27.3(09) 0.0(00) 0.0(00) 33 Slum 27.3(09) 48.5(16) 24.2(08) 12.1(04) 24.2(08) 33

National 79.7(366) 12.9(59) 3.9(18) 9.6(44) 16.1(74) 1.1(05) 1.3(06) 459 National 12.0(55) 31.6(145) 39.9(183) 33.8(155) 1.5(07) 2.4(11) 459 National 19.6(90) 42.9(197) 29.8(137) 13.3(61) 36.8(169) 459


Table 5.16 Prompted Knowledge and Media Exposure on Risks Associated with Un-tested Blood Transfusion Risk Associated with un-tested blood transfusion Can be infected with HIV/AIDS Possibility of having different STDs Nothing with happen Others Donâ&#x20AC;&#x2122;t know N Major sources of information Radio TV Newspaper Billboard Poster Magazine Booklet/Book Peers School Teacher Neighbours Relative Health service providers Hospital NGOs Pharmacy Community function Others N Television Channel provided information BTV ATN NTV Channel I Others N When you watched this program Morning Noon Afternoon Evening Night N Program watched AIDS Related Program Discussion Advertisement Drama Movie News Others N

Rural

Urban

Slum

National

85.5(1751) 91.5(1040) 1.5(31) 1.8(20) 0.3(06) 0.3(03) 1.1(23) 1.1(13) 12.6(259) 7.4(84) 2049 1136 Rural Urban 20.2(362) 7.9(83) 64.5(1154) 75.6(795) 4.6(83) 8.0(84) 5.4(96) 10.6(111) 2.8(51) 4.2(44) 1.0(18) 2.6(27) 13.5(241) 16.1(171) 11.9(213) 14.9(157) 3.0(53) 2.9(30) 7.2(129) 5.6(59) 2.5(44) 1.3(14) 4.9(88) 6.4(67) 3.2(57) 4.0(42) 2.8(50) 3.7(39) 0.7(12) 0.5(05) 2.1(37) 3.0(32) 12.5(224) 6.9(73) 1790 1052 Rural Urban

88.2(291) 5.5(18) 0.3(01) 1.8(06) 8.8(29) 330 Slum 10.0(30) 64.8(195) 2.0(06) 3.7(11) 2.3(07) 1.0(03) 4.7(14) 11.6(35) 4.3(13) 9.6(29) 1.7(05) 18.9(57) 4.7(14) 13.6(30) 0.0(00) 10.0(30) 8.3(25) 301 Slum

87.7(3082) 2.0(69) 0.3(10) 1.2(42) 10.6(372) 3515 National 15.1(475) 68.2(2144) 5.5(173) 6.9(218) 3.2(102) 1.5(48) 13.6(426) 12.9(405) 3.1(96) 6.9(217) 2.0(63) 6.7(212) 3.6(113) 4.1(130) 0.5(17) 3.1(99) 10.2(322) 3143 National

99.2(1145) 1.9(22) 1.0(11) 1.2(14) 0.1(01) 1154 Rural 2.3(26) 14.1(163) 39.4(455) 16.2(187) 61.0(704) 1154 Rural 11.8(136) 13.9(160) 79.8(921) 13.3(154) 1.2(14) 0.3(04) 1.0(11) 1154

95.9(187) 11.8(23) 6.7(13) 8.7(17) 0.0(00) 195 Slum 5.1(10)) 20.0(39) 41.0(80) 18.5(36) 66.2(129) 195 Slum 22.1(43) 26.2(51) 60.5(118) 27.2(53) 1.5(03) 1.0(02) 0.5(01) 195

97.1(2081) 6.9(147) 4.5(96) 4.3(93) 0.5(10) 2144 National 2.6(56) 14.8(318) 36.8(788) 17.0(364) 64.4(1380) 2144 National 14.2(305) 15.5(333) 76.5(1641) 15.7(337) 2.1(46) 0.3(07) 0.7(14) 2144

94

94.2(749) 12.8(102) 9.1(72) 7.8(62) 1.1(09) 795 Urban 2.5(20 14.6(116) 31.8(253) 17.7(141) 68.8(547) 795 Urban 15.8(126) 15.3(122) 75.7(602) 16.4(130) 3.6(29) 0.1(01) 0.3(02) 795


Table 5.16 Contd. Radio station you listened Dhaka Chittagong Sylhet Rajshahi Khulna Barishal Others N Time of listening program Morning Noon Afternoon Evening Night N Program listened Drama/Life story AIDS related discussion Health message/discussion Advertisement News Others N, 362, 83, 30, 475

Rural 85.9(311) 11.0(40) 3.0(11) 7.2(26) 14.9(54) 0.8(03) 1.1(04) 362 Rural 19.1(69) 39.2(142) 33.4(121) 17.7(64) 38.4(139) 362 Rural 14.9(54) 29.0(105) 37.6(136) 35.4(128) 2.2(08) 3.3(12) 343

95

Urban 73.5(61) 20.5(17) 3.6(03) 8.4(07) 9.6(08) 0.0(00) 0.0(00) 83 Urban 16.9(14) 39.8(33) 27.7(23) 8.4(07) 39.8(33) 83 Urban 14.5(12) 34.9(29) 42.2(35) 33.7(28) 2.4(02) 2.4(02) 83

Slum 66.7(20) 6.7(02) 0.0(00) 26.7(08) 23.3(07) 6.7(02) 6.7(02) 30 Slum 30.0(09) 53.3(16) 26.7(08) 6.7(02) 30.0(09) 30 Slum 10.0(02) 40.0(12) 56.7(17) 23.3(07) 0.0(00) 3.3(01) 33

National 82.5(392) 12.4(59) 2.9(14) 8.6(41) 14.5(69) 1.1(05) 1.3(06) 475 National 19.4(92) 40.2(191) 32.0(152) 15.4(73) 38.1(181) 475 National 14.5(69) 30.7(146) 39.6(188) 34.3(163) 2.1(10) 3.2(15) 459


Table 5.17 Prompted Knowledge and Media Exposure on Risks Associated with Pregnancy of HIV/AIDS Infected Mother Risk Associated with pregnancy of Rural HIV/AIDS infected mother The Child can be infected with 80.0(1640) HIV/AIDS Child can be handicapped 1.4(28) Nothing with happened 0.6(13) Others 0.9(19) Donâ&#x20AC;&#x2122;t know 18.1(370) N 2049 Major sources of information Rural Radio 18.6(312) TV 58.4(981) Newspaper 3.6(61) Billboard 3.3(56) Poster 2.0(34) Magazine 1.0(17) Booklet/Book 12.6(212) Peers 10.7(180) School Teacher 2.9(49) Neighbours 7.9(133) Relative 2.4(41) Health service providers 4.9(82) Hospital 2.6(43) NGOs 2.7(45) Others 17.0(286) N 1679 Television Channel provided information Rural BTV 99.4(975) ATN 1.2(12) NTV 0.5(05) Channel I 1.1(11) N 981 When you watched this program Rural Morning 1.3(13) Noon 15.0(147) Afternoon 40.3(395) Evening 15.6(153) Night 62.7(615) N 981 Program watched Rural AIDS Related Program 11.0(108) Discussion 14.3(140) Advertisement 78.4(769) Drama 15.1(148) Movie 1.5(15) News 1.3(13) Others 1.1(11) N 981

96

Urban

Slum

National

86.8(986)

80.6(266)

82.3(2892)

2.0(23) 0.0(00) 1.2(14) 1.7(133) 1136 Urban 7.6(76) 68.7(689) 7.2(72) 7.7(77) 3.8(38) 2.5(25) 15.5(155) 12.1(121) 2.2(22) 5.7(57) 1.9(19) 7.4(74) 3.2(32) 4.5(45) 9.8(98) 1003 Urban 94.5(651) 11.6(80) 8.9(61) 7.8(54) 689 Urban 1.7(12) 13.4(92) 34.4(237) 17.4(120) 67.8(467) 689 Urban 18.3(126) 16.8(116) 73.3(505) 16.8(116) 2.5(17) 0.1(01) 0.1(01) 689

6.1(20) 2.1(07) 3.0(10) 14.5(48) 330 Slum 5.3(15) 60.3(170) 2.1(06) 2.5(07) 1.4(04) 0.7(02) 4.3(12) 10.6(30) 5.0(14) 10.6(30) 2.8(08) 18.1(51) 3.2(09) 13.1(37) 14.9(42) 282 Slum 96.5(164) 11.8(20) 6.5(11) 8.8(15) 170 Slum 3.5(06) 19.4(33) 34.7(59) 24.1(41) 64.1(109) 170 Slum 28.8(49) 20.0(34) 64.1(109) 22.4(38) 0.6(01) 0.6(01) 2.4(04) 170

2.0(71) 0.6(20) 1.2(43) 15.7(551) 3515 National 13.6(403) 62.1(1840) 4.7(139) 4.7(140) 2.6(76) 1.5(44) 12.8(379) 11.2(331) 2.9(85) 7.4(220) 2.3(68) 7.0(207) 2.8(84) 4.3(127) 14.4(426) 2964 National 97.3(1790) 6.1(112) 4.2(77) 4.3(80) 1840 National 1.7(31) 14.8(272) 37.6(691) 17.1(314) 64.7(1191) 1840 National 15.4(283) 15.8(290) 75.2(1383) 16.4(302) 1.8(33) 0.8(15) 0.9(16) 1840


Table 5.17 Contd. Radio station you listened Dhaka Chittagong Sylhet Rajshahi Khulna Barishal Others N Time of listening program Morning Noon Afternoon Evening Night N Program listened Drama/Life story AIDS related discussion Health message/discussion Advertisement News Others N

Rural 85.6(267) 13.8(43) 4.5(14) 9.0(28) 13.8(43) 0.6(02) 1.6(05) 312 Rural 19.9(62) 39.4(123) 34.3(107) 14.4(45) 35.9(112) 312 Rural 14.4(45) 24.0(75) 36.9(115) 38.8(121) 0.3(01) 4.2(13) 312

97

Urban 67.1(51) 22.4(17) 3.9(03) 11.8(09) 15.8(12) 0.0(00) 1.3(01) 76 Urban 19.7(15) 32.9(25) 21.1(16) 13.2(10) 40.8(31) 76 Urban 18.4(14) 28.9(22) 47.4(36) 30.3(23) 0.0(00) 0.0(00) 76

Slum 86.7(13) 0.0(00) 0.0(00) 26.7(04) 33.3(05) 0.0(00) 0.0(00) 15 Slum 46.7(07) 46.7(07) 13.3(05) 0.0(00) 13.3(02) 15 Slum 13.3(02) 40.0(06) 66.7(10) 26.7(04) 0.0(00) 0.0(00) 15

National 82.1(331) 14.9(60) 4.2(17) 10.2(41) 14.9(60) 0.5(02) 1.5(06) 403 National 20.8(84) 38.5(155) 31.8(128) 13.6(55) 36.0(145) 403 National 15.1(61) 25.6(103) 40.0(161) 36.7(148) 0.2(01) 3.2(13) 403


Table 5.18 Prompted Knowledge and Media Exposure on Perceived Severity of HIV/AIDS Perceived Severity of HIV/AIDS Infected person will die Donâ&#x20AC;&#x2122;t know N Major sources of information Radio TV Booklet/Book Peers Others N Specific television channels BTV When you watched this program Afternoon Night Program watched Advertisement Drama N Major radio station you listened Dhaka Chittagong N Time of listening program Noon Afternoon Night Program listened AIDS related discussion Health message/discussion Advertisement N

Rural 83.3(1707) 13.4(275) 2049 Rural 19.0(337) 66.7(1184) 12.3(219) 12.6(224) 13.7(243) 1774 Rural 99.3(1176) Rural 38.9(461) 64.9(769) Rural 79.1(937) 15.6(185) 1184 Rural 88.1(297) 14.5(49) 337 Rural 41.5(140) 30.6(103) 39.5(133) Rural 32.6(110) 35.9(121) 37.1(125) 337

98

Urban 87.5(994) 10.2(116) 1136 Urban 7.7(79) 77.3(788) 13.6(139) 11.7(119) 8.9(91) 1020 Urban 94.9(748) Urban 33.0(260) 68.7(541) Urban 71.3(562) 18.0(142) 788 Urban 77.2(61) 26.6(21) 79 Urban 39.2(31) 22.8(18) 43.0(34) Urban 36.7(29) 45.6(36) 29.1(23) 79

Slum 90.0(297) 6.7(22) 330 Slum 10.4(32) 68.2(210) 2.3(07) 8.4(26) 10.4(32) 308 Slum 95.7(201) Slum 37.6(79) 65.7(138) Slum 65.2(137) 25.2 (53) 210 Slum 56.3(18) 18.8(06) 32 Slum 43.8(14) 40.6(13) 25.0(08) Slum 46.9(15) 46.9(15) 18.8(06) 32

National 85.3(1998) 11.7(413) 3515 National 14.4(448) 70.3(2182) 11.8(365) 11.9(369) 11.8(366) 3102 National 97.4(2125) National 36.7 (800) 66.4(1448) National 75.0(1636) 17.4(380) 2182 National 83.9(376) 17.0(76) 448 National 41.3(185) 29.9(134) 39.1(175) National 34.4(154) 38.4(172) 34.4(154) 448


Appendix 3

Summary of Major Indicators for Pre-Intervention Audience Impact Survey 2005 Pre-Intervention Audience Impact Survey 2005,

Log Frame Indicators

Ever attendance of any school Currently attendance of school Media Habits Whether Reading Newspaper Newspaper (name) read Daily Ittefaq Daily Inquilab Daily Janakantha Daily Protom Alo Others General Habits of Watching Channel Generally Watched BTV ATN NTV Channel I Others Preferred Session of Watching Television Morning Noon Afternoon Evening Night General Habits of listening to Radio Radio Station(s) usually listen to Dhaka Chittagong Sylhet Rajshahi Khulna Preferred Session to listen to radio Morning Noon Afternoon Evening Night Awareness about HIV and AIDS: Have you ever heard of HIV/AIDS Major Sources of information on HIV and AIDS Radio TV Newspaper Billboard Poster Magazine Booklet/Book Peers School Teacher Neighbors Relative Television Channel provided information on HIV/AIDS BTV ATN NTV Channel I Others

Rural 85.5 23.6 31.7

Urban 91.1 30.3 53.3

Slum 76.7 13.6 45.1

National 86.4 24.7 39.4

22.1 17.7 16.1 26.3 54.7 80.4

15.2 10.5 15.7 37.3 56.8 97.1

16.8 8.0 10.4 32.8 69.6 91.3

18.8 13.8 15.4 31.5 56.9 86.4

98.5 2.6 1.9 1.8 1.2

91.9 18.0 14.0 15.4 6.3

95.7 18.2 9.5 14.6 7.5

96.0 9.2 6.7 7.5 3.5

1.7 7.7 34.8 10.5 63.9 43.1

2.3 7.9 22.7 10.5 75.5 28.7

2.0 10.3 31.6 14.6 69.2 35.0

1.9 8.0 30.4 10.8 68.4 38.1

87.6 11.2 7.2 11.4 26.4

80.1 13.5 5.8 14.7 16.7

83.5 9.3 3.1 25.8 22.7

85.5 11.6 6.6 13.2 23.9

18.4 39.3 24.9 7.6 35.6 80.3

18.3 46.5 15.7 5.8 30.8 95.2

20.6 46.4 26.8 4.1 27.8 91.4

18.5 41.4 22.9 6.9 34.0 85.6

27.1 78.5 6.8 5.2 3.6 0.9 13.3 16.1 3.8 13.9 3.2

12.1 91.7 16.6 13.1 6.8 2.6 15.1 17.7 4.0 9.4 2.0

20.6 83.0 8.5 7.6 4.8 0.0 5.2 13.6 4.8 17.0 2.1

21.7 83.2 10.1 8.0 4.8 1.4 13.1 16.4 4.0 12.7 2.7

99.1 2.2 0.7 1.1 0.7

95.8 14.3 10.9 11.9 1.2

96.4 12.8 6.6 11.7 2.2

97.7 7.5 4.9 5.9 1.1

99

Post-Intervention Audience Impact Survey 2006


Major Program watched on HIV/AIDS AIDS Related Program Discussion Advertisement Drama Radio station providing HIV/AIDS information Dhaka Chittagong Sylhet Rajshahi Khulna When you listened this program Morning Noon Afternoon Evening Night Program listened Drama/Life story AIDS related discussion Health message/discussion Advertisement Spontaneous knowledge on the routes of HIV Transmission: Having un-safe sex with HIV/AIDS infected person Through HIV infected blood Through HIV infected syringe/needle HIV/AIDS infected mother-to-child Through breast feeding Un-safe sex with CSWs Un-safe sex with multiple partners Don’t know Prompted knowledge on the routes of HIV Transmission: Risk Associated with multiple sex partners and Non-use of condom Can be infected with HIV/AIDS Risk Associated with un-tested blood transfusion Can be infected with HIV/AIDS Risk Associated with pregnancy of HIV/AIDS infected mother The Child can be infected with HIV/AIDS Risk Associated with breastfeeding by HIV/AIDS infected mother The Child can be infected with HIV/AIDS Spontaneous Knowledge on the ways of Preventing HIV/AIDS Refraining from all sorts of sex Following religious and social rules Refraining from having sex with CSWs Avoiding sex other than husband/wife Checking blood before transfusion Using sterile needles/syringes AIDS infected mother should consult doctor before conception Others Don’t know How to behave with an HIV infected person Should take care Should extend our sympathy

9.4 12.7 83.4 12.9

15.9 15.5 83.1 14.7

21.5 24.5 74.5 19.7

12.9 14.8 82.5 14.2

85.9 9.0 3.2 7.6 18.7

74.6 18.1 1.4 9.4 14.5

67.6 5.9 0.0 32.4 19.1

82.3 10.4 2.6 10.1 18.0

19.8 44.9 29.0 16.9 34.4

16.7 52.2 27.5 7.2 32.6

22.1 45.6 29.4 10.3 23.5

19.4 46.3 28.8 14.6 33.1

11.5 28.5 39.8 38.7

10.1 43.5 39.1 31.2

7.4 36.8 29.4 38.2

10.9 31.9 38.8 37.3

39.0

46.0

48.8

42.2

41.9 44.9

49.0 56.2

45.8 51.5

44.6 49.2

9.2

9.9

5.8

9.1

7.3 22.4 19.5

6.9 29.9 22.1

7.3 34.5 17.6

7.1 26.0 20.2

21.2

14.1

11.2

18.0

76.9

85.1

83.0

80.1

85.5

91.5

88.2

87.7

80.0

86.8

80.6

82.3

80.8

81.7

81.5

81.2

20.9 8.0 22.5 49.3 47.3 38.9

23.5 11.7 27.9 57.7 56.9 46.6

32.7 10.3 31.2 55.8 50.9 45.2

22.8 9.4 25.1 52.6 50.7 42.0

9.9 4.2 17.1

10.7 4.0 11.4

10.9 8.2 6.7

10.2 4.5 14.3

33.8 32.8

36.7 41.7

48.5 41.5

36.1 36.5

100


Should extend our all support Keep distance Donâ&#x20AC;&#x2122;t know Knowledge on Consequences of HIV/AIDS infection Infected person will die Types of newspaper read on HIV/AIDS Daily Ittefaq Daily Inquilab Daily Janakantha Daily Protom Alo Others Correct knowledge on HIV/AIDS: HIV Can be transmitted by coughing or sneezing Sharing drinking with HIV infected person Having un-safe anal sex, From HIV infected pregnant mother to child There is immunization for HIV/AIDS HIV can be transmitted by kissing/hugging with an infected partner Woman can not get HIV if make sex during menstruation Multiple sex partners increase the chance of HIV transmission Sharing the same pond with HIV infected person can transmit HIV HIV can be transmitted through unprotected oral sex A healthy looking person can have HIV/AIDS HIV can be transmitted through one single unsafe sexual contact HIV can be transmitted through sharing eating utensils with HIV infected person HIV can be transmitted by mosquito/insect bites A person can not get HIV if he/she takes antibiotics Using condom during sexual intercourse may prevent HIV transmission There is a cure for HIV/AIDS AIDS is a curse Importance of HIV/AIDS related information: Interested to learn more about HIV/AIDS Support providing information on HIV/AIDS through TV, Radio, newspaper and other media Support the necessity of providing HIV/AIDS information to adolescents Why is it necessary? To make them aware about HIV/AIDS To protect them from HIV/AIDS Appropriateness of information on HIV/AIDS provided by TV, Radio and other media

11.5 18.6 13.0

18.7 11.5 9.8

21.5 16.7 4.8

14.7 16.1 11.2

83.3

87.5

90.0

85.3

20.1 18.1 16.1 36.7 40.2

14.3 10.7 13.1 43.9 40.2

15.0 5.0 12.5 37.5 65.0

16.8 13.3 14.3 40.4 42.2

39.3 42.0 62.8 85.1 34.8

51.6 55.8 61.9 91.2 45.2

41.8 43.3 60.3 81.8 7.0

43.5 46.6 62.3 86.7 38.3

42.8

41.7

35.8

41.8

22.7

23.7

25.2

23.2

88.5

94.8

88.5

90.6

55.4

68.0

57.3

59.7

47.8 67.6

45.1 72.1

44.5 64.5

46.6 68.8

72.4

79.0

71.5

74.4

47.1 37.2

62.3 49.8

50.9 47.6

52.4 42.2

39.1

47.4

40.6

41.9

86.6 62.7 54.1

90.1 67.3 51.3

85.2 58.2 59.4

87.6 63.8 53.7

94.5

92.9

88.9

93.0

92.0

98.2

95.0

94.1

93.7

96.0

96.0

94.6

71.6 37.9

75.6 40.3

76.3 46.1

73.2 39.3

84.4

92.4

92.4

87.0

101


More perfected media to diffuse HIV/AIDS information Radio TV Newspaper Billboard/Signboard Poster Magazine Booklet/Book Peers School teacher Health service providers Ever watched/seen any program about HIV/AIDS on TV, Radio and other media targeting adolescents Types of program AIDS related program AIDS related discussion Advertisement Drama Whether the information were necessary for you Suggestions to improve the standard of those programs No suggestions Broadcast messages frequently Provide information through drama Message/Discussion should be detailed Whether HIV/AIDS could be a serious problem for Bangladesh HIV/AIDS infected person should be allowed to mix with general public/un-infected person Knowledge on STDs/STIs: Ever heard of any STD/STIs Heard about Syphilis Heard about Gonorrhea Heard about Chlamydia Heard about Genital Ulcers/warts More perfected media to diffuse STD information Radio TV Peers Neighbors Relatives Health service providers Hospital Ways of transmitting STDs/STIs Having un-protected sex with STD/STIs infected person Un-protected sex with multiple person Non use of condom during sex Using used towel/towel Using uncleaned toile If not maintain personal hygiene Donâ&#x20AC;&#x2122;t know Ways of protection from STDs/STIs Limiting sex between husband and wife Using condom during sex Avoiding untested blood transfusion Avoiding using infected needle/syringe Avoiding sex with CSWs

59.6 83.7 19.3 6.8 5.1 0.8 8.3 7.4 4.7 16.9

50.4 93.3 29.2 12.2 10.1 2.8 9.2 6.7 6.6 19.8

53.9 91.9 22.4 10.0 5.6 1.2 3.4 5.6 7.8 24.3

56.4 87.2 22.5 8.6 6.6 1.4 8.1 7.0 5.5 18.4

17.1

28.4

29.9

21.5

20.0 17.6 47.5 18.3 95.5

28.8 14.4 36.3 24.1 98.1

31.3 24.0 17.7 36.5 96.9

24.8 17.1 39.6 22.7 96.7

16.1 27.0 12.9 33.9

14.4 23.8 12.8 41.6

15.6 25.0 28.1 20.8

15.4 25.5 14.6 35.4

91.6

94.4

92.5

92.5

48.4

62.2

42.7

52.0

27.9 44.7 37.5 1.3 61.9

38.0 50.1 42.6 3.1 59.2

42.7 60.4 40.3 .6 51.3

32.1 48.4 39.6 1.8 59.7

7.0 10.7 28.1 24.0 14.0 13.2 5.9

3.5 13.9 28.5 20.1 10.8 13.9 6.4

1.9 17.5 25.3 13.0 9.7 19.5 5.8

5.2 12.6 27.9 21.4 12.4 14.2 6.1

35.8

34.9

37.0

35.6

23.2 23.6 3.5 5.8 16.4 28.8

25.8 31.8 3.3 5.1 21.0 23.0

24.7 45.5 6.5 2.6 21.4 14.3

24.3 29.0 3.8 5.2 18.6 25.1

15.0 16.2

19.0 18.8

14.3 20.8

16.3 17.6

32.4

40.4

51.9

37.5

6.3 4.9

7.1 7.5

11.0 14.3

7.1 6.9

102


Other Don't know Condom Behaviors: Heard about condom Ever seen condom Reasons to use condom For family planning To prevent HIV transmission To prevent STDs/STIs Don’t know Condom is available in the locality Major sources of condom in the locality Pharmacy Grocery shop Ever use of any condom Reasons to use condom FP/Prevent pregnancy To prevent HIV/AIDS To prevent STDs/STIs STD Services: Availability of STD services(Hospital/ Pharmacy/doctor’s chamber) nearby Knowledge on any STD service providers which provide service in suitable time STD treatment is expensive Availability of any nearest place to buy condoms Condom is sold to young people Confidentiality is maintained by the condom sellers The price of condom is affordable Perception of local people if you buy condoms Nothing/Don’t mind It creates bad impression Self-Efficacy: Feel comfortable in discussing HIV/AIDS and STDs with doctor/paramedics Feel comfortable in discussing HIV/AIDS and STDs with friends/sex partners Friends/peers can influence drug practice Able to ask sex partners to use condoms Capable to influence irregular sex partner to use condoms Confident to seek STD services with the nearest clinic Confident to refuse forced sex Self confident to take decision in selecting sex partner Reproductive and sexual health issues should be discussed with parents of other family members Reproductive and sexual health issues should be discussed at school Possibility of contacting STDs like syphilis and gonorrhea

9.3 31.0

13.7 25.2

22.7 14.3

12.4 27.1

96.0 93.3

98.2 91.8

94.7 91.5

96.5 92.7

76.5 33.7 4.9 9.1 88.5

78.1 48.1 8.7 6.2 87.1

68.1 60.8 8.8 7.3 89.8

76.2 40.3 6.3 8.1 88.2

55.1 78.0 25.7

80.6 59.9 33.1

75.1 67.7 30.1

64.2 71.9 28.3

93.5 13.0 3.5

94.1 11.9 3.6

81.6 35.0 5.8

92.6 14.6 3.8

41.4

57.0

56.2

47.3

42.8 17.0 82.1 71.7 54.7 65.8

52.1 15.6 85.3 74.3 54.1 67.7

52.6 23.8 83.4 64.0 51.8 54.8

46.4 17.2 83.2 71.7 54.3 65.4

20.3 60.2

19.2 59.9

24.9 60.7

20.4 60.1

71.5

78.7

68.1

73.3

75.2 4.7 51.6

79.0 4.0 55.9

72.3 10.8 56.0

76.0 5.0 53.3

27.6

32.3

35.7

29.6

74.0 82.6

78.8 82.5

68.4 83.9

74.9 82.7

75.5

75.9

77.3

75.8

63.9

70.5

66.5

66.0

76.0

82.1

76.5

77.9

13.9

12.7

18.6

13.9

103


104



Pre-Intervention Audience Impact Study for Youth and adolescents on HIV/AIDS 2005