An Assessment of Comprehensive Knowledge of HIV/AIDS among Slum and Non-Slum Populations in Delhi, India

"...to reduce HIV/AIDS vulnerability among women and men in slum and non-slum areas, programs must focus on appropriate behaviour change communication and build awareness to educate them on HIV/AIDS prevention methods especially among women in the reproductive age group in slum areas."

This article explores comprehensive knowledge of HIV/AIDS prevention methods among women and men in slum and non-slum areas in the National Capital Territory (NCT) of Delhi, India, where about 98% of the population lives in urban areas, and 15% of urban households live in slums. Data were drawn from the National Family Health Survey, 2005-06 (NFHS-3). In India, the National AIDS Control Program (NACP) focuses on enhancing HIV/AIDS awareness and knowledge through behaviour change preventive practices.

The sample included 3,096 women aged 15-49 years and 1,321 men aged 15-54 years. A respondent was considered to have comprehensive knowledge of HIV/AIDS prevention methods if s/he responded positively (yes) to questions 1-4 (using a condom for every act of sexual intercourse, limiting sexual intercourse to just one uninfected faithful partner, abstaining from sexual intercourse, aware that a healthy looking person can have HIV/AIDS) and responded negatively (no) to question number 5 (HIV/AIDS can be transmitted through mosquito bites and by sharing food with a person who has HIV/AIDS). Pearson Chi-square test and logistic regression analyses were conducted to examine the association between the study variables and the background characteristics of the slum and non-slum populations.

Of the 4,417 respondents, 90% of women and 98% of men had heard of HIV/AIDS. Overall, more women and men in non-slum than slum areas were aware of HIV/AIDS. Awareness of HIV/AIDS in slum areas was highest among women who never had sex, while in non-slum areas, awareness was highest among women who had experienced first sex after age 20 years. While awareness was high among men who never experienced sex in slum as well as non-slum areas, awareness was higher in non-slum than slum areas. In slum and non-slum areas, HIV/AIDS awareness was higher among men who did not drink alcohol than others. Among women and men with regular media exposure, awareness of HIV/AIDS was high in both locations. The highest proportion of women and men from the richest wealth group in both slum and non-slum areas were aware of HIV. However, awareness was highest among women and men from the middle wealth category in slum as compared to non-slum areas.

Comprehensive knowledge of HIV/AIDS prevention methods was significantly lower among women and men in slum areas as compared with non-slum areas. Compared to men, women had less comprehensive knowledge of HIV/AIDS prevention methods in slum and non-slum areas, even after controlling for various demographic and socio-economic and exposure variables. In both slum and non-slum areas, comprehensive knowledge of HIV/AIDS prevention methods was high among women who were educated (more than 10 years education), never married, working, had first sex after age 20, had regular media exposure, and were from the richest wealth category. Among men, comprehensive knowledge of prevention methods was high in the younger group (less than 25 years) in slum areas, and in the older group (aged 35 years or more) in non-slum areas.

Findings indicate that comprehensive knowledge of HIV prevention methods is low among women in slum areas. The low level of comprehensive knowledge of preventive methods of HIV/AIDS in slum areas is a cause for concern because heterosexual unprotected sex is still the primary mode of HIV transmission in India, and slum dwellers also engage in unprotected sex and multiple partner sex. In addition, men sometimes migrate to cities without their spouse, and have unprotected sex with unpaid partners or paid sex workers, playing a bridging role in transmitting HIV infection their spouse. People living in slum areas often have poor access to services, and lack awareness about available services, especially in the case of stigmatising diseases like HIV.

The authors conclude by emphasising the importance of education in halting and reducing the HIV epidemic in this vulnerable group. Strategies to build awareness of HIV/AIDS could include mass media campaigns HIV/AIDS, and information, education, and communication programmes (IEC) on HIV/AIDS in slum areas.