Survey shows need for HIV education and prevention

By Sarah Yang, Public Affairs

13 November 2002 | As strategies for preventing the spread of HIV and AIDS, many Californians support access to clean needles for drug users and giving condoms to prisoners, according to a statewide survey by researchers from Berkeley and the California Department of Health Services.

The survey’s findings on these issues and more provide one of the most detailed pictures to date of what Californians know and believe about HIV and AIDS. Joel Moskowitz, director of Berkeley’s Center for Family and Community Health, presented the results of the “California 2000 AIDS Knowledge, Attitudes, Beliefs and Behaviors Survey” on Tues., Nov 12, at the annual meeting of the American Public Health Association.
Fifty percent or more of the Californians who participated in the survey said the following five policies are effective and should receive state funding:

• Providing clean needles to injection-drug users in the community (62 percent)
• Providing condoms to prisoners (62 percent)
• Providing clean hypodermic needles to injection-drug users in prison (54 percent)
• Requiring doctors and clinics to report cases of HIV to the state health department (52 percent)
• Requiring HIV tests for pregnant women (50 percent).

“Although some of these policies need more debate — giving prisoners needles may not be wise, for example — the message for policymakers is that there is public support for adopting progressive HIV-prevention strategies,” said Moskowitz.

The survey also found that 67 percent of Californians support HIV reporting through the use of a unique code. Healthcare providers and clinics in California began using a non-name code to report HIV cases in July. The code includes information on the patient’s gender and age, a four-digit alphanumeric code derived from the patient’s last name, and part of his or her social security number. The new rules are meant to comply with a 2004 federal deadline for all states to establish an HIV tracking system.

The center conducted the survey for the state’s Office of AIDS to examine the prevalence of risk behaviors, identify socio-economic differences in knowledge and beliefs, and measure public support for key policy issues. More than 2,500 adults 18 and over throughout the state were randomly called over a 10-week period between April and June 2000. Of those called, 1,739 people completed the 70-question interview, which was given in English or Spanish.

Overall, the majority of respondents answered correctly when asked key questions to assess their knowledge of HIV and AIDS. For instance, 87 percent of adults know that homosexuals are not the only ones who need to worry about contracting AIDS, and 83 percent know that people infected with HIV could look and feel fine and still be capable of spreading the disease.

However, while 93 percent of adults were aware that an HIV-infected woman could infect her unborn child, only 22 percent knew that medication was available to prevent the pregnant woman from infecting her baby.

Some differences in perception about HIV emerged among ethnic and socio-economic groups, and some groups were less likely than others to get tested for HIV. “We found that Hispanics were more likely to perceive themselves to be at moderate or high risk of HIV infection and considered themselves to be ‘little informed’ about ways to prevent HIV,” said Moskowitz. “Yet they were also less likely to have been tested for HIV. The same is true for high-school dropouts.”

A ‘sense of fatalism’ in those who feel at risk
Moskowitz said these findings are of concern because people who feel at risk for HIV infection, even if they are not at risk, may develop a sense of fatalism. “People can mistakenly believe that they will inevitably get HIV, and therefore think it’s not worthwhile to take steps to prevent infection,” he said.

“These misconceptions about HIV transmission may result in unnecessary anxiety and discrimination against HIV-infected persons,” added Assunta Ritieni, a research scientist at the state Office of AIDS, who, with her colleague Maya Tholandi and Berkeley research epidemiologist Bethany Young Holt, co-authored the survey.

Tholandi noted the challenges of developing health-education programs to function on a statewide basis. “California is an extremely complex state with a huge degree of diversity,” she said. “Among certain populations more than others there may be a need to revisit some of the basic transmission messages that were common in the early stages of the epidemic.”

Interviewers also asked about the occurrence of risk behavior for HIV infection within the prior 12 months, such as having more than six sex partners, injecting non-prescription drugs, or engaging in high-risk casual sex. The survey found that 2.4 percent of respondents said they had engaged in at least one risk behavior in the previous 12 months. Of those, men were significantly more likely than women to engage in at least one risk behavior.

“Although the percentage may seem small, 2.4 percent of the state’s adult population translates into 640,000 people engaged in risky behavior,” said Moskowitz. “That’s a major concern for public health officials.”

The response rate was similar to that of other major health surveys, but Moskowitz added the caveat that phone surveys may only be reflective of those who choose to participate. “Nonetheless, this survey provides a timely snapshot of the state of HIV/AIDS-related knowledge and behavior among Californians, and it highlights areas where more education is needed,” he said.