Knowledge of fearfulness of HIV / AIDS between floating and frequently moving population of three metropolitan cities in Bangladesh

This paper identifies the vulnerable groups which have lower level of specific knowledge about transmission and ways of avoiding human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Majority of respondents, about 92% floating and 99% frequently moving, heard the name HIV/AIDS from various sources of media, but 52% floating and 31% frequently moving respondents do not know the fearfulness of HIV/AIDS. Electronic media is the most dominant source of hearing about HIV/AIDS. In this study, it was also found that uncontrolled and unsafe sexual relation is the main cause of HIV/AIDS (answer given by the respondents). Further, all the variables (respondents’ age, marital status, educational level and occupation) of contingency analysis were significantly associated with HIV/AIDS in frequently moving respondents but the same variables were not seen in floating respondents. In multivariate logistic analysis, we found that in case of frequently moving respondents, variables like respondents’ age, marital status, education and occupation exert significant effect on the knowledge about the fearfulness of HIV/AIDS; whereas in floating respondents, only education variable exerts significant effect on the knowledge about the fearfulness of HIV/AIDS.


INTRODUCTION
Bangladesh is passing through a period of demographic transition.The most distinctive demographic change is the shift of population from rural to urban areas; especially in Metropolitan cities.In Dhaka City, more than one million people every year in Bangladesh become urban dwellers in recent years.This has resulted not only in a significant increase in the urban population, but also has created thinning slums city centers and shantytowns in their peripheries.For this reason, urban poor females have been receiving attention, as they are the perpetuators of victims of human immunodeficiency virus/ *Corresponding author.E-mail: jidba54@yahoo.com.Tel: +880-721-750041-49/4121, +880-1718154367.Fax: +880-721-750064.
In many countries, HIV/AIDS has stalled or reversed decades of human development.The impact of HIV/AIDS reaches every concern of society in Bangladesh.HIV/AIDS also has become national concern in Bangladesh, and the government has already developed a national strategy and an operational plan to address this need of the country (Sarkar, 2009).Worldwide experience of HIV/AIDS disease has suggested that public knowledge about AIDS is the most fundamental weapon against its pandemic; although its vaccine or remedy has not been developed (UNAIDS China, 2002).The level of knowledge of the population is thus an important measure for understanding the magnitude of the challenges by government and non-government organizations.It is strongly needed to assess the current level of specific knowledge about HIV/AIDS transmission and prevention by women and other key sociodemographic factors to meet the targets and goals of HIV/AIDS prevention and control.
In recent years, there has been an increasing incidence of research on the clinical and epidemiological aspects of HIV.A study by Swinne et al. (1991) focused on AIDS related infections, and they were convinced that the pigeon coops of the city play a part in the contamination of HIV/AIDS patients.Epidemiological research mostly focused on attitudes of people of Iran and Turkey in relation to HIV transmission routes (Nakhaee, 2002;Ayranci, 2005).So far, the disease has no reliable antibiotic medicine, but a cure for HIV infection remains an elusive goal despite the significant impact of current treatments.This is because of the virus' ability to adapt to and resist those treatments, and by-pass the immune system's natural defenses (Robert and Suhadolnik, 2007).
HIV/AIDS is one of the main causes of death of human being and worldwide wreaking devastation on millions of people communities.It poses a serious challenge to human kind and at present, HIV/AIDS has increasingly become a major public-health concern in many developing countries, as well as in Bangladesh.It is a threat to social and economic development, to people in the most productive period of their lives, to family life, to mothers and their children, to the entire culture and population.Bangladesh is passing 'window of opportunity', and without HIV prevention program this country will have epidemic of HIV/AIDS, which would be disastrous for it.The whole situation would be out of control.A comprehensive HIV/AIDS prevention program including mass awareness, coupled with targeted behavioral intervention for high-risk groups, community based education program, and capacity building are some of the steps urgently needed for tackling the HIV problem in Bangladesh.
It is difficult to generate knowledge about the risks associated with HIV transmission due to the conservative social environment and level of denial, which limit free and open discussion of sexual issues.While knowledge does not always lead to safe behaviour; it is harder for people to protect themselves from HIV/AIDS when they are unaware.This leads to the fact that strategies and campaigns to raise knowledge about HIV/AIDS related issues are too important to be ignored in Bangladesh.Keeping these in mind, this study is an attempt to know the knowledge level of respondents regarding sexual health related diseases, especially HIV/AIDS.In this context, the study is conducted on knowledge of fearfulness of HIV/AIDS between the floating (a section of the population not permanently residing in a place) and frequently moving (a section of the population frequently moving in and out of a place) population.

Objective of the study
The present study focuses on: 1. Identifying the socio-demographic factors related to knowledge about HIV/AIDS; 2. Investigating the factor related to knowledge about HIV/AIDS transmission and prevention; 3. Examining the knowledge of fearfulness of HIV/AIDS; 4. Comparing the levels of knowledge about HIV/AIDS between floating and frequently moving groups of selective people; 5. Formulating future plan on HIV/AIDS.

MATERIALS AND METHODS
The study was based on the data from a quota sampling, of which 30 are of floating and 70 are of frequently moving residents for every 100 respondents.But due to the unavailability of floating respondents regarding HIV/AIDS issues, we choose about 27% which are of floating and about 73% which are of frequently moving respondents from three Metropolitan City Corporations namely Dhaka, Rajshahi and Chittagong.The information was collected on the basis of structured question from floating and frequently moving persons.All the respondents were interviewed during 1st October to 20th December, 2008.
Binary logistic regression was used to estimate the number of respondents exhibiting fearfulness of HIV/AIDS.This model expresses a qualitative dependent variable as a function of several independent variables, both qualitative and quantitative (Fox, 1984).pi =

Socio-economic characteristics of floating and frequently moving respondents
Socio-economic and demographic characteristics of the study population are essential for interpretation of collected data and examination of any cause-effect relationship among different variables.They also help in comparing findings with similar characteristics in other independent study findings.Table 1 provides the descriptive summary of some selected socio-economic and demographic characteristics of the study population.Findings revealed that 28% of the respondents in floating category were in age 50+ years and above; whereas about 39% of the respondents in frequently moving category were in age group 30 to 39 years.Education is one of the most important indicators of increasing knowledge.Table 1 shows that 56% floating respondents had no education whereas 28% frequently moving respondents had secondary and higher education.Professional characteristics are the subject matter analysis which influences the socio-economic performance and identification of issue of HIV/AIDS in Bangladesh.Table 1 shows that in floating category, respondents (about 64%) were engaged in other category work whereas, frequently moving category respondents (about 34%) were engaged in rickshaw and auto rickshaw work.Findings also revealed that most of the respondents of floating (about 72%) and frequently moving (about 86%) were married.

Sources of information about HIV/AIDS
The role of sources of information about HIV/AIDS is alarming to public knowledge.Table 2 shows that about 92% floating and 99% frequently moving respondents heard the name, HIV/AIDS from various sources of media, but 52% floating and 31% frequently moving respondents did not know the fearfulness of HIV/AIDS.Also, the use of mass media could also be a successful strategy in reaching different population with information on HIV/AIDS, particularly those who are living in floating areas.Electronic media was the most dominate source of hearing about HIV/AIDS for both floating (41%) and frequently moving (about 51%) respondents.Most of the respondents knew HIV/AIDS as a transmitted disease, and that it was transmitted by multiple (one or more) routes (for both floating (29%) and frequently moving (about 57%) respondents).
Awareness of prevention of HIV/AIDS by both floating and frequently moving population is dependent on the knowledge of HIV/AIDS prevention.Majority of persons (sex workers in Bangladesh) are aware of various ways to avoid HIV/AIDS.They mainly use condoms during intercourse (Ahmed, 2004).Nowadays, condom has been considered as a popular method for HIV/AIDS prevention.When respondents were asked on ways to prevent AIDS virus, it seemed that they wanted to rely on personal opinions about ways to prevent HIV/AIDS.Table 2 pointed that about 21% floating respondents mentioned the use condoms during intercourse as the best way to prevent HIV/AIDS whereas about 21% frequently moving respondents mentioned the avoidance of the use of contaminated syringe and razors as the best way to prevent HIV/AIDS.

Bi-variate analysis of HIV/AIDS transmission based on background characteristics
The knowledge of HIV/AIDS transmission among floating and frequently moving population based on background characteristics is presented in Table 3.A higher proportion of respondents, about 47% floating, with age group of 50+ years, believe that HIV/AIDS transmission route is by misconception transmitted route; whereas, only about 22% of frequently moving respondents felt the same way.We know that more misconception makes people less aware and less misconception makes them more aware.It may be said that frequently moving respondents are more aware than the floating respondents; and the differences of various transmission routes and age are statistically not significant for floating respondents, but for frequently moving respondents, they are highly significant.Table 3 shows that the higher proportion of respondents (about 56% floating, widowed) believe HIV/AIDS transmission route is by misconception transmitted route; whereas for frequently moving respondents, the proportion was about 39%.A proportion of married floating and frequently moving respondents believe that HIV/AIDS transmission routes are by multiple (one or more) routes, with about 33 and 57%, respectively.
It is worth mentioning that widows without any spouse are less aware of the misconception than married persons; and the differences in various prevention ways and marital status are statistically not significant for floating respondents, but for frequently moving respondents, they are significant.Education is strongly and positively associated with a correct understanding of HIV/AIDS transmission.The higher proportion of respondents, about 59% floating, with no education believe HIV/AIDS transmission routes are via misconception transmission routes; whereas, about 70% of frequently moving respondents with secondary and higher education believe in different HIV/AIDS transmission routes (that is, multiple (one or more routes).It is notable that educated persons are more aware about HIV/AIDS transmission routes; and the differences of transmission routes and education are statistically highly significant for both types of respondents.Findings revealed that according to a rickshaw puller, about 50% floating respondents believe that HIV/AIDS transmission routes are by misconception transmission routes; whereas, in frequently moving, the proportion was about 25%.
Since the misconception of frequently moving respondents is low than floating respondents, frequently moving respondents are more aware than floating respondents; and the differences between transmission routes and occupation are statistically significant for frequently moving respondents and not significant for floating respondents.

Knowledge of HIV/AIDS prevention based on background characteristics
Prevention knowledge is one of the most important elements of social and economic life.It is also associated with control of HIV/AIDS.Table 4 indicates the higher proportion of respondents (40% floating, with age group of 18 to 29 years) reported that the correct knowledge of sexual prevention of HIV/AIDS was by avoiding unsafe sexual relationship alone; whereas, about 33% of frequently moving, with age group of 30 to 39 years, reported that the correct knowledge of sexual prevention of HIV/AIDS was by multiple (one or more) ways.Though the difference between age and prevention ways is not significant for floating respondents, it is highly significant for frequently moving respondents.Table 4 also shows that the higher proportion of respondents, 35% floating and married, believed that prevention method was to avoid unsafe sexual relationship alone; whereas, 38% of frequently moving and unmarried believed that prevention method was through multiple (one or more) ways; and the differences were statistically significant.
Findings showed that a higher proportion of respondents, about 38% floating, with incomplete primary education have heard of prevention method by avoiding unsafe sexual relationship and the differences are not statistically significant; while about 36% of frequently moving, with primary incomplete education have heard of prevention methods by multiple (one or more) ways, and the differences are statistically highly significant.A higher proportion of respondents, about 41% floating, who are rickshaw pullers, believed that the popular prevention method was by avoiding unsafe sexual relationship, while 36% of frequently moving, who are engaged in business work, believed that the popular prevention method was by multiple (one or more) ways.The differences in both cases for the prevention of HIV/AIDS and occupation were statistically highly significant.

RESULTS OF LOGISTIC REGRESSION ANALYSIS
Multiple logistic regression analysis (Table 5) was conducted to assess the knowledge of fearfulness of HIV/AIDS as a dependent variable (0 = if he/she does not know the fearfulness of HIV/AIDS and 1 = if he/she knows the fearfulness of HIV/AIDS) by some selected characteristics for both floating and frequently moving respondents.There are many potential independent variables.Of all the potential independent variables, we consider only those variables which give significant results in empirical study and that are also suitable for theoretical purpose.Here, the independent variables are age, marital status, educational qualification and occupation of the respondents.
In the case of floating respondents (30 to 39 years), the result was 1.80 times more and (40 to 49 years, 50+ years age group) 0.891, 0.805 times less for those who have a knowledge about the fearfulness of HIV/AIDS than that of the respondents of 18 to 29 years age group (reference group), respectively.Here, there was no age group which had experiences in different areas of life, or a significant acquaintance with HIV/AIDS.For marital status, married and widow-widower have 0.857 and 0.554 times less knowledge about the fearfulness of HIV/AIDS than that of the respondents who are single (reference group).Further, respondents from educational level (incomplete primary and complete primary education) are 2.332 and 3.771 times more with the knowledge about the fearfulness of HIV/AIDS than that of the respondents with no education (reference group), respectively.
A low educational level person generally has a little knowledge about the fearfulness of HIV/AIDS than an illiterate person because illiterates are always worried about their little knowledge and get carried away with everyday problems of life.Consequently, they have more knowledge about the fearfulness of HIV/AIDS than that of low educational persons.Perhaps, tertiary educated persons have more knowledge in every area of life, but this study has all tertiary educated respondents.For respondents' occupation, business and others have 1.665 and 1.132 times more knowledge about the fearfulness of HIV/AIDS; on the other hand, sex workers have 0.836 times less knowledge about the fearfulness of HIV/AIDS than that of the respondents doing rickshaw and auto rickshaw (reference group), respectively.Here, the business men and others who are more conscious about HIV/AIDS have positive in respect of the fearfulness of HIV/AIDS; whereas sex workers have negative impact.
Frequently moving residents, of 30 to 39, 40 to 49 and 50+ years age group, have 2.693, 1.311 and 2.767 times more knowledge about the fearfulness of HIV/AIDS than that of the respondents of 18 to 29 years age group (reference group), respectively.Here, the middle age  group (40 to 49 years) is less than the old age group and less aware about the fearfulness of HIV/AIDS.Consequently, they have negative significant impact on the fearfulness of HIV/AIDS.For marital status, married and widow-widower have 0.400, 0.228 times less knowledge about the fearfulness of HIV/AIDS than that of the respondents who are single (reference group).Here, the married and widow-widower who have experiences in different aspects of life had a significant acquaintance with HIV/AIDS.Again, respondents' educational level including incomplete primary, complete primary, secondary and higher secondary, graduate and higher have 7. 020, 8.825, 19.325 and 6.914 times more knowledge about the fearfulness of HIV/AIDS than that of the respondents with no education (reference group).
Here, the educational level of those who have experiences in different aspects of life had a highly significant acquaintance with HIV/AIDS than those with no education.For respondents' occupation, service men, business men, drivers and others had 0.820, 0.701, 0.337 and 0.534 times less knowledge about the fearfulness of HIV/AIDS than that of the respondents with occupation of rickshaw and auto rickshaw driver (reference group).Here, since drivers move here and there, they consequently have a significant acquaintance with HIV/AIDS.But the service men and business men have no such opportunity, so they have negative impact in respect of the fearfulness of HIV/AIDS than rickshaw and auto rickshaw drivers.

CONCLUSION AND RECOMMENDATION
Knowledge of HIV/AIDS has become the burning question of the day.The knowledge of HIV/AIDS in Bangladesh has long been a topic of interest to researchers because of its apparent direct relationship with lack of health facilities and poverty, indirectly.At the significance level among the selected variables, we have seen that more knowledge is gathered on HIV/AIDS in

Table 1 .
Selected socio-economic characteristics of floating and frequently moving respondents.

= 300) Frequently moving (N = 798)
Figure in parenthesis indicate that the percentage distribution, single define never married and (-) not available.

Table 2 .
Sources of Information about HIV/AIDS.

Table 3 .
Knowledge of HIV/AIDS transmission routes: Floating and frequently moving population.

Table 4 .
Knowledge of prevention ways about HIV/AIDS by floating and frequently moving population.

Table 5 .
Examination of the levels of knowledge about fearfulness of HIV/AIDS between floating and frequently moving population.Ref.) denotes reference category, ***denotes 1% level of significance, **denotes 5% level of significance, *denotes 10% level of significance, B denotes estimate regression coefficient and others included day labor, farmer and beggar. (