7.Results or findings.

Since HIV was first recognized, approaches and methodologies to monitor the epidemic and the response have continuously improved. As a result, the world is better equipped than ever to estimate HIV prevalence or the rate of new HIV infections, to determine the extent of programme coverage, to characterize and evaluate national responses, and to gauge the level of funding available for HIV programmes in low- and middle-income countries. In over half of the countries, at least 90% of the female population had heard of Aids and in more than three fourths of the countries, at least 90% of the male population had heard of disease. In some countries Brazil, Colombia, the Comoros, the Dominican Republic, Ghana, Haiti, Kenya, Malawi, Uganda, the United Republic of Tanzania, Zambia, and Zimbabwe virtually the entire adult population was aware of Aids. In contrast, responses to the DHS point to moderate levels of Aids awareness in Indonesia and the Niger and low levels of awareness in Bangladesh and Nepal. 51% of woman in Indonesia in 1997 and 55% in the Niger 1998 had heard of Aids. In Nepal in 1996, the level of awareness of Aids was only 27% among ever married Women (men were not surveyed). In Bangladesh, only 31% of ever-married women and 50% of current married women had heard of Aids in 1999-2000, the period during which the survey was conducted. However, these figures represent a significant increase over the level of knowledge observed in the period 1999-2000, When no more than 19% of ever married women and 33% of currently married men were aware of Aids.

COUNTRY

Percentage

Females Males Bangladesh 31 50 Nepal 27 .. Uganda 99 100 Zimbabwe 99 100 Malawi 99 100 Brazil 99 99 Kenya 99 99 Haiti 98 98 Central African republic 93 99 Colombia 99 .. Zambia 100 100 Comoros 98 99 Ghana 97 99 United Republic of Tanzania 97 99 Nicaragua 96 98 Togo 96 98 Madagascar 69 .. Peru 90 96 Cameroon 90 97 Burkina Faso 88 96 Turkey 84 93 Mozambique 82 94 Dominican republic 100 .. Bolivia 79 85 Mali 77 96 Benin 82 95 Nigeria 74 90 Guinea 95 .. Eritrea 72 89 Senegal 92 96 Chad 60 88 Niger 55 89 Indonesia 51 .. Table 1.1: Proportion of respondents who had ever heard of AIDS Note: Two dots (..) indicate that data are not available.

Proportion of respondents who had ever heard of AIDS.

120 100 80 60 40 20 0 Females Males

Ba Ne Ug Zi M Br Ke Ce Co Za Co G Un Ni M Ca Bu Tu M Do Bo Be Ni G Eri Se Ni In Ha To Pe M Ch ng pa an m al az ny ntr lo m m ha ite ca ad m rki rk oz mi livi ni ge ui tre ne ge do iti go ru ali ad la l da ba aw il a al m bi or na d ra ag er na ey a ni a n ria ne a ga r ne 50 0 10 10 10 99 99 98 99 0 10 99 99 99 98 98 0 96 97 96 93 94 0 85 96 95 90 0 89 96 88 89 0

Females 31 27 99 99 99 99 99 98 93 99 10 98 97 97 96 96 69 90 90 88 84 82 10 79 77 82 74 95 72 92 60 55 51 Males

Figure 1.1: Proportion of respondents who had ever heard of AIDS.

In many countries, survey results reveal that awareness of Aids is higher among men than women. This gender gap reaches 34% points in the Niger and 28% points in Chad. Also striking are the gender differences in Aids awareness in___

COUNTRY Bangladesh Uganda Zimbabwe Malawi Brazil Kenya Haiti Comoros Ghana United Republic of Tanzania Nicaragua Togo Gabon Peru Cameroon Burkina Faso Turkey Mozambique Benin Bolivia Mali Nigeria Eritrea Senegal Chad Niger

Gender gap in AIDS (%) 19 2 2 2 1 1 1 2 3 3 3 3 3 6 7 8 9 12 13 6 19 15 17 4 27 34

Table 1.2: Gender gap in AIDS

The diagrammatic representation of the percentage points by which mens AIDS awareness exceeds that of women has been shown below:

Gender gap in AIDS (%) 40 35 30 25 20 15 10 5 0 Ba Ug Zi Ma Ke Co Gh Uni Nic Ga Ca Bur Tur Mo Nig Se Bra Hai To Per Be Bol Ma Erit Ch Nig ngl an mb law ny mo an ted ara bo me kin ke za eri ne zil ti go u nin ivia li rea ad er ad da ab i a ros a Re gu n roo a y mb a gal 19 2 2 2 1 1 1 2 3 3 3 3 3 6 7 8 9 12 13 6 19 15 17 4 27 34 Gender gap in AIDS (%)

Gender gap in AIDS (%)

Figure 1.2: Gender gap in AIDS

As expected, awareness increases with the spread of the disease. In 12 countries where HIV prevalence exceeded 5%, awareness had reached at least 90%, whereas in 2 countries where prevalence was less than 1%, lwess than half of the female respondents were aware of Aids. Results from the DHS show little variation in awareness according to the age of respondents in most countries.

Awareness of AIDS in relation to prevalence:

Proportion of female respondents who have heard of AIDS: Less than 50% 50% - 65% Bangladesh, Nepal

Chad, Niger, Indonesia Mozambique, Burkina Faso, Nigeria, Eritrea, Benin, Mali, Senegal, 65% - 90% Guinea, Turkey, Madagascar, Bolivia Zimbabwe, Zambia, Malawi, Kenya, Central African republic, Uganda, United Rep. Of Tanzania, Cameroon, Togo, Haiti, Nigeria, Gabon, 90% and above Ghana, Dominican republic, Brazil, Peru, Colombia, Nicaragua Table 1.3: Proportion of female respondents who have heard of AIDS

20 15 10 5 0 Series1 Less than 50% - 65% 65% - 90% 90% and 2 3 11 19 Less than 50% 50% - 65% 65% - 90% 90% and above

Fig Figure 1.3: Proportion of female respondents who have heard of AIDS:

Awareness of Aids in relation to Urban and Rural residence:

Awareness of Aids varies significantly according to the place of residence, with urban residents reporting higher levels of awareness than rural residents. In all countries surveyed, at least 64% of urban females had heard of Aids, and in all but three countries, the level of awareness in urban areas reached 93%. In several countries, including Bangladesh, Bolivia, Chad, Eritrea, Guatemala, Indonesia, Nepal and Peru, the differentials between rural and urban knowledge is enormous. Proportion of respondents who had ever heard of Aids.

Country
Bangladesh Nepal Zambia Dominican republic Uganda Zimbabwe Malawi Brazil Kenya Colombia Haiti Comoros Ghana United Republic of Tanzania Nicaragua Togo Guinea Central African Republic Gabon Peru Cameroon Burkina Faso Turkey Mozambique Benin

Percentage Female 64 67 100 100 100 100 100 100 100 100 100 99 99 100 98 99 99 98 99 98 97 99 90 96 90

Male 23 23 99 99 99 98 99 98 99 97 97 97 95 96 91 94 95 89 94 65 86 85 72 78 77

Bolivia Mali Nigeria Eritrea Madagascar Chad Niger Indonesia Jordan Viet Nam Guatemala

93 91 88 97 87 87 94 77 99 97 89

44 70 61 60 62 52 45 42 93 89 57

Table 1.4: Proportion of respondents who had ever heard of Aids. In Bolivia, only 44% of rural respondents had heard of Aids in 1997 survey, compared with 935 respondents of urban respondents. The differential was just as a great in Niger in 1998, where 45% if rural respondents and 94% of urban respondents said they had heard of Aids. The two countries with the lowest general awareness of Aids showed very low levels of knowledge among rural respondents, especially among women and large differentials between urban and rural areas. In Bangladesh, although nearly two out of three female urban respondents knew about Aids, only 23% of rural women were aware of he disease. Men were more knowledgeable about Aids in both urban and rural areas, with proportions of 76% and 44%, respectively. Moreover, in Nepal, two thirds of urban respondents said they had heard of Aids. Where general awareness is high, as in Dominican Republic, Kenya, Uganda and Zambia, it is high in both rural and urban settings. In 18 of the 37 countries examined, at least 90% of both urban and rural respondents were aware of the disease. The data suggests a general relationship between the levels of Aids awareness, in particularly among women, and the level of urbanization of a country. Clearly, in several countries that are predominantly rural, the majority of people still have little or no knowledge of Aids. Yet in a number of predominantly rural countries, such as Uganda and Viet Nam, very high levels of awareness are reported. Percentage points by which Aids awareness among living women in urban areas exceeds that among living in rural areas:

COUNTRY

Percentage

Bangladesh 42 Nepal 43 Zambia 1 Dominican republic 1 Uganda 2 Zimbabwe 2 Malawi 2 Brazil 2 Kenya 1 Colombia 3 Haiti 2 Comoros 2 Ghana 3 United Republic of Tanzania 3 Nicaragua 5 Togo 3 Guinea 4 Central African Republic 8 Gabon 3 Peru 33 Cameroon 11 Burkina Faso 15 Turkey 17 Mozambique 18 Benin 12 Bolivia 46 Mali 22 Nigeria 27 Eritrea 38 Madagascar 25 Chad 35 Niger 48 Indonesia 34 Jordan 3 Viet Nam 6 Guatemala 32 Table 1.5: Percentage gap of awareness in the living women of urban and rural areas

Percentage 60 50 40 30 20 10 0 Percentage

Ba Za Do Ug Zi Ma Br Ke Col Co Gh Uni Nic Gu Ce Ga Ca Bu Tur Mo Nig Eri Ma Ind Jor Vie Gu Ne Hai To Pe Be Bol Ma Ch Nig ngl mb mi an mb law azi ny om mo an ted ara ine ntr bo me rki ke za eri tre da on da t ate pal ti go ru nin ivia li ad er ad ia nic da ab i l a bia ros a Re gu a al n roo na y mb a a ga esi n Na ma 42 43 1 1 2 2 2 2 1 3 2 2 3 3 5 3 4 8 3 33 11 15 17 18 12 46 22 27 38 25 35 48 34 3 6 32

Percentage

Figure 1.4: Percentage gap of awareness in the living women of urban and rural areas

Awareness of Aids in relation to education: In Aids as in many health issues, the level of education influences awareness: education is associated with greater awareness. In most countries, nearly all respondents with at least a secondary education had heard about Aids. In 31 of 34 countries examined, at least 95% of the most educated female respondents knew about aids. Respondents with no education were much less likely to know about the disease. In eight countries, fewer than half the respondents with no education were aware of Aids. Awareness of Aids was found to be particularly low among uneducated women in various countries with data: Secondary Country No education Primary or higher Bangladesh 12 20 35 Indonesia 14 28 34 Nepal 17 33 33 Bolivia 30 31 35 Madagascar 40 28 27 Guatemala 42 33 24 Peru 47 30 22 Niger 49 31 19 Turkey 50 36 13 Chad 52 37 11 Viet Nam 54 30 14 Eritrea 59 39 2 Cameroon 71 24 5 Mali 73 15 11 Mozambique 74 15 9 Benin 75 20 4 Table 1.6: Awareness of Aids in relation to education In some countries, however, the differentials between the more and less educated respondents were striking. In Peru, for example, virtually all of the most educated respondents (99%) said they had heard of Aids compared with fewer than half (47%) of those with no education. Indonesia also reported considerable educational differentials in its 1997 survey: whereas 88% of the most educated group knew

80 70 60 50 40 30 20 10 0 Ban Indo glad nesi esh a 12 20 35 14 28 34 Mad Guat Cam Moz Nep Boliv Nige Turk Cha Viet Eritr Beni agas emal Peru eroo Mali ambi al ia r ey d Nam ea n car a n que 17 33 33 30 31 35 40 28 27 42 33 24 47 30 22 49 31 19 50 36 13 52 37 11 54 30 14 59 39 2 71 24 5 73 15 11 74 15 9 75 20 4 No education Primary Secondary or higher

No education Primary Secondary or higher

Figure 1.5: Awareness of Aids in relation to education

In countries where awareness was generally high, level of education made little difference. In 14 countries with higher awareness, 90% or more of those with no education had heard of aids. In Brazil, Malawi, Uganda and Zambia, fully 98% of those with no education said they knew about Aids. Surprisingly, schools and teachers were not an important source of Aids information in most countries surveyed. In many countries particularly those with low levels of Aids awareness schools and teachers were mentioned fewer than 10% respondents. Only in Brazil did at least half the young woman cite this source of information. Proportion of girls aged 15-19 who had heard about AIDS at school/from teachers COUNTRY Percentage

Bangladesh 0 Viet Nam 0 Indonesia 1 Nepal 1 Mali 2 Chad 3 Burkina Faso 5 Niger 6 Central African Republic 6 Mozambique 7 Benin 7 Guinea 7 Comoros 9 Madagascar 11 Turkey 14 Jordan 14 Guatemala 16 Haiti 17 Eritrea 19 Bolivia 19 Table 1.7: Proportion of girls heard about AIDS at school/from teachers

Percentage 20 18 16 14 12 10 8 6 4 2 0 Bang Burki Centr Moza Mada Guat Viet Indon Nepa Beni Guin Com Turke Jorda Eritre Bolivi lades Mali Chad na Niger al mbiq gasc emal Haiti Nam esia l n ea oros y n a a h Faso Afric ue ar a 0 0 1 1 2 3 5 6 6 7 7 7 9 11 14 14 16 17 19 19 Percentage

Percentage

Figure 1.6: Proportion of girls heard about AIDS at school/from teachers

Level of awareness of Aids by mass media:

Radio, television and newspaper or magazines rank first, third and fourth respectively, among the sources of awareness by DHS respondents. Radio us by far the most often cited source of knowledge about Aids. About half of the female respondents and more than 7 in 19 male respondents had heard of Aids on the radio. Also striking is the difference in media exposure between men and women. In many countries, men are far more likely to have heard about Aids on the radio. The gender gap is at least 20% in 14 African and is highest in Benin, Chad, Mali, the Niger and Nigeria. In some countries, where TV is widely accessible, respondents mentioned TV more frequently than many other sources. At least three quarters of those questioned cited TV as a source of information in Brazil, Colombia, the Dominican Republic, Jordan, Turkey and Viet Nam. By contrast, television was mentioned by fewer than 10% of female respondents in the Central African Republic, Chad, Madagascar, Mozambique, Nepal, Uganda and the United Republic of Tanzania. Newspapers and magazines were cited by only about 14% of female respondents overall, but they were a significant source of awareness about Aids in Latin American countries and Jordan. Second only to radio, friends and relatives proved to be on one the important sources of Aids awareness in many countries. At least 50% of female respondents in 10 African countries said they had heard of aids from friends or relatives, and in Uganda and the United Republic of Tanzania, the proportions were 82% and 65%, respectively. However, few respondents mentioned channels that are often thought to be sources of awareness, such as clinics and healthy workers, community meeting, pamphlets and posters, churches or mosques and the workplace. The following data represents the proportion of respondents who had heard about Aids on the radio:

Country Female Chad 31 Niger 33 Nigeria 46 Benin 59 Mali 50 Burkina Faso 56 Cameroon 47 United republic of Tanzania 64 Togo 47 Central African republic 64 Zambia 54 Uganda 41 Mozambique 43

Male

Gender gap

69 68 72 85 76 81 72 87 69 87 76 63 63

38 35 26 26 26 25 25 23 22 23 22 22 20

Table 1.8: Proportion of respondents who had heard about AIDS on the radio

100 90 80 70 60 50 40 30 20 10 0 Chad Female Male Gender gap 31 69 38 Niger 33 68 35 Nigeria 46 72 26 Benin 59 85 26 Mali 50 76 26 United Burkina Camero republic Faso on of 56 81 25 47 72 25 64 87 23 Central Mozamb African Zambia Uganda ique republic 64 87 23 54 76 22 41 63 22 43 63 20 Female Male Gender gap

Togo 47 69 22

Figure 1.7: Proportion of respondents who had heard about AIDS on the radio

The major sources awareness on Aids mentioned by female respondents:

Female Sources Radio 48 Friends and relatives 35 TV 35 Newspapers 15 Clinic 14 Community meetings 8 Pamphlets and posters 7 Churches and mosques 4 Workplace 3 Table 1.9: The major sources awareness on Aids mentioned by female respondents The following diagram shows the major sources awareness on Aids mentioned by female respondent.

Female 60 50 40 30 20 10 0 Radio Female 48 Friends and relatives 35 TV 35 Newspaper s 15 Clinic 14 Community Pamphlets meetings and posters 8 7 Female

Churches and mosques 4

Workplace 3

Figure 1.8: The major sources awareness on Aids mentioned by female respondents

Recommendation Prevention of Mother-to-Child Transmission In the absence of any preventative interventions, infants born to and breastfed by HIVinfected women have roughly a one-in-three chance of acquiring infection themselves. This can happen during pregnancy, during labour and delivery or after delivery through breastfeeding. Support for Children Affected by HIV and AIDS As the number of orphaned and vulnerable children continues to grow, adequate support to families and communities needs to be assured. In practice, care and support for orphaned children comes from families and communities. As a foundation for this support, it is important that households are connected to additional support from external sources. Life Skills-based HIV Education in Schools Life skills-based education is an effective methodology that uses participatory exercises to teach behaviours to young people that help them deal with the challenges and demands of everyday life. It can include decision-making and problem-solving skills, creative and critical thinking, self-awareness, communication and interpersonal relations. It can also teach young people how to cope with their emotions and causes of stress. When adapted specifically for HIV education in schools, a life skills-based approach helps young people understand and assess the individual, social and environmental factors that raise and lower the risk of HIV transmission.