January 22, 2013

January 22, 2013
Young People Know Less About HIV

Welcome to another day in my life. Today is Tuesday and I hope you are having a beary safe and great week so far. It is another busy week for Dab the AIDS Bear and me.

I recently read some very disturbing news concerning young people in France. They are less knowledgeable about HIV and less trustful of condoms.

The first survey for six years of attitudes to HIV and sexual risk behavior among the general public in France has found that young people are less frightened of AIDS than they used to be, are more likely to believe in unlikely routes of HIV transmission, and are strikingly less trustful that condoms will reliably protect them against HIV.

The study finds that almost everyone knows about the most common ways HIV is transmitted, and that condoms as a general anti-HIV and contraceptive strategy are still widely used, far more so than the days before widespread public awareness of HIV.

However, it finds a considerable decline, relative to earlier surveys, in the proportion of people who used condoms the last time they had sex, especially in longer-term relationships.

The survey

The French Knowledge, Attitudes, Beliefs and Practice (KABP) survey has been conducted at irregular intervals since 1992 and therefore, with the last data gathered in 2010, represents a unique 18-year longitudinal data set of knowledge and practice about HIV.

In the words of the researchers: “To our knowledge, this is the first time in any country that [KABP] data have been collected over such a long period.”

One advantage of the survey is that the first one, in 1992, was conducted before the first comprehensive HIV awareness campaign was conducted in France and thus provides some measure of baseline awareness and practice. The survey is specifically aimed at the general public rather than high-risk groups such as gay men, injecting drug users and migrants.

The survey, conducted in 1992, 1994, 1998, 2001, 2004 and 2010, was done by random-dialing the home phones of members of the public aged 18-69. For the 2010 survey, to reflect that an increasing proportion of people no longer use a land line, random dialing of all phone numbers including mobiles was used. The acceptance rate for the survey was reasonably consistent, ranging from 63% in 1994 to 81% in 2001. In 2010 it was 67% in land line calls and 65% in mobile calls.

Overall, 26,519 members of the public were interviewed but for this paper only the 6136 aged between 18 and 29 were selected, 54% women and 46% men. The survey did not ask about gender of sexual partners and only 2.5% of men and 1.4% of women volunteered the information that they had had same-sex partners in the previous year. Numbers in this age group interviewed in individual surveys ranged from 187 in 1994 to 398 in 2004, while 3-4 times as many as this – 926 – were interviewed in 2010.

Results: knowledge and beliefs

Knowledge of the major routes of HIV transmission was near-universal: over 99% of people knew you could get HIV from unprotected sexual intercourse in each survey between 1994 and 2010, and over 98.5% knew you could get it from sharing needles in the last three surveys (the questions were not asked in other years).

Beliefs that HIV could be transmitted in unlikely ways, however, have grown. In 1992, 28% of men and 17% of women thought you could get HIV from a mosquito bite and 20% of both sexes thought it could be acquired just from using a public toilet. After a public HIV awareness campaign these proportions were down in 1994 to 12% in both sexes for mosquito bites and 9% in men and 7% in women for transmission in public toilets. By 2010, these had increased to pre-awareness campaign levels: 31% of men and 28% of women in the latest survey thought that mosquitoes transmitted HIV and 21% and 18% respectively thought you could get it from using a public toilet.

Accompanying this was a striking fall in believing that condoms could reliably prevent HIV. Although 93.2% of respondents thought that using a condom reduced the likelihood of HIV transmission, only 54% of men and women thought that condoms offered 100% protection against HIV in 2010, compared with 79% of men and 76% of women in 1994.

When the question was asked another way, by asking people if HIV transmission was possible in sexual intercourse with a condom, 40% of men and 33% of women in 2010 reported this was possible compared with 15.5% of all respondents in 1994.

As the researchers say, these views on condoms could be due to ignorance of their efficacy but could just as well be due to better practical knowledge of the difficulties of using them and their tendency to break or slip.

Personal acquaintance of someone with HIV is now back to 1992 levels: in 1992 and 2010 about 10% of respondents said they knew someone with HIV compared with over 20% in 1998 and 2001, despite HIV prevalence in France having increased by 50% during this time. This is probably both due to treatment reducing symptomatic AIDS and to a reduction in the resultant necessity to disclose.

People have become a lot less scared of the consequences of HIV infection. In 1992, about 20% of respondents were afraid of ‘getting AIDS’. After the HIV awareness campaign this more than doubled to 44% in men and 49% in women in 1994. However, it had already declined to 25% in men and 33% in women in 1998, suggesting that the effect of broad-brush campaigns is relatively transient.

In 2010, 20% of women and 18% of men were afraid of getting AIDS, figures not hugely bigger than their fear of getting other sexually transmitted infections (16 and 14% respectively).

This was accompanied by increasing fatalism about (asymptomatic) HIV infection, though, especially among men. In 2010, 38% of men and 33% of women were afraid they might already have HIV, up from 26 and 28% respectively in 1998, when the question was first asked.

Tomorrow, I will finish blogging about this study.

Hope you have a beary safe and great Tuesday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab