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Current Trends HIV Epidemic and AIDS: Trends in Knowledge -- United States, 1987 and 1988
Education and information can play an important role in preventing human immunodeficiency virus (HIV) transmission by reducing high-risk behaviors and encouraging safe practices. To collect information for developing and targeting new education programs, the National Health Interview Survey (NHIS) began in August 1987 to include specific questions to assess the public's knowledge about the transmission, prevention, and consequences of HIV infection; attitudes toward persons already infected; and awareness and utilization of the HIV-antibody test.
NHIS is a continuous, cross-sectional household interview survey conducted by CDC's National Center for Health Statistics (NCHS). Each week, a national probability sample of the civilian, noninstitutionalized population is interviewed by Bureau of the Census personnel to obtain information on health, demographic, and other characteristics of each household member. Supplemental information is collected for all or a sample of household members. The 1987 and 1988 NHIS acquired immunodeficiency syndrome (AIDS) knowledge and attitudes questionnaires were administered to one randomly chosen adult greater than or equal to 18 years of age in each household. The estimates in this report are based on the approximately 3500 interviews completed each month.
The first NHIS AIDS Knowledge and Attitudes Survey was implemented from August to December 1987, and provisional survey results were published monthly (1-5). From January to April 1988, the NHIS AIDS questionnaire was revised to include questions about the brochure, "Understanding AIDS," which was mailed to every U.S. household in May and June. The revised AIDS Knowledge and Attitudes Survey was implemented in May 1988, and provisional results are being published periodically (6-9).
The current questionnaire contains items on self-assessed knowledge about AIDS, HIV transmission, perceived effectiveness of various preventive measures, experience with blood donation and testing, and self-assessed likelihood of being seropositive. In the survey, the term "AIDS virus" was used in place of HIV, and that wording has been maintained in this report. All estimates in this report are provisional. Unless otherwise indicated, all changes and differences cited in the text are statistically significant (pless than 0.05). BASELINE FINDINGS In August 1987, the proportions of U.S. adults who responded that they knew "a lot" and "some" about AIDS were 20% and 40%, respectively (Table 1). Sixty-seven percent of adults had discussed AIDS with a friend or relative; of those adults who had children 10-17 years of age, 60% had discussed AIDS with their children; 36% reported that their children had received AIDS education in school (Table 1).
Most adults answered that they had "no" chance (60%) or a "low" chance (30%) of acquiring the AIDS virus (Table 1). Although 70% of adults had heard of the blood test to detect the presence of HIV antibody, only 15% had had their blood tested, including 7% who reported having had their blood tested and 8% who reported having donated blood since 1985, when routine testing of donation began.
Thirty-four percent of adults considered use of a condom as "very effective" in preventing HIV infection, and 84% answered that having a monogamous relationship with an uninfected partner is a "very effective" preventive measure (Table 1). Two percent of adults responded that use of a diaphragm or spermicidal jelly, foam, or cream are "very effective" preventive techniques.
Most adults knew that AIDS is a fatal disease and that no cure for AIDS exists (89% and 83%, respectively) (Figure 1). Seventy-five percent answered that it was "definitely true" that the AIDS virus can be transmitted during sexual intercourse; 69%, that it was "definitely true" that a pregnant woman can pass the AIDS virus to her baby; 91%, that it was "very likely" that a person would acquire the AIDS virus from sharing needles for drug use with a person who has AIDS (not shown in the figure). The proportions of adults who responded that it was either "probably true" or "somewhat likely" that HIV could be transmitted in these three ways were 18%, 22%, and 5%, respectively.
Sixty-five percent of the adults responded that the following were "definitely false": a vaccine is available to the public that protects against the AIDS virus; AIDS is especially common in older persons; and it is possible to tell by looking at someone if he or she has the AIDS virus.
Seventy-four percent of respondents answered that it is "very unlikely" or "definitely not possible" to transmit the AIDS virus by living near a hospital or home for AIDS patients; 58%, by attending school with a child who has the AIDS virus; 53%, by working near someone with the AIDS virus; 40%, by using public toilets; and 27%, by sharing eating utensils with someone who has the AIDS virus (Figure 2). CHANGES BETWEEN AUGUST 1987 AND AUGUST 1988
Between August 1987 and August 1988, both objective and self-assessed measures of knowledge increased (Figure 1). Over this period, the proportion of adults who answered that it was "definitely true" that AIDS is an infectious disease caused by a virus increased from 44% to 64%. The proportion responding that it was "definitely true" that a pregnant woman can transmit HIV to her baby increased from 69% to 80%. The proportion answering that it was "definitely false" that a vaccine exists that protects against HIV infection increased from 65% to 76%. The proportion of adults responding that they knew "a lot" about AIDS increased from 20% to 22%; adults answering that they knew "some" about AIDS increased from 40% to 44% (Table 1).
A substantial increase occurred in the proportion of adults who answered that the AIDS virus could not be transmitted through casual contact with infected persons (Figure 2). In August 1987, 35% of adults responded it was "very unlikely" that a person could become infected with the AIDS virus by working near someone with it, and 18% responded that it was "impossible." In August 1988, these proportions had increased to 40% and 27%, respectively. The perceived effectiveness of condoms ("very effective" or "somewhat effective") in preventing HIV transmission remained essentially the same (Table 1), as did attitudes about the other forms of contraception and the perceived "effectiveness" of a mutually monogamous relationship with an uninfected partner.
The proportion of adults who had heard of the blood test for early diagnosis increased from 70% to 75%. In August 1988, 17% of adults had been tested, including 9% who reported having had their blood tested and 8% who reported having donated blood since 1985.
The proportion of adults reporting their chances of becoming infected with HIV as "high" or "medium" showed limited change (1% to less than 1% (nonsignificant), 4%-2%, respectively), but a large proportion shifted from the low-risk to no-risk category, the latter increasing from 60% to 75%.
Three percent of adults reported that they belonged to one or more of the groups associated with increased risk for HIV transmission. Among these persons, perceived risk for HIV transmission varied: 5% reported that their chances of already having been or of becoming infected with HIV were "high," 7% reported a "medium" chance, and 42% reported a "low" chance of infection.
The proportion of adults who reported discussing AIDS with their children aged 10-17 years remained at 60%; in contrast, the proportion who reported that their children had received AIDS education in school increased from 36% to 59%. Little change occurred in the proportion who reported having discussed AIDS with friends or relatives. Reported by: Div of Health Interview Statistics, National Center for Health Statistics; National AIDS Information and Education Program, Office of the Deputy Director (HIV), CDC.
Editorial Note: In comparing August 1987 to August 1988, the most substantial increase in knowledge was related to transmission of HIV. The increases in the percentages of adults who considered it "very unlikely" or "definitely not possible" to transmit HIV through various forms of casual contact represent important gains in knowledge.
The overall gain in levels of knowledge about HIV and AIDS coincided with the national multimedia public awareness campaign. Analysis of the NHIS data is under way to assess the impact of one element of this campaign, the mailing of the brochure entitled "Understanding AIDS" to every U.S. household during May and June 1988. Evaluation of this and other public education efforts will help guide future campaigns so that progress can continue.
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