Knowledge, Awareness and Perception about HIV/AIDS among Primary School Teachers in Bangladesh

Introduction: Since the first report in 1981 among homosexuals in the United States, HIV/AIDS has been described as the most dangerous and deadly disease of the millennium, caused by a tiny germ called Human Immunodeficiency Virus (HIV). Ogunbodede (2004) showed in a study that the pandemic of HIV/AIDS has not only been the most awful tragedy in contemporary history, but has also posed serious demographic, humanitarian, economic and developmental crisis.


Knowledge, Awareness and Perception about HIV/AIDS among Primary School Teachers in Bangladesh
Choudhary SR 1 , Rahman MM 2

Introduction:
Since the first report in 1981 among homosexuals in the United States, HIV/AIDS has been described as the most dangerous and deadly disease of the millennium, caused by a tiny germ called Human Immunodeficiency Virus (HIV).Ogunbodede (2004) showed in a study that the pandemic of HIV/AIDS has not only been the most awful tragedy in contemporary history, but has also posed serious demographic, humanitarian, economic and developmental crisis 1 .
The achievements of the global HIV response over the last 10 years have been extraordinary.
The incidence of HIV infection declined by more than 25% between 2001 and 2009 in 33 countries, and the HIV prevalence among young pregnant women attending antenatal clinics has declined by 25% or more in 7 countries 2 .At the end of 2010, more than 6.6 million people were receiving antiretroviral therapy in low-and middle-income countries, a 16-fold increase from the approximately 400 000 people recorded in December 2003.Forty-eight low-and middle-income countries now provide antiretroviral therapy to more than 50% of adults in need, including 10 countries with universal access, and about 50% of pregnant women received the most effective regimens to prevent the mother-tochild transmission of HIV in 2010.As a result of these efforts, the number of people newly infected globally with HIV has fallen from 4.9 million in 2005 to 2.7 million in 2010, including 390 000 chil-dren, while the annual number of AIDS related deaths worldwide has fallen from the peak of 2.2 million recorded in 2005 to an estimated 1.8 million in 2010, bringing the total number of people living with HIV to 34 million in 2010 from 40.3 in 2005 2 .
The Bangladesh Government has embarked on creditable and multiple strategies aimed at curtailing the HIV/AIDS scourge across the country.It has been regularly collecting information on HIV prevalence in the country since 1998 by conducting HIV surveillance among populations who are considered to be most at risk.According to the 9 th Round of HIV Serological Surveillance 3 , the overall prevalence of HIV in population most at risk remains below 1% and most importantly, HIV prevalence has declined among people who inject drugs (PWID) in Dhaka from 7% to 5.3%, however, the decline is not statistically significant.The scaling up of the Needle/Syringe Programme (NSP) and the special attention given to PWID living with HIV are possible factors contributing to the decline in rates 4 .In spite of, Bangladeshis still engage in unwholesome behavioral practices that may foster the spread of the disease.

Populations over the Years 5
The evaluation of teachers' knowledge is necessary because of its implications on the accuracy of information about HIVAIDS, which they deliver to students, and also for them to know how to protect their own health.Several studies carried out to evaluate the knowledge of adolescents mostly under schoolbased settings in Nigeria have identified gaps in awareness, thus recommending the involvement of school based programs in the HIV awareness campaign. 6,7,8However, the literatures on evaluation of the knowledge of the primary school teachers in Bangladesh who are the ones to be at the vanguard of the implementation of the school based HIV enlightenment activities are quite limited.Thus, the objective of this study was to evaluate the knowl-edge, awareness and perception about HIV/AIDS among primary school teachers in Bangladesh.

Materials and methods
The present study was conducted in Rajshahi City Corporation (RCC), one of the divisional cities of Bangladesh.There are about 68 primary schools in RCC area, of which 47 government primary and 21 non-governments registered primary.Among these, only 28 primary schools were selected purposively (27 from government primary schools and 1 from non-governments registered primary schools) due to time and money constraint.The teachers who were found on the day of survey in these selected schools constituted the study participants.A total of 120 teachers (113 teachers from government primary schools and rest of them from non-government registered primary) were interviewed purposively for this study using a self-administered questionnaire where every question carried a specific score.The questionnaire covered mainly on some background information such as age, sex, occupational & educational status, religion etc., health hazards, maintenance of personal hygiene, sanitary system, preventive approaches of diseases and their habits.The collected data were then coded & edited and statistical analysis was performed using frequency and percentage distribution in computer by the software -Statistical Packages for Social Sciences (SPSS).

Ethical issue
As integrity in research is vital, ethical consideration should be given prime importance when preparing research designs 9 .Therefore, the purpose and importance of this study were explained to teachers before participating in the study and verbal consent was taken both from the head teachers and assistant teachers of the schools.The teachers were told that their participation is voluntary and have the liberty not to answer all or any part of the questionnaire.They were assured that the information will be kept confidential and will be used only for research purposes.

Results
Table 2 revealed the background information of the respondents participated in the study.It is revealed that the respondents comprised 24 males (20.0%) and 96 females (80.0%); most of the respondents were married (87.5%),only 7.5% and 5.0% were unmarried and divorced/widowed respectively.Their mean age was 39.7 years with a standard deviation of 9.15, and ranged from 21 to 58 years (Table 2).Approximately 41.0% (n = 49) of the respondents were born in rural areas, while the rest of them were born either in urban or semi-urban areas.About 72.5% of the respondents were serving in the primary school as assistant teachers, where approximately 96.0% of the respondents were Muslim.The results also revealed that a little more of 45.0% of the respondents were being graduate and above degree, while only 15.0% were being Secondary School Certificate (SSC) pass and 39.0% were being Higher Secondary Certificate (HSC).The respondents' knowledge of fact about HIV/AIDS is shown in Table 3, giving correct answers to each of the four questions.Only 16 (13.3%)respondents knew that HIV is a viral infection.However, 32 respondents (26.7%) were aware that infection with other sexually transmitted diseases could increase the risk of contracting HIV infection.Although 67 respondents (55.8%) were believed that there is no treatment for HIV/AIDS but at the same time, it is to observe that about 17% mentioned HIV/AIDS can't be cured.

Table 3: Knowledge of Facts about HIV/AIDS among Primary School Teachers (N = 120)
Table 4 shows the percentage distribution of the primary school teachers with correct response on modes to reduce transmission of HIV/AIDS.Only 44% of the respondents stated that safe blood can play a role to reduce transmission of HIV/AIDS and 45% stated of maintaining only one sex partner who is not affected by HIV and emphasized on using disposable syringe.

Table 4: Knowledge of Modes to Reduce Transmission of HIV/AIDS among Primary School Teachers (N = 120)
The sources of information on HIV/AIDS mentioned by the teachers are revealed in Table 5.The respondents stated that television is the most important source of getting information about HIV/AIDS which is about 56%, followed by news paper (27.5%).The lowest ranked source of getting information about HIV/AIDS from reading books (2.5%).

Table 5: Sources of Information on HIV/AIDS among Primary School Teachers
From Table 6, it is clear that only 19% of the respondents cited the transmission of HIV through unpro- The study also indicates that efforts are still considered necessarily to increase the knowledge of the teachers serving at primary school level as they had much misperception about the knowledge of facts (Table 3), modes of transmission to reduce contamination (Table 4) and the modes of transmission from one person to another (Table 6).In Bangladesh, like other countries in the region, HIV risk arises mainly from unprotected paid sex, sharing of used needles and syringes by IDU, and unprotected sex between men who have sex with men 10 .Although it is expected that teacher's knowledge must have at a certain level to deliver high quality messages that will impact positively on the behavior of school going children but the study showed that they are not too sure of their own knowledge about the issue.It is immense necessary to train teachers to be able them to deliver sufficient quality information and passion that would have positive behavioral impact on the students.The respondents in this study stated that television and news paper were the first and second most important sources respectively of getting information about HIV/AIDS.The lowest ranked source is of reading books (Table 5).Bankole  and Mabekoje (2008) in a study showed that television was the major sources of getting information on HIV/AIDS to the secondary school teachers in Nigeria 11 .From this scenario, it is to recommend the involvement of libraries in activities that will promote easy access and retrieval of HIV/AIDS information materials.Government should regularly organize and sponsor teachers to attend in training workshops, where clarifications could be sought from experts on areas of misunderstandings.Last but not least, a lot still need to be done to inform teachers for getting information on all areas of human endeavors.