Knowledge of Men and Women about Reproductive Tract Infections and AIDS in a Rural Area of North India

This is an impact study of a community-level health-education intervention for reproductive tract infections/sexually transmitted diseases (RTIs/STDs) that was carried out in three villages of the Haryana state in north India. The intervention, implemented by the Community Medicine Department of Postgraduate Institute of Medical Education and Research in Chandigarh, India, was aimed at increasing awareness among men and women of reproductive age about the prevention and treatment of RTIs and HIV/AIDS. Health education was imparted through one-to-one interactions with men and women during home visits, at village-based clinics and health camps, and through health-education talks with men and women. The effects of the intervention were measured against a baseline study carried out two years prior. Earlier research in the region had indicated that sixty-one percent of women in another rural area of Haryana state had symptoms of RTIs, but their treatment-seeking practice was very poor.



The intervention itself involved several different components over the two years. In the first year, the emphasis was on case identification and referral to clinics and special RTI/STD health camps organised in the villages. In the second year greater focus was given to providing health information to male and female respondents, aged 15-49 years, about RTI/STDs during home visits. In addition, six RTI/STD camps (two per village - one round each year) were organised to manage the cases referred during home visits. These camps were advertised in the villages through announcements and key-informants. Facilities for vaginal examinations were made available, and medicines for RTIs/STDs were given free of charge.



Twenty health-education sessions (addressed to married women aged 15-49 years) were conducted during the second year of the intervention in the entire area while nine health-education talks (4 for women and 5 for men) were conducted only in the study villages in the second year of the intervention.



In addition, pamphlets that were designed in simple vernacular language were given to treatment seekers on the understanding that even if they were not able to read, someone else in the family or neighbourhood would be able to help them. The pamphlets were of two types: one was focused exclusively on RTIs, while another was designed for HIV/AIDS. The latter had messages on modes of HIV/AIDS transmission and prevention.



The evaluation was carried out using a series of semi-structured interview tools in the three chosen evaluation villages. The villages were chosen for the study because a weekly clinic is organised at a nearby, centrally-located sub-centre as part of the Indian government's community health service programme. A complete house-to-house visit was done at baseline as part of the first round of active surveillance activity, while a sample survey was done at follow-up. The authors recognise that some of the dramatic changes observed may be attributable to the second evaluation only using a sample rather than a comprehensive survey of all households.



The socio-demographic profile and knowledge of respondents on RTI/STDs and AIDS was recorded and assessed. Health education activities were initiated after the baseline survey and for the evaluation stage, a scoring system was developed. All correct responses were given a score of 1 and incorrect responses or no responses were given a score of 0. The total score was 10. Questions included in the scoring system were related to knowledge about the prevention and treatment of RTI/STDs and HIV/AIDS.



Baseline and follow-up evaluations revealed that there was an improvement in the median total knowledge score of women from 0 to 6, whereas it remained at 5 for men both at baseline and follow-up. Knowledge about RTI/STIs increased among both men and women from the median score of 0 to 2 and from 0 to 3 respectively. The median knowledge score on HIV/AIDS declined among men from 4 to 2 but increased from 0 to 3 among women. There were also substantial improvements in knowledge about specific aspects of STDs and HIV/AIDS such as which were curable and treatable and which were not, as well as ways of transmission.



In addition, records of clinic attendance were examined to assess the likely impact of the intervention on clinic attendance. Clinic attendance for RTI/STD cases (those referred to the regional hospital) showed an eight-fold rise from an average of four cases per month in 1998-1999 to an average of 35 cases per month in 1999-2000.



As noted, there were substantial gender differences in knowledge and treatment-seeking behaviour in this study. Women had lower initial knowledge but gained the most from the intervention. They were also more likely to seek treatment. The authors suggest that several factors might have contributed to these differences including the fact that women were the prime users of clinic and camp services and likely acquired more knowledge during this process.



The present study has shown an increase in men's knowledge score about RTI/STDs but showed a dip for HIV/AIDS. The availability of services for RTI/STDs and inter-spouse communication might have contributed to better knowledge among men, though HIV communications probably did not diffuse well into the community, and mass media has remained the popular source of information on HIV/AIDS, possibly with a lesser overall impact.



The authors' conclusion is that a multi-pronged health-education strategy through home visits, RTI case management and counselling, and organisation of regular weekly clinics, periodic camps, and health education talks could increase the level of awareness about RTIs/STIs among both men and women. They feel it is important to note that no single intervention will be as effective as an approach that spans multiple message mediums.