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ABSTRACT Knowledge of prisoners regarding HIV/AIDS in
Kerman was evaluated. Analysis indicated that the sample
(n = 350) of prisoners had relatively high
knowledge about HIV/AIDS and its modes of transmission.
However, they had a lower level of knowledge about
HIV/AIDS prevention. The overall knowledge of men about
AIDS was significantly lower than women. Persons aged 46
years and older and illiterate inmates had the least
knowledge about modes of transmission. In addition, the
knowledge of illiterate prisoners about HIV/AIDS
prevention was significantly lower than others.
Evaluation of attitudes and practices of prisoners and
implementation of educational programmes regarding
HIV/AIDS are suggested.
Connaissances des prisonniers en ce qui concerne le VIH/SIDA
et sa prévention à Kerman (Répu-blique islamique d’Iran)
RESUME Cette étude a été réalisée pour évaluer les
connaissances des prisonniers en ce qui concerne le VIH/SIDA
à Kerman. L’analyse a indiqué que les prisonniers
constituant l’échantillon (n = 350) connaissaient
relativement bien le VIH/SIDA et ses modes de
transmission. Toutefois, leurs connaissances concernant
la prévention du VIH/SIDA étaient plus faibles. Les
connaissances globales des hommes sur le SIDA étaient
significativement moindres que celles des femmes. Les
prisonniers âgés de 46 ans et plus et les prisonniers
analphabètes étaient ceux qui avaient le moins de
connaissances au sujet des modes de transmission. De
plus, les connaissances des prisonniers analphabètes en
ce qui concerne la prévention du VIH/SIDA étaient
considérablement moindres que celles des autres
prisonniers. L’évaluation des attitudes et pratiques des
prisonniers et la mise en place de programmes éducatifs
pour modifier les comportements à haut risque en ce qui
concerne le VIH/SIDA sont proposées.
Introduction
It has been estimated that 42 million people were living
with HIV at the end of the year 2002, with young people
being the group most affected and women being the more
vulnerable [1,2]. Many infected people do not
know that they are carriers and millions of people have
low knowledge of HIV/AIDS or do not know how to protect
themselves against infection [1,2]. There were
7.2 million people living with HIV in South-East Asia in
2002, and the first mode of transmission was through
sexual contact and the second through intravenous (IV)
drug abuse [3]. In the Islamic Republic of Iran,
it has been estimated that about 35 000 people are
living with HIV [4]. Only 4424 cases are
recognized, of whom 95.6% are men and 4.4% are women,
and 66% are IV drug addicts. Thus the commonest mode of
transmission is IV drug abuse [4].
Some studies have indicated that high risk behaviours
are common among prison inmates [5–9]. One study
at a prison revealed that many inmates knew the modes of
AIDS transmission, but 85% of them were IV drug users
and 43% of addicts were using shared syringes [10].
In another prison, there were high rates of history of
drug and alcohol use among prisoners [11].
Education on HIV/AIDS and its means of prevention is
thus essential among such groups in order to control the
disease.
Since prisoners are a high risk population, many studies
have assessed their knowledge level. It has been
reported that the average knowledge scores about
HIV-infected people were lower among prison inmates than
in the general population [12]. In one prison,
the highest knowledge scores were found for those aged
15–16 years, and women had a higher mean knowledge score
than men [13]. Inmates usually are poorly
educated, and one study showed a high school sample to
be more knowledgeable than incarcerated youths [14].
Since little is known about the knowledge of prisoners
regarding HIV/AIDS in the Islamic Republic of Iran, the
objectives of this study were:
• To identify the knowledge level of prisoners about
HIV/AIDS, its modes of transmission and prevention.
• To determine the relationship between the prisoners’
knowledge level and characteristics such as age, sex,
education and length of stay in prison.
Methods
The study sample consisted of 350 prisoners selected
from the only prison in the city of Kerman. Since the
prison is partitioned into eight sections according to
the type of crime, the members of the sample were chosen
by stratified sampling. Data were collected by a
questionnaire that was developed from an earlier
questionnaire used to evaluate the knowledge of some
students and teachers at schools [15]. The
questionnaire included three sections with items about
overall knowledge of HIV/AIDS, its modes of transmission
and prevention. Also personal characteristics, such as
age, sex, education and the length of imprisonment were
determined. All of the prisoners had been exposed to one
of various informational sources (e.g. instructors in
prison, radio, television). Illiterate prisoners
answered the questions by instructing a prison warden.
Knowledge was calculated by summing correct answers and
dividing by the total number of questions in each
section and multiplying by 100. The mean was then
calculated for all persons in the sample. Frequency of
correct answers was also calculated and differences
between prisoners according to personal characteristics
were tested by t-test, analysis of variance and
Kruskal–Wallis test.
Results
The total response rate was 97%. Women made up 36.2% of
the sample and men 63.8%, and the mean age was 33 years.
Prisoners were divided into four age groups: under 25
years old (26.3%), 25–35 years (40.3%), 36–45 years
(22.1%), and 46 years and over (11.3%). Participants
with an education level below high-school diploma level
represented 49.8% of the sample and illiterate prisoners
constituted 27.0%, while those with a high-school
diploma and a graduate degree represented 18.3% and 4.8%
respectively.
In answering the question "Do you know about AIDS?" many
prisoners (73.4%) answered positively. Among
informational sources, they had received a lot of
information from instructors in prison (63.8%). Six
items were used to evaluate the overall knowledge about
HIV/AIDS
(Table 1).
Nearly all prisoners (97.7%) knew that IV drug users
were at high risk, and almost half of them (44.8%) had a
knowledge score of 100. The mean index was 86.7 (SD =
15). Analysis indicated a difference between the sexes.
Women had a mean score of 90.4 and men had a mean score
of 84.6 (t = 3.36, P = 0.001).
Table 2
shows the prisoners’ knowledge about modes of
transmission of HIV. The table shows the percentages of
correct answers and mean scores in subgroups of
prisoners. Analysis of knowledge scores indicated that
21.5% of the participants obtained a score of 100 and
the mean was 84 (SD = 14.7). There were statistically
significant differences between age group and education
level for knowledge scores. Prisoners aged 46 years and
older had the lowest mean score of 75.6 (F = 6.2,
P = 0.0007) and illiterate inmates had the lowest
mean score of 77.7 (K–W = 15.16, P =
0.001).
Fourteen items (14) were used to estimate the knowledge
of HIV/AIDS prevention
(Table 3).
Only 3.4% of prisoners got the highest score of 92.9 and
the mean was 67.5 (SD = 10). Statistical differences
were also found between educational level. Illiterate
prisoners had the lowest mean score of 65.2 (K–W
= 20.2, P = 0.0002).
Discussion
The most important finding in this study was a
relatively high level of knowledge prisoners had about
HIV/AIDS and its modes of transmission, but lower
knowledge about HIV/AIDS prevention. Another positive
finding was that prisoners under 26 years of age had a
significantly high mean score of knowledge about modes
of transmission. Despite this, the overall knowledge
about HIV/AIDS and its prevention was the same among
different age groups. In some studies, it has been
documented that adolescent prisoners had significantly
poorer knowledge about HIV/AIDS than other age groups [12,16].
In earlier studies, it has been shown that new prisoners
had a low level of knowledge [17,18], but in the
present study there was no significant difference
between inmates according to their length of
imprisonment. This might be due to a fairly high
knowledge in Iranian society. Also, a significant
difference was found between prisoners depending on
their level of education. Prisoners with a lower level
of education had low knowledge scores about HIV/AIDS
transmission and prevention. It is essential therefore
to prepare more educational programmes for illiterate
persons and those with a low level of education.
IV drug use is one of the most significant modes of HIV
transmission in the Islamic Republic of Iran [4].
It is very possible that a number of our participants
were IV drug abusers. However, 95.2% of the participants
knew that sharing syringes is one of the modes of HIV
transmission. The usage of shared syringes was reported
among prisoners in Spain even though they knew that it
was a significant mode of transmission [10]. It
is essential to design educational programmes about the
dangers of abusing drugs, especially IV drugs, to alter
attitudes and practices of inmates to avoid addiction
and the use of shared syringes. Sexual transmission is
the other important means of transmission in the country
[4]. In this study, prisoners had a high level of
knowledge about transmission through intercourse with
infected homosexuals and heterosexuals. They also knew
that avoidance of unusual sexual behaviours and being
faithful to the one’s spouse could help prevent
infection. Some studies have reported a high level of
knowledge among prisoners about HIV transmission through
sexual behaviour, but at the same time have reported a
high degree of practising risk behaviours among them [10,12].
This suggests that it is vital to provide educational
programmes to alter high-risk behaviour inside and
outside of prisons.
There was a significant difference in overall knowledge
of HIV/AIDS between men and women. Women were more
knowledgeable than men and this has also been shown in
another study [13]. However, knowledge of men and
women about modes of transmission and prevention was
identical. According to the World Campaign against AIDS
in December 2000, men were targeted because they are
more at risk [19]. In the Islamic Republic of
Iran more cases of AIDS are found among men [4]
so special educational programmes must be designed for
this group.
Information and education are vital in the fight against
HIV/AIDS. Therefore, informational sources (schools,
television, radio) must provide more educational
programmes about this topic in order to change high-risk
behaviour in prisons, schools and among the general
public. This study did not investigate attitudes and
practices of inmates regarding AIDS and therefore it is
recommended that further studies be conducted to assess
these aspects.
Acknowledgements
The author acknowledges with thanks the support and help
of the Vice-Chancellor of Research at Kerman University
of Medical Sciences and also all staff at Kerman prison.
References
1. AIDS epidemic update–December 2001. Available at:
www.unaids.org/epidemic_ update/report_dec01/index.html
(accessed 20 May 2003).
2. Centers for Disease Control and Prevention, Division
of HIV/AIDS Prevention, International Statistics.
Available at: http://www.cdc.gov/hiv/stats.
htm#international (accessed 20 May 2003).
3. AmfarTM AIDS research. AIDS in Asia. Available at:
www.amfar.org/cgi_bin/iowa/asia/aids/index.html
(accessed 31 May 2004).
4. Report from the beginning of the Program for
Control of AIDS from 1986 to 2002. Teheran, Ministry
of Health and Medical Education, Department of Disease
Control, 2002.
5. Dolan K et al. Availability and risk behavior in
prison in New South Wales, Sydney, Australia.
Syndey, National Drug and Alcohol Research Centre,
1994:14.
6. Gaughwin MD et al. HIV prevalence and risk behaviours
for HIV transmission in South Australian prison. AIDS,
1991, 5:845–51.
7. Horsburgh CR et al. Seroconversion to human
immunodeficiency virus in prison inmates. American
journal of public health, 1990, 80:209–10.
8. Mutter RC, Grimes RM, Labarthe D. Evidence of
intraprison spread of HIV infection. Archives of
internal medicine, 1994, 154:793–5.
9. Turnbull P, Stimson GV, Stillwell G. Drug use in
prison. London, Centre for Research on Drugs and
Health Behaviour, 1994:3.
10. Carrasco Rodriguez P, Sanchez-Cruz JJ. Comparación
de los conocimientos y los comportamientos de riesgo
sobre el SIDA de los internos VIH+ y VIH– de la prisión
provincial de Granada. [Comparison of knowledge and risk
behavior regarding AIDS among HIV+ and HIV– inmates at
the provincial prison of Granada.] Gaceta sanitaria,
1996,10(54):104–9.
11. Mahon N. New York inmates’ HIV risk behaviors: the
implications for prevention policy and programs.
American journal of pubic health, 1996, 86:1211–15.
12. Delorme C et al. Connaissances, croyances et
attitudes des détenus face au Sida et a l’infection a
VIH: une enquête au centre penitentiaire de Marseille.
[Knowledge, beliefs and attitudes of inmates towards
AIDS and HIV infection: a survey in Marseille
penitentiary centre.] Revue d’épidémiologie et de
santé publique, 1999, 47(3):229–38.
13. Lanier M et al. Changes in incarcerated adolescents’
human immunodeficiency virus knowledge and selected
behaviors from 1988 to 1996. Journal of adolescent
health, 1999, 25:182–6.
14. Katz R et al. Knowledge and attitudes about AIDS: a
comparison of public high school students, incarcerated
delinquents and emotionally distributed adolescents.
Journal of youth and adolescence, 1995, 24:117–31.
15. Mosavi A. et al. Assessing of the knowledge level
of boys and girls in school of Kerman regarding AIDS.
[Thesis]. Kerman, Kerman University of Medical Sciences,
1999.
16. Nader P et al. Comparison of beliefs about AIDS
among urban, suburban, incarcerated and gay adolescents.
Journal of adolescent health care, 1989,
10:413–8.
17. Celentano DD et al. Maryland inmates knowledge of
HIV–1 transmission and prevention; a comparison with the
US general population. Journal of prison & jail
health, 1990, 9(1):45–54.
18. Vaz RG, Gloyd S, Trindade R. The effects of peer
education on STD and AIDS knowledge among prisoners in
Mozambique. International journal of STD & AIDS,
1996, 7(1):51–4.
19. World AIDS Campaign 2000. Men and AIDS. Men make
a difference. Cairo, World Health Organization
Regional Office for the Eastern Mediterranean, 2000 (EMRO
press release No. 16). |
