Superframe Segmentation Framework

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87 intervention group and 72.0% in the control group) since the major ethnic group in Lagos State is Yoruba.

The mass media has played a major role in creating awareness about HIV/AIDS awareness since the first case in Nigeria was discovered in 1986. This is probably the reason for the high level of awareness of the disease among respondents in this survey where 91.5% and 90.0% of respondents in the intervention and control groups respectively were aware of HV/AIDS. This is similar to what was observed in a national survey in Nigeria where 88% of women and 94% of men had heard about HIV.⁵⁹ Most of the respondents in both the intervention group (91.5%) and the control group (90.0%) identified sexual intercourse as a mode of transmission of HIV. This is higher than what was reported in a study among market women in Lagos where 48% of the respondents believed that heterosexual intercourse is the primary route of HIV transmission.⁴²

Mother to child transmission is a well established mode of HIV transmission and these infections may occur during pregnancy, delivery and breastfeeding.⁵⁹ However, this was the least mentioned mode of transmission among respondents in both groups. In addition, during the pre-intervention Focus Group Discussions (FGDs), none of the participants in both markets mentioned mother to child transmission as a mode of HIV transmission. The association of HIV with promiscuity has probably made the sexual mode of transmission more popular than other modes of transmission. This might explain why more respondents were aware of the sexual mode of transmission as opposed to mother to child transmission. However, about 50% of respondents in a survey in Ghana knew that an HIV positive woman can transmit HIV to her baby before birth. This study was carried out among pregnant women attending antenatal clinic

88 in a teaching hospital and it is therefore not surprising that about half of them were aware of this mode of transmission since antenatal health talks usually emphasize the importance of HIV screening during pregnancy in order to prevent mother to child transmission.⁶⁴ In a Haitian survey, the respondents who knew about mother to child transmission of HIV were in the minority (4.7%).⁶⁵

More than half of the respondents in the intervention group (58.2%) and control group (53.3%) who knew about mother to child transmission of HIV mentioned pregnancy as a period when HIV can be transmitted from a mother to her child. Less than half of the respondents in both groups (37.3% in the intervention group and 37.2 % in the control group) knew that HIV can be transmitted from a mother to her child during delivery while 61.2% and 60.5% of respondents in the intervention and control group respectively knew that HIV can be transmitted while a child is breastfeeding. These proportions are higher than what was observed in a national survey in Nigeria where 52% of women and 59% of men knew that HIV can be transmitted through breastfeeding.⁵⁹ Interestingly in Kenya, 87% of respondents in a survey knew that HIV can be transmitted through breastfeeding.⁶⁶ The finding in the Kenyan study could be because the HIV messages that the respondents were exposed to emphasized on this mode of transmission.

Majority of the traders in the intervention group (75.4%) and control group (73.7%) also knew that HIV can be transmitted through blood transfusion. Similarly 70.4% of respondents in the intervention group and 71.1% in the control group were aware that sharing contaminated sharp objects places an individual at risk of acquiring HIV. This shows that awareness is high about

89 these modes of transmission of HIV in contrast to the low awareness on mother to child transmission of HIV observed in both the intervention and control groups.

Latex condoms when used consistently and correctly are highly effective in preventing heterosexual transmission of HIV.³¹ Promotion of condom use as a way of preventing not only HIV but also other sexually transmitted infections is widespread. This may explain whymajority of respondents in the intervention and control groups knew that HIV can be prevented by using condoms. This finding is supported by what was observed in a survey in Nigeria where 53.0% of women and 72.4% of men knew that the use of condoms can prevent against HIV and even more by findings in a national survey in Ghana where 80% of respondents knew the same.⁶⁷ Other ways of preventing HIV such as limiting sexual intercourse to one HIV negative partner who has no other sex partners and abstaining from sexual intercourse were known to majority of the respondents. However the difference in knowledge of ways of preventing the sexual transmission of HIV among respondents in both groups was not statistically significant.

Less than half of the respondents in both the intervention and control groups had correct knowledge of HIV/ AIDS. This shows that despite the high awareness of HIV/AIDS among the respondents in both groups, knowledge of HIV and AIDS was poor. This is similar to what was observed in a Nigerian survey where 26.9% of women and 38.4% of men in Lagos State had correct knowledge of HIV/AIDS while 23.4% of women and 35.6% of men in Nigeria had correct knowledge of HIV/AIDS.⁵⁹

Despite the fact that South Africa has the highest burden of HIV in Africa, more participants in this survey knew that a healthy-looking person can have HIV than what was found in a survey

90 which was conducted in South Africa where only 54% of respondents knew that a healthy-looking person can have HIV.^{11, 68} This suggests that the high prevalence of a disease in a particular region does not translate to a good knowledge of the disease among the population.

About 75% of respondents in the intervention group and 61.6% in the control group knew that HIV cannot be transmitted by mosquito bite. During the pre-intervention FGDs, one of the misconceptions about HIV/AIDS was the transmission of HIV through mosquito bite. The participants revealed that transmission of HIV from mosquito bites is due to the exchange of blood that occurs during such bites. In another survey conducted in the United States of America only 43.3% of respondents knew that HIV cannot be transmitted by mosquito bite. ⁶⁹ Mosquitoes constitute a serious problem in Nigeria because of their role in the transmission of malaria parasite in contrast to the United States where they are not encountered in everyday life.. This could explain why Nigerians are more likely to seek information about the possibility of the transmission of the AIDS virus through mosquito bite.

Antiretroviral therapy has significantly reduced morbidity and mortality, prolonged life expectancy and improved quality of life among people with HIV infection^.70 Majority of respondents in the intervention (67.3%) and control (55.1%) groups were not aware of antiretroviral drugs. This may be partly responsible for the association of HIV/AIDS with death among the traders during the FGDs. More than half of respondents in the intervention and control groups (58.3% and 56.1% respectively) knew that HIV cannot be cured compared to 40%

in a South African survey.⁶⁸

91 Despite the high level of awareness of HIV/AIDS among respondents, uptake of HCT was low as only 18.6% of respondents in the intervention group and 24.7% in the control group had checked their HIV status. Majority of the respondents who had checked their HIV status did so two or more years prior to this survey and most of the tests were carried out in government health facilities. A possible reason for this could because HIV test in many Government health facilities is free of charge. Fear of rejection and discrimination can discourage people from going for HIV Counseling and Testing.⁵¹ Many traders may not go for HCT due to the long waiting time in many health facilities especially Government owned facilities as revealed during the focus group discussions.

Most of the respondents in both the intervention (88.9%) and control (84.3%) group did not personally know someone who was HIV positive. HIV-related stigma may have prevented individuals who are positive from disclosing their status making it unlikely for many of these traders to know people who have the infection.

Stigma and discrimination have been shown to be barriers to HIV prevention, HIV Counseling and Testing and care for people living with HIV/AIDS.⁷⁰ HIV-related stigma was common among respondents in both the intervention and control markets. Only 21.1% of respondents in the intervention group and 38.4% in the control group had a positive attitude towards PLWHA.

This might not be unrelated to the poor knowledge of HIV/AIDS observed in both groups. In addition, during the FGDs about half of the participants in both markets believed that people who are HIV positive are inferior to those who do not have the disease.

The initial association of HIV with death helped to shape the attitude of people towards those who have the disease. ^{41, 44} Health care providers were blamed for this during the FGDs.

92 A higher proportion of males in this study had correct knowledge of HIV and AIDS compared to the females. This is not surprising because men actively seek information from the mass media compared to women. Similarly, a higher proportion of respondents in the age group 30-39 had correct knowledge of HIV and AIDS compared to their counterparts in other age groups. People in their thirties are knowledgeable members of the society and many in this age group are likely to be well informed about HIV.

Knowledge of HIV and AIDS increased with educational level of respondents. High proportions of respondents who had primary and secondary education had incorrect knowledge of HIV and AIDS whereas high proportions of respondents with tertiary education had correct knowledge of HIV/AIDS. In Nigeria, the likelihood of having correct knowledge of HIV and AIDS increases with educational level.⁵⁹

Tertiary education, being a male and having tested for HIV were associated with a positive attitude towards people living with HIV/AIDS. This is partly supported by findings from another survey in four African countries where negative attitudes were related to never having tested for HIV, lacking knowledge of HIV and never having discussed HIV/AIDS.⁷¹ In another survey among traders in China, punishing beliefs towards PLWHA was related to unwillingness to test for HIV.⁴⁷

The proportions of respondents in the intervention group who knew the modes of transmission of HIV increased significantly after the health education. The increases in proportions of respondents who knew that sexual intercourse and mother to child transmission were modes of transmission of HIV were statistically significant (P=0.013 and 0.000 respectively). The

93 increases observed in the control group were not statistically significant. This means that the health education gave the traders an opportunity to learn more about the modes of transmission of HIV. There were also increases in the proportions of respondents in the intervention group who knew how to prevent sexual transmission of HIV. The proportions of respondents who knew that HIV can be prevented by using condoms and abstaining from sexual intercourse increased significantly in the intervention group (p = 0.015 and 0.000 respectively) but not in the control group. This difference in knowledge shows that the intervention programme was effective.

Antiretroviral drugs improve and prolong the lives of people living with HIV/AIDS and in addition reduces HIV transmission and as expected, the future HIV/AIDS burden.⁷² The proportion of respondents in the intervention group who were aware of antiretroviral drugs increased significantly after the health education (p = 0.000). The increase observed in the control group was not significant.

The health education sessions provided an opportunity for the traders to acquire a comprehensive knowledge of HIV/AIDS. The proportions of respondents who had correct knowledge of HIV and AIDS increased by 27.9% in the intervention group and 3.6% in the control group. The increase was statistically significant in the intervention group (p = 0.008) but not in the control group. Health education is known to improve knowledge on HIV and therefore leads to a reduction in HIV-related stigma.^{17, 20} There was also a statistically significant increase in the proportion of respondents in the intervention group who had a positive attitude towards PLWHA

94 (p = 0.006). There was no increase in the proportion of respondents in the control group who had a positive attitude towards PLWHA.

The proportion of respondents who had checked their HIV status increased by 13.4% and 2.1%

in the intervention and control groups respectively. The increase was statistically significant in the intervention group (p = 0.02) but not in the control group. Awareness about HCT centres was created during the health education and this may be responsible for the increase observed in the intervention group. In the intervention group, the proportion of traders who knew about mother to child transmission of HIV increased significantly by 39.8% whereas in the control group only a 3% increase was observed. This increase in the control group was not significant. Mother to child transmission was the least mentioned mode of transmission of HIV in both groups pre-intervention. The increase in the proportion of traders in the intervention group who knew about this mode of transmission shows that the health education was effective.

The effectiveness of the intervention is also seen in the statistically significant increase in the proportion of respondents in the intervention group who knew that HIV can be transmitted from a mother to her child during pregnancy and breastfeeding (p = 0.020 and 0.000 respectively). The increases observed in the control group were not statistically significant.

There is no evidence that HIV can be cleared by drugs or the immune system which makes the search for a cure one of the most challenging and potentially rewarding areas of AIDS research.⁷³ The proportion of respondents who knew that HIV cannot be cured increased by 14.1% in the intervention group and 7.1% in the control group. The increase in proportion was statistically significant in the intervention group (p = 0.013) but not significant in the control group. About

95 half of the respondents in both groups would sleep in the same room with an HIV positive person pre-intervention (intervention; 48.7% and control; 52.5%). There was a statistically significant increase in the percentage (69.6%) of respondents in the intervention group who would sleep in the same room with an HIV positive person after the intervention (p=0.000). An increase was also observed among respondents in the control group (57.9%) but this was not significant. In a similar survey among traders in Ibadan 35% of the respondents would sleep in the same room with an HIV positive person before the intervention but this increased to 52% after the intervention.²⁰ In both instances the traders participated in HIV education programmes and correct knowledge of HIV/AIDS led to a reduction in stigma among the traders.

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