Date of Award

5-11-2013

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Richard Rothenberg

Second Advisor

Dr. Sheryl Strasser

Abstract

Introduction: HIV-related knowledge, attitudes, and behavior are important for HIV prevention, so many studies had been conducted to assess these factors in each country. However, not many studies had been done to compare these factors between high and low HIV prevalence countries. This study aimed at comparing HIV-related knowledge, attitudes, and behavior between an African country with high HIV prevalence, Lesotho, and an African country with low HIV prevalence, Senegal.

Methods: The study used secondary data from Demographic and Health Surveys (DHS), including the 2009 Lesotho DHS and the 2010-11 Senegal DHS, which were nationally representative datasets. Sample sizes of study population were 10,623 in Lesotho and 20,102 in Senegal. IBM SPSS 20 was used to run chi-square tests for descriptive results of all independent and dependent variables, and binary logistic regression for associations between HIV-related knowledge, attitudes, and behavior and HIV status, and associations between these factors and countries.

Results: In both countries, HIV infection had significantly positive associations with having more than one sex partners (Lesotho OR 1.4, Senegal OR 2.7), and with having sexually transmitted disease (STD) in the last 12 months (Lesotho OR 2.0, Senegal OR 4.0). Besides, other variables relating to HIV knowledge, attitudes, and behavior did not show necessarily important associations with HIV status. The study also found that people in Lesotho were less likely to have better comprehensive correct knowledge (OR .8), and use condom with the most recent partner (OR .3), but more likely to have better knowledge of mother-to-child transmission (MTCT) (OR 1.9) and its prevention (OR 3.8). In terms of attitudes, respondents from Lesotho were more likely to have positive HIV-related attitudes toward people living with HIV (OR 15.2), agree with women’s ability to negotiate safer sex (OR 1.7), and support condom education for youth (OR 2.2). Behaviors between respondents in Lesotho and Senegal were also significantly different, with more respondents in Lesotho reporting earlier sexual initiation (OR 1.4), having more sex partners (OR 4.0), paying for sex in the last 12 months (OR 2.0), having any STD in the last 12 months (OR 3.0), and receiving the most recent HIV test results (OR 2.0) than people in Senegal. Knowledge of HIV prevention methods in Lesotho did not differ significantly from Senegal (p-value .9).

Conclusion: Having more than one sexual partners and having STD were important indicators for HIV infection in both countries. Compared to Senegal, people in Lesotho seemed to have better knowledge relating to MTCT of HIV, more positive HIV-related attitudes, but more risky sexual behavior. Continued intervention research is warranted as there are clear patterns of risk between Lesotho and Senegal that highlight opportunities for more tailored prevention efforts surrounding HIV knowledge, attitudes, and sexual risk-taking behavior.

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