Date of Award

Spring 5-11-2018

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Richard Rothenberg

Second Advisor

Dr. Monica Swahn


INTRODUCTION: HIV/AIDS knowledge is a major factor in the prevention of further HIV/AIDS spread. South Asia has some of the worst literacy rates in the world, with Afghanistan and Pakistan having the lowest rates in the region. There is very limited data on the association between literacy rates and HIV knowledge in Afghanistan and Pakistan. Both countries have recorded low prevalence of HIV, but have been categorized as high-risk countries for epidemic due to the active intravenous drug use and low education in the countries.

AIM: The purpose of this study is to identify associations between literacy and HIV knowledge and also to compare HIV knowledge between Afghanistan and Pakistan.

METHOD: The study used secondary data from the Demographic and Health Surveys (DHS) that collect nationally representative data on Pakistan (2012-2013) and Afghanistan (2015). Sample sizes of the study populations were 40,221 people from Afghanistan and 16,654 people from Pakistan. Variables were created in order to evaluate HIV knowledge in the Afghanistan and Pakistan population. SAS 9.3 was used to run binary logistic regression for associations between literacy and HIV-related knowledge in Afghanistan and Pakistan. Logistic regression was also used to analyze the association of country (Afghanistan and Pakistan) and HIV-related knowledge. Socio-demographic factors i.e. residence, age, marital status, education, and wealth index were controlled for in the analysis.

RESULTS: In both Afghanistan and Pakistan, there was a significant association between literacy and HIV-related knowledge. In both countries, literacy had a positive association with the specific variables chosen to signify accurate HIV knowledge. After controlling for socio-demographic factors, people who were illiterate had lower chances of having accurate comprehensive preliminary HIV knowledge (Afghanistan OR .820, Pakistan OR .642), comprehensive HIV transmission knowledge (Pakistan OR .756), comprehensive HIV prevention knowledge (Afghanistan OR .829, Pakistan OR .676), MTCT knowledge (Afghanistan OR .696, Pakistan OR .588), and accurate overall HIV knowledge (Afghanistan OR .835, Pakistan OR .701). The Pakistan population was more likely to have accurate knowledge of HIV/AIDS than the population in Afghanistan (Preliminary HIV Knowledge OR 2.426, HIV Prevention Knowledge OR 1.233, HIV Transmission Knowledge OR 2.322, MTCT Knowledge OR 2.468, and Overall HIV Knowledge OR 2.275).

DISCUSSION: The results of this study continue previous research about associations between literacy and health information, while showing its impact on Afghanistan and Pakistan.

CONCLUSION: The study illustrates that more attention on education is needed in order to effectively prevent HIV spread. Afghanistan and Pakistan exhibit a high risk for HIV epidemics due to their high illiterate population, high intravenous drug use, and low knowledge of HIV. Further research should be conducted in order to implement interventions that could proactively prohibit an epidemic.

Available for download on Friday, February 08, 2019