Knowledge, attitude and prevention behavior related to HIV/AIDS among students of a college in Lao-PDR: a cross-sectional study

Study design and study site

The study used a cross-sectional self-report questionnaire survey design and was carried out in Kham Mouane Technical-Vocational College, based in Thakhek, the major town in Kham Mouane Province. This urban-based college has a yearly enrolment of around 3,000 students. It offers more than 21 vocational courses, including daytime and evening classes across three academic years.

Participants and data collection

An initial sample size of 750 participants was calculated, based on the total student population of 2734, with the confidence level set at 95%, and a variance value of 0.82 (Mayuree & Pannee, 2015). In case of a high non-participation rate due to the sensitivity of the issue, we included approximately 20% more participants, with a final sample size of 939 participants. A list of 2,734 student names was obtained and of these, participants were selected by simple random sampling (939 names were drawn), ensuring that the same proportion of each academic year was invited. All participants invited to the study volunteered to participate.

The researcher (SC) explained the purpose of the study to all potential participants, their rights to participate and assured them that their information would be kept confidential. Consent forms were handed out and signed by participants or the parents of those aged less than 18 years for participation in the study. Data collection was conducted using the self-report questionnaire and participants completed it individually during an hour break in their classes. All questionnaires were returned to the researchers the next day. Exclusion criterion was failure to give consent. All participants received a small souvenir (a pen) after data collection (participants were not aware they would receive this souvenir prior to participation). All recruitment and data collection took place between 15^th–25^th May 2018.

Questionnaire

The Knowledge, Attitude and Practice (KAP) survey questionnaire for HIV/AIDS prevention behavior was modified from previous research [Kosay et al., 2008; Thanavanh et al., 2013] and was initially developed in Thai. To assure content validity, it was checked by an expert in health behavior from Khon Kaen University, an expert in AIDS prevention and treatment from the Center for HIV/AIDS/ STIs of Khammoune Province and a teacher from Kham Mouane Technical-Vocational College. It was translated into Lao by the second author (SC), who is fluent in Thai and Lao, and then back-translated from Lao to Thai by another health worker at Khammoune Hospital. An assessment of clarity, feasibility and appropriateness was carried out with 30 additional participants who studied cultivation in a college located 25 km from the study site. We pre-tested and edited three times and finally, it had a Conbrach’s Alpha Reliability Coefficient of 0.75.

Questionnaire scoring

The questionnaires were scored as follows: 1) responses to the knowledge of HIV/AIDS section was recorded through answers of true or false and the level of knowledge of HIV/AIDS was classified as ‘low’ for mean scores of less than 60% correct, ‘medium’ between 60–80%, and ‘high’ over 80% correct (Bloom et al., 1971); 2) responses to the attitudes towards people living with HIV/AIDS section were recorded using a Likert scale of strongly agree (5) to strongly disagree (1) and the level of attitudes towards people living with HIV/AIDS was defined as ‘low’ when the mean score was less than 2.7, ‘medium’ when the mean score was between 2.71–3.7 and ‘high’ when the mean score was over 3.7 (Likert, 1961); 3) responses to the HIV/AIDS prevention practices section were recorded using a Likert scale of 5 (regularly) to 1 (never) and the level of practice was defined as ‘safe’ for mean score over 4.2 and ‘risky’ for those scoring less than 4.2 (Best, 1981). When testing the association between HIV knowledge and HIV attitudes and practices by binary logistic regression, Level of knowledge was defined as ‘low’ for scores up to 50% (0–9.0) and high for those more than 50% (9.1–18.0), level of attitudes was defined as ‘positive’ for those scoring above the mean, and ‘negative’ for those scoring below the mean and level of practice was defined as ‘safe’ for those scoring higher than the median and ‘risky’ for those scoring below the median.

Data analysis

All questionnaire data was checked, coded, rechecked and entered into Microsoft Excel (v2017), before being checked and double entered into Epi-Info (version 3.5.4). Missing data was removed from analysis by making listwise data deletion. The data were then transformed by converting to true values for terms that have a negative meaning and all data were analyzed using Stata (v 13.0). Descriptive statistics were used to describe demographic characteristics and KAPs about HIV/AIDS. Pearson's chi-squared test and binary logistic regression was used to test the association between factors.

Ethical approval

This research proposal was reviewed and approved by the Mahasarakham University Ethics Committee for Human Research (No.056/ 2561). Permission to collect data in the local area was obtained from the head of the Public Health Provincial Office (Kham Mouane province) in Laos.

Social-demographic and risky behavior data

Of the 939 participants, 61.6% were women and the mean age was 20.7 years (range 18–28 years). Accounting (20.7%), IT (18.3%), and electrical (15.5%) were the major fields of study, and 49% were first year students. In total, 37.4% lived in their family home, 42.1% in private dormitories and 20.5% in a relative’s house or with friends. For monthly income given to the participants from their parents, 57.1% received more than 400,000 Lao Kip (LAK; USD $46.59), 38.3% received 100,000–400,000 LAK (USD $11.65–46.59) and 4.6% received less than 100,000 LAK (USD $11.65). The majority of the money was spent on fees and food, with one fifth spent on alcohol. More than 80% reported drinking alcohol; 54% reported drinking only sips, 31.9% drinking until slightly intoxicated and 13.9% drinking until drunk. Of those that drank alcohol, 50% drank up to 1–2 times a month, 30% drank 1–2 times a week, and 10% drank every day. Free time was spent in employment (44%) and various entertainment; for example, television (44.1%), partying (37.7%), social media (22.4%), games (20%), and reading (30%). Table 1 presents this information.

HIV/AIDS prevention information sources

Although the college had never conducted specific HIV/AIDS intervention education, participants had heard of HIV/AIDS and some students reported, to the researchers in person, their peers previously dying of AIDS. Information about HIV came from various sources, such as the internet (76.6%), television (55.3%) or health personnel/teacher (see Table 2).

HIV knowledge, attitude and practices

Overall, the reported level of HIV/AIDS knowledge was low, with very poor/erroneous knowledge of HIV transmission routes: 22.8% correctly reported that HIV transmission could be controlled by having a single partner and using condoms while having sex; 27.9% indicated that HIV could not be transmitted through a mosquito bite; 27.2% incorrectly perceived that couples who are already infected with AIDS did not need to use condoms; 39.4% incorrectly perceived that HIV can be transmitted through sharing a toilet with a PLHIV and almost half (48.9%) incorrectly believed drinking alcohol could disinfect them from HIV infection (Table 3).

Attitudes towards PLHIV

Overall, the level of attitude towards PLHIV was moderate (Table 4). There were many negative stigma issues: more than 80% believed that people who were HIV positive should not reveal themselves to society; and not be allowed to continue his/her teaching or studies. Between 60–70% believed that: requesting a boyfriend to use a condom indicated mistrust; and if someone has AIDS, he/she needn’t maintain their health because it is an incurable disease. In addition, 50–59% felt that: people should not buy from a shopkeeper or food seller who is HIV positive; buying condoms was disgusting and embarrassing; relatives who had progressed to the AIDS stage should be separated from their families due to the disgust of other people; sex education is shameful and shouldn’t be in school programs as it does not need to be taught or instructed; and HIV testing is not necessary as it does not cure disease. Finally, 50.8% believed that healthy-looking men are unlikely to have HIV, so if they are having sex, they shouldn’t have to wear condoms. Table 4 presents fuller details.

Practices regarding HIV/AIDS

Table 5 reveals that 60.2% reported behaviors to prevent HIV/AIDS through avoidance of risky behaviors such as: using condoms regularly during sex with casual partners; 75.2% don’t co-habit with boy/girlfriends, which can increase opportunity for sex or watching porn videos; 77% don’t share needles and syringes; 61% don’t have sex with girl/boyfriends who they are just dating; and 52.3% don’t have sex when under the influence of alcohol. When visiting nightclubs, 73.4% of them reported drinking alcohol.

Association between knowledge about HIV and attitudes and practices related to HIV

The binary logistic regression reveals that participants with low levels of knowledge were likely to have proportionately higher negative attitudes (OR=1.80; CI=1.07, 1.89; P value <0.001) and risky practices relating to HIV/ AIDS (OR=1.51; CI: 1.07, 1.89; P value=0.014). Demographic factors associated with attitudes and practices include: aged less than 20.6 years was related more significantly to negative attitudes (OR=0.73; CI: 0.56, 0.94; P value=0.016 and OR=0.69; CI: 0.52, 0.91; P value 0.009); being male was associated with proportionately higher risk behaviors (OR=2.27; CI: 1.71, 3.02; P value <0.001); and there was a non-significant association between alcohol drinking and negative attitudes and risky behaviors. Table 6 presents fuller details.

Underlying data

Raw datasets have not been made available at the request of the Mahasarakham University Ethics Committee in order to maintain participant confidentiality. Access to the raw data can be obtained upon request after seeking permission from the Mahasarakham University Ethics Committee. Anyone wishing to access the data should first contact the corresponding author, who will facilitate contact with the Ethics Committee (contact email: research@msu.ac.th). Access will be granted under the conditions that the person or organization seeking access provides sufficient rationale, highlighting the benefits for use of this data, and are operating under appropriate research ethics.

Extended data

Figshare: Knowledge, attitude and prevention behavior related to HIV/AIDS among students of a college in Lao-PDR: a cross-sectional study, https://doi.org/10.6084/m9.figshare.11846097.v1 [Wongkongdech, 2020].

This project contains the following extended data:

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).