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ORIGINAL RESEARCH

Determinants of the Community Knowledge and

Attitude Towards HIV Prevention Methods in
Majang Zone, Southwest Ethiopia
This article was published in the following Dove Press journal:
HIV/AIDS - Research and Palliative Care

1
Wondimagegn Wondimu Background: Although in Ethiopia there is a high burden of HIV/AIDS, the community
Adane Asefa 1 knowledge and attitude towards HIV/AIDS prevention has not been investigated adequately.
Qaro Qanche 2 Thus, this study assessed the determinants of the community knowledge and attitude towards
Tadesse Nigussie 3 HIV/AIDS prevention in the Majang zone which is the zone with the highest HIV prevalence
in Ethiopia.
Tewodros Yosef 1
Methods: A community-based cross-sectional study was conducted in the Majang zone,
1
Department of Epidemiology and southwest Ethiopia from March 1st to May 31st, 2019 by including randomly selected 845
Biostatistics, School of Public Health,
College of Medicine and Health Sciences, adults. Knowledge and attitude towards HIV prevention methods were dependent variables.
Mizan-Tepi University, Mizan Aman, The independent variables include socio-demographic characteristics and behavioral factors.
Ethiopia; 2Department of Public Health,
A binary logistic regression was employed to determine the association using the odds ratio
School of Public Health, College of
Medicine and Health Sciences, Mizan-Tepi at 95% confidence intervals. A p-value of less than 5% was considered to declare the final
University, Mizan Aman, Ethiopia; significance.
3
Department of Reproductive Health and
Nutrition, School of Public Health, Results: Of 845 respondents recruited, 772 participated yielding a 91.4% response rate. Not
College of Medicine and Health Sciences, sharing contaminated sharp materials (63.4%), consistent condom use (61.2%), and absti­
Mizan-Tepi University, Mizan Aman, nence (57.9%) were the prevention methods mentioned by majority of the respondents. Only
Ethiopia
two of five respondents (39.6%) had good HIV prevention knowledge. More than half [412
(53.4%)] of the respondents had a positive attitude towards HIV prevention. The independent
determinants of HIV prevention knowledge were secondary educational status (AOR=1.84;
95% CI=1.04, 3.24), tertiary and above educational status (AOR=2.01; 95% CI=1.07, 3.75)
and positive HIV prevention attitude (AOR=1.89; 95% CI=1.39, 2.57). Similarly, age of
greater than 27 years (AOR=2.13; 95% CI=1.55, 2.95) and good HIV prevention knowledge
(AOR=1.83; 95% CI=1.35, 2.48) were significantly associated with a positive HIV preven­
tion attitude.
Conclusion: This study revealed insufficient HIV prevention knowledge and attitude in the
community with the highest HIV prevalence. To achieve the goal of ending the HIV
epidemic, health education should be considered using different innovative approaches
especially by prioritizing young and less educated individuals.
Keywords: HIV/AIDS prevention, knowledge, attitude, Majang, Ethiopia

Introduction
Correspondence: Wondimagegn
Wondimu The prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency
Mizan-Tepi University, College of Syndrome (HIV/AIDS) is not decreasing as expected and leads to a significant number
Medicine and Health Sciences, School of
Public Health, Department of of life loss. The pandemic of HIV/AIDS leads to 960, 000 deaths globally in 2019. In
Epidemiology and Biostatistics, PO Box: Eastern and Southern Africa, there were an estimated 300,000 AIDS-related deaths in
260, Mizan Aman, Ethiopia
Email [email protected] the same year.1 In 2017, an estimated 613,000 people were living with HIV in Ethiopia;

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Wondimu et al Dovepress

of whom 62% were females.2 The adult HIV prevalence in Majang zone is found in Gambella regional state and it is
Ethiopia in 2016 was estimated to be 1.1%. There was sub­ among HIV high prevalent areas in Ethiopia.8 It is found
stantial prevalence variation by region (6.6% in Gambella, 628 km from Addis Ababa, the capital of Ethiopia to the
5.0% in Addis Ababa, and 0.7% in Southern Nations, southwest direction. It has three woredas namely Godere,
Nationalities and Peoples’ (SNNPR) region). This indicates Mengeshi, and Meti. Based on the population projection
that the Gambella region had the highest share of HIV done by the Central statistical agency (CSA) for
prevalence.3 2014–2017, the zone had a total population of 79,041, of
Considering the fatal impact of HIV/AIDS’ prevalence, whom 40,896 were men.9
there is a great struggle globally to end its epidemic. In
2014, UNAIDS launched new targets named 90-90-90 to Sample Size Determination, Sampling
help end the AIDS epidemic.4–6 Ethiopia has adopted the Technique, and Study Population
global goal to attain the 90-90-90 targets: 90% of people The single population proportion formula was used by
living with HIV (PLHIV) know their status, 90% of taking the following assumptions. The proportion of
PLHIV who know their status are on treatment (ART) good knowledge about HIV prevention methods taken as
and 90% of PLHIV on treatment have attained viral sup­ 50% since there was no study conducted in a comparable
pression. The country has developed a national prevention setting. Moreover, a 95% confidence level and 5% margin
road map with different pillars to attain the global goal and of error were considered. The calculated sample size
combination of HIV prevention. Furthermore, the road became 384. After using the design effect of 2 and adding
map also specified the geographic priorities for interven­ 10% for non-response rate the final sample size was 845.
tion due to variation in the burden of the HIV infection by The study population for this study were all randomly
residence, and population groups.2 selected adults in the Majang zone and whose age was
The goals set nationally and internationally can be greater or equals to 18. To identify the calculated sample,
achieved when the community, particularly those living in first, we have selected 30% of Kebeles (the smallest
high prevalent areas, have adequate knowledge and administrative unit) from three woredas found in the
a positive attitude towards HIV prevention methods. HIV Majang zone. Using a sampling frame obtained from the
prevention is a complex issue and having good knowledge health post family folder registry, a systematic random
and a positive attitude are essential for its success.7 In sampling technique was employed to select the sampling
Eastern and Southern Africa, many people lack basic HIV unit (households) from the identified Kebeles. Then, the
related knowledge, and the level of negative attitude includ­ selected households’ eligible individual was selected by
ing stigma towards people living with HIV remain high.6 lottery method, if there were more than one eligible parti­
Although Ethiopia is among the countries with a high cipant in the household.
burden of HIV/AIDS, there is a gap of community-based
study that investigated the knowledge and attitude towards Study Variables
HIV/AIDS prevention methods in the country. As per the Knowledge and attitude towards HIV prevention methods
knowledge of the authors, no published community-based were dependent variables. The independent variables include
study assessed the knowledge and attitude towards HIV socio-demographic characteristics (age, sex, marital status,
prevention methods in Ethiopia. As a result, this study occupation, educational status, and residence) and behavioral
assessed the factors determining the knowledge and atti­ factors (history of alcohol drinking and chat chewing).
tude of the community regarding HIV prevention methods
in the Majang zone (Gambella region) which had the
Data Collection Procedures and Quality
highest (3.5%) estimated HIV prevalence at the second
administrative level (zonal level) in Ethiopia in 2017.8 Management
A structured questionnaire developed from different litera­
tures was used. The internal validity of the questionnaire
Methods and Materials was checked by computing the Pearson correlation coeffi­
Study Design, Setting, and Period cient (r). The minimum calculated r (0.123) was signifi­
A community-based cross-sectional study was conducted cantly (p=0.001) higher than the critical value (0.071) with
in the Majang zone from March 1st to May 31st, 2019. degree of freedom (df)=770 and two-sided α=0.05. This is

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Dovepress Wondimu et al

suggestive of the validity of the questionnaire used. Nine ratio at a 95% confidence level. Independent variables
BSc nurses collected the data with a close follow-up of with p-values less than 25% were candidates for multi­
three supervisors. The English version questionnaire was variable logistic regression. A p-value of less than 5% was
first translated into the Amharic language. Then, it was considered as the level of significance for the final model.
back-translated to English to check its consistency. The Regarding the model fitness, the Hosmer and Lemeshow
one-day training was given for the data collectors and analysis provided the p-value for knowledge and attitude
supervisors concerning the objectives and data collection as 10.8% and 62.9%, respectively, which indicate that the
procedures. Pre-testing was conducted on 10% of the final models fit the data well.
sample outside the selected Kebeles and some modifica­
tions were done on the study tool accordingly. Close
supervision was conducted daily to ensure the complete­
Ethical Consideration
This study was conducted in accordance with the
ness and consistency of the filled questionnaire.
Declaration of Helsinki. Ethical approval was sought
Data Entry, Processing, and Analysis from the ethical review committee of Mizan-Tepi
The collected data were coded and entered using Epidata University and a cooperation letter was written to the
manager version 4.0.2.101, and cleaned and analyzed respective government bodies of study areas and permis­
using SPSS version 21 statistical software. Summary sta­ sion was obtained. Informed written consent was obtained
tistics of the categorical independent variables were pre­ from the study participants after interviewers explained the
sented using frequency tables and proportions. The objectives, purposes, participants’ rights, and confidential­
continuous variables were described using mean with stan­ ity of the study. The study participants were informed
dard deviation (SD) and median with interquartile range about their right to withdraw from the study at any time
(IQR) depending on the suitability of the data. The parti­ or to skip questions. Moreover, they were briefed that
cipants were asked ten knowledge and thirteen attitude there will be no direct benefit or harm due to participation
questions that were related to HIV prevention methods except taking some minutes for answering the questions.
and further composited to categorize an individual whether The participants were also informed that the information
he/she has good or poor knowledge and positive or nega­ obtained from them will be kept confidential and merely
tive attitude. Negatively worded knowledge and attitude used for research purposes.
questions were reverse scored.
The knowledge questions had three categories of
Results
responses (yes, no and I do not know) which further
reduced to two categories (correct and incorrect answers). Socio-Demographic Characteristics
The response “I don’t know” was classified under an Of 845 respondents recruited, 772 participated in the study
incorrect category. The correct answers were coded as 2 yielding a response rate of 91.4%. The median age of the
and incorrect answers were coded as 1. Thus, the max­ study participants was 25 (±10 IQR) years and more than
imum knowledge score was 20. Likewise, five-point scale half (58.4%) of the respondents were in the age group of
attitude questions were used and each question (statement) less than 27 years. More than two-thirds (67.7%) and more
had five categories (strongly disagree, disagree, neutral, than half (54.8%) of the respondents were males and
agree, and strongly agree) coded from 1 to 5. The max­ protestant religion followers, respectively. More than half
imum attitude score that can be achieved by the respon­ (59.6%) and about three-fourths (75.5%) of the respon­
dents was 65. Participants who scored greater or equals to dents had Majang ethnicity and rural residence, respec­
an average score of knowledge questions (10.8) were tively (Table 1).
categorized as knowledgeable, otherwise not knowledge­
able. Similarly, those who scored greater or equals to an Behavioral and Related Characteristics
average score of attitude questions (35.3) were categorized More than a fourth (27.8%) of the respondents were alco­
as having a positive attitude and otherwise negative atti­ hol drinkers. Of these more than half (58.1%) drink before
tude. A binary logistic regression was computed to deter­ sexual intercourse and one-third (33%) drink two to three
mine the association between independent variables and times a week. Regarding chat chewing, more than three-
outcome variables (knowledge and attitude) using the odds fourths (77.2%) were not chewers (Table 2).

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Table 1 Socio-Demographic Characteristics of the Respondents Table 2 Behavioral and Related Characteristics of the Study
at Majang Zone, Southwest Ethiopia, 2019 Participants in Majang Zone, Southwest Ethiopia, 2019
Variables Category Frequency Percent Variables Category Frequency Percent

Age < 27 years 451 58.4 Alcohol drinking Yes 215 27.8

≥ 27 years 321 41.6 No 557 72.2

Sex Male 523 67.7 Alcohol consumption Yes 125 58.1

before sexual intercourse
Female 249 32.3 No 90 41.9

Marital status Single 319 41.3 Frequency of drinking Monthly or 77 35.8

alcohol less
Married 373 48.3
2–4 times 47 21.9
Divorced/widowed 80 10.4
a month
Religion Protestant 423 54.8
2–3 times in 71 33
Orthodox Tewahido 238 30.8 a week

Muslim 111 14.4 4 or more 20 9.3

times
Ethnicity Majang 460 59.6
a week
Amhara 219 28.4
Amount of drinking in 1–2 89 41.4
Shekicho 55 7.1 a day (in a bottle)
3–6 75 34.9
a
Others 38 4.9
7or more 51 23.7
Educational status No formal education 80 10.4
Frequency of drinking six Never 99 46
Primary 318 41.2 or more drinks on one
Less than 40 18.6
occasion
Secondary 252 32.6 a month

Tertiary and above 122 15.8 Monthly 18 8.4

Occupational Government 123 15.9 Weekly 43 20

status employee
Daily or 15 7
Student 281 36.4 almost daily

Merchant 149 19.3 Chat chewing Yes 176 22.8

Farmer 219 28.4 No 596 77.2

Residence Urban 189 24.5 Frequency of chat Every day 36 20.5

chewing
Rural 583 75.5 Every 26 14.7
other day
Note: aOromo, Tigray and Kafa.
Twice 28 15.9
a week
Knowledge About HIV and Its Prevention Methods
Almost all (99.2%) and a very high proportion (98.1%) of Occasionally 86 48.9

the respondents had ever heard about HIV and think that
HIV is preventable, respectively. Not sharing contaminated
sharp materials (63.4%), consistent condom use (61.2%), Source of Information About HIV and Its Prevention
and abstinence (57.9%) were the prevention methods men­ Methods
tioned by the majority of the respondents. The mean knowl­ Health professionals (92.6%) and faith-based organiza­
edge score of the study participants was 10.8 (±2.9 SD). In tions (39.9%) were the sources of information about HIV
general, among the respondents, only 39.6% had good and its prevention methods for the majority of the study
knowledge of HIV prevention methods (Tables 3 and 4). participants (Table 5).

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Table 3 Knowledge of Participants Regarding HIV Prevention Table 4 Prevention Methods Mentioned by the Study
Methods in Majang Zone, Southwest Ethiopia, 2019 Participants, Majang Zone, Southwest Ethiopia, 2019
Variables (Question) Category Frequency Percent Prevention Method (n=757b) Response Frequency Percent
(n=772) (Response)
Abstinence Yes 438 57.9
Ever heard about HIV Yes 766 99.2
No 319 42.1
No 6 0.8
Being faithful Yes 357 47.2
Think that HIV is Yes 757 98.1
No 400 52.8
preventable
No 11 1.4
Consistent condom use Yes 463 61.2
Do not know 4 0.5 No 294 38.8

Washing genitals after Yes 154 19.9 Not sharing contaminated sharp Yes 480 63.4
sexual intercourse keeps materials
No 450 58.3 No 277 36.6
a person from getting
HIV Do not know 148 21.8 Counseling Yes 199 26.3

There is an effective Yes 39 5 No 558 73.7

vaccine for HIV for adults
No 503 65.2 Arranging health education on Yes 193 25.5
HIV
Do not know 230 29.8 No 564 74.5

People are likely to get Yes 131 17 Treatment of STI Yes 123 16.2
HIV by deep kissing
No 395 51.2 No 634 83.8

Do not know 246 31.9 Male circumcision Yes 144 19

Healthy looks might be Yes 297 38.5 No 613 81

infected with HIV/AIDS
No 224 29 Preventing mother to child Yes 211 27.9
transmission
Do not know 251 32.5 No 546 72.1

HIV can be transmitted Yes 20 2.6 ART for exposed Yes 152 20.1
through sharing meals
No 680 88.1 No 605 79.9
with an infected person
Do not know 72 9.3 ART for infected Yes 134 17.7

HIV can be transmitted Yes 463 60 No 623 82.3

b
through an infected Note: Among those who responded as HIV is preventable.
No 121 15.7
mother to her fetus
Do not know 188 24.4
Factors Associated with Knowledge of
HIV can be transmitted Yes 520 67.4
through breastfeeding HIV Prevention Methods
No 74 9.6 The factors that were a candidate for multivariable logistic
Do not know 178 23.1 regression include sex, age group, educational status, and
HIV can be transmitted Yes 113 14.6
attitude towards HIV prevention method. In multivariable
through a mosquito bite logistic regression the independent determinants of knowledge
No 545 70.6
of HIV prevention methods were secondary educational status
Do not know 114 14.8 (AOR=1.84; 95% CI=1.04, 3.24), tertiary and above educa­
Overall knowledge Good 306 39.6 tional status (AOR=2.01; 95% CI=1.07, 3.75) and attitude
towards HIV prevention methods (AOR=1.89; 95%
Poor 466 60.4
CI=1.39, 2.57) (Table 6).

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Table 5 Source of Information About HIV Prevention Methods Attitude Towards HIV Prevention
as Mentioned by Respondents (n=757)
Methods
Source of Informationc Response Frequency Percent
Among the total participants, 82 (10.6%) responded that
Radio Yes 273 36.1 they will not give a care if one of their family members
No 484 63.9
has HIV. Similarly, half [385 (50%)] of the respondents
reported that they will not keep the secret if a family mem­
Television Yes 258 34.1
ber is infected with HIV. Moreover, 161 (20.9%) said that
No 499 65.9 they will not buy food from a vendor who is living with HIV.
Newspaper Yes 152 20.1 A significant proportion [314 (40.7%)] of the participants
agreed that sexual intercourse should only take place
No 605 79.9
between married couples. About one-third of the participants
Friends Yes 191 25.2 [240 (31.1%)] replied that it is ashamed to buy or ask for
No 566 74.8 condoms. The mean attitude score towards HIV preventive
behavior was 35.3 (± 4.2 SD). More than half [412 (53.4%)]
Parents Yes 137 18.1
of the respondents had a positive attitude towards HIV
No 620 81.9 prevention methods and 360 (46.6%) had negative attitudes.
NGOs Yes 130 17.2
Factors Associated with the Attitude of
No 627 82.8
HIV Prevention Methods
Health Professionals Yes 701 92.6 At bivariable analysis, age group, marital status, occupa­
(Doctors/Nurses)
No 56 7.4 tional status, alcohol drinking, chat chewing, and knowl­
edge of HIV prevention methods were statistically
Faith-Based Organization Yes 302 39.9
associated with a positive attitude towards HIV prevention
No 455 60.1
methods and finally, age group (AOR=2.13; 95% CI=1.55,
c
Note: An individual can get information from one or more sources. 2.95), and knowledge of HIV prevention methods

Table 6 Bivariable and Multivariable Logistic Regression for Factors Affecting Knowledge of the Community Regarding HIV Prevention
Methods in Majang Zone, Southwest Ethiopia, 2019
Variables Category Knowledge COR (95% CI) AOR (95% CI) P-value

Poor Good

Sex Male 306 217 1

Female 160 89 0.78 (0.57, 1.07) 0.8 (0.58, 1.11) 0.185

Age (in years) <27 291 160 1

≥27 175 146 1.52 (1.13, 2.03) 1.29 (0.95, 1.76) 0.104

Educational status No formal education 58 22 1

Primary 192 126 1.73 (1.01, 2.97) 1.72 (0.99, 2.99) 0.056

Secondary 149 103 1.82 (1.05, 3.16) 1.84 (1.04, 3.24) 0.036*

Tertiary and above 67 55 2.16 (1.18, 3.97) 2.01 (1.07, 3.75) 0.03*

Attitude Negative 247 143 1

Positive 219 193 1.93 (1.43, 2.59) 1.89 (1.39, 2.57) <0.001*
Note: *Significant at p-value less than 0.05.
Abbreviations: OR, odds ratio; AOR, adjusted odds ratio; CI, confidence interval.

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Table 7 Factors Associated with the Attitude Towards HIV Prevention Methods in the Majang Zone, Southwest Ethiopia, 2019
Variables Categories Attitude COR (95% CI) AOR (95% CI) P-value

Negative Positive

Age group < 27 years 247 204 1 1

≥ 27 years 113 208 2.23(1.66–2.99) 2.13(1.55–2.95) <0.001*

Marital status Single 158 161 1 1

Married 160 213 1.31(0.97–1.76) 1.00(0.72–1.39) 0.994

Divorced/Widowed 42 38 0.89(0.54–1.45) 0.79(0.48–1.31) 0.361

Occupational status Government employee 54 69 1.29(0.83–2.01) 1.22(0.77–1.93) 0.388

Student 131 150 1.16(0.81–1.65) 1.14(0.79–1.65) 0.480

Merchant 65 84 1.30(0.86–1.98) 1.25(0.81–1.93) 0.312

Farmer 110 109 1 1

Alcohol drinking Yes 88 127 1 1 0.243

No 272 285 1.38(1.00–1.89) 0.80(0.56–1.15) 0.234

Chat chewing Yes 73 103 1 1

No 287 309 0.76(0.54–1.07) 0.82(0.56–1.21) 0.316

Knowledge of HIV prevention methods Poor 247 219 1 1

Good 113 193 1.93(1.43–2.59) 1.83(1.35–2.48) <0.001*

Note: *Significant at p value less than 0.05.

(AOR=1.83; 95% CI=1.35, 2.48) were found to be signifi­ probability of getting information about HIV prevention
cantly associated with a positive attitude towards HIV methods from different sources and their ability to analyze
prevention methods (Table 7). the information they get. Similarly, the Ecuadorian study
showed that participants with a higher level of education
Discussion had good knowledge compared to those with primary
Knowledge of HIV prevention is a key to the successful education.11 The strength of the association is a bit higher
prevention of HIV/AIDS. In this study, although a high compared to our finding and the difference might be attri­
proportion of the respondents had ever heard about HIV butable to the population difference between the
and think that HIV is preventable, only about 40% of Ecuadorian study and our study.
respondents had good knowledge about HIV prevention In the current study, a positive attitude was signifi­
methods and this is comparable with the finding of a study cantly associated with good knowledge. If peoples have
conducted in Peru where 41.5% of respondents had good a positive attitude towards HIV prevention methods, they
knowledge about HIV prevention practices.10 This is may investigate them more and they will have good
a shocking figure and it can be considered as a ringing knowledge. Scholars recommend that for an individual to
bell regarding the speed of progress towards ending the be successful and to have a better understanding of the
AIDS epidemic.4 issue, he/she should have a positive attitude about the
Higher educational levels (secondary and, tertiary and issue.12
above) were significantly associated with good knowledge Regarding the attitude of the participants, half of them
in our study. The finding of a study conducted in Peru reported that they will not keep the secret of their HIV-
revealed a similar conclusion, where there was direct positive family members. In addition, a considerable propor­
proportionality between the overall level of knowledge tion of the respondents responded that they will not give
and educational level.10 This might be due to that indivi­ a care if one of their family members has HIV and they will
duals with higher educational levels will have a higher not buy food from a vendor who is living with HIV. These are

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HIV/AIDS - Research and Palliative Care 2021:13 27
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Wondimu et al Dovepress

supported by the finding from a countrywide survey and culture to reduce premarital sex and it was also mentioned
these findings support the continuity of discriminatory atti­ by many respondents as one of the HIV prevention
tudes against HIV patients in Ethiopia still now.13 method. Using this opportunity, it is possible to improve
A significant proportion of the participants agreed that sexual the HIV prevention knowledge and attitude of people
intercourse should only take place between married couples. which in turn can reduce the HIV burden in the country.
This is very important to prevent HIV by encouraging absti­
nence which is among the prevention methods mentioned by Abbreviations
more than half of the respondents in the current study. AIDS, acquired immunodeficiency syndrome; AOR, adjusted
Abstinence is among the highly promoted and effective odds ratio; ART, anti-retro viral therapy; CI, confidence inter­
HIV preventive behaviors considering its role in reducing val; COR, crude odds ratio; HIV, human immunodeficiency
the risk of other sexually transmitted infections and the crisis virus; IQR, interquartile range; SD, standard deviation; SPSS,
of premarital sexual intercourse.14–17 The overall magnitude Statistical Package for Social Sciences; UNAIDS, The Joint
of positive attitude towards HIV prevention methods was United Nations Programme on HIV/AIDS.
found to be 53.4% and this is comparable with the findings
of studies from Goba and Hawassa towns.18,19 Acknowledgments
Respondents with the age of 27 years and above had 2 The authors would like to acknowledge the staffs of the
times increased odds of having a positive attitude towards Majang zone health department, the study participants,
HIV prevention methods. This may be explained in that an data collectors, and the supervisors for the valuable roles
increase in age can be associated with increased knowledge they played in this study.
about HIV and its prevention methods, which resulted in
developing a positive attitude towards HIV prevention meth­ Disclosure
ods. Supporting this, the knowledge status was also signifi­ The authors have declared that no competing interests
cantly associated with attitude in our study. This finding was exist.
inconsistent with a study conducted in Brazil which revealed
that there was no association between age and HIV preven­
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