Indian Jounal of Community Medicine Vol. XXVI, No.3, Jul-Sept, 2001 KNOWLEDGE REGARDING MODES OF TRANSMISSION AND PREVENTION OF ‘SEXUALLY TRANSMITTED DISEASES INCLUDING HIV/AIDS AMONG CHILD DEVELOPMENT PROJECT OFFICERS Dinesh Paul, Shanta Gopalakrishnan Depit. of Child Health, "National Insitute of Public Co-operation & Child Development, New Delhi Abstract: (Research question: What isthe level of knowledge of Child Development Project Officers (CPO), the functionaries of India’s largest ild development programme regarding STDs and HIV? Opjectives: |. To asess the knowledge of Child Development Project Otficers (CDPOs) regarding modes of transmission and prevention Of STDs and HIVIATDS. 2. To suggest improvement in traning of ICDS functionaries regarding STDs including AIDS, Setting: Training insttation. Study design. Cross sectional Panicipans: Child Development Project Officers (CDPOs) with two years experience, Results” All CDPOs were aware that HIV infection has emerged as anew disease. Majority of them were aware that use of condom, disposable needles and avoiding mul parner sex could preven HIV/AIDS. The major source of information on HIV/AIDS has been the heath worker. Major lacunae in the knowledge which need o be substantiated include complications of STDs, association of STDs with HIV, concept of window penod and misconception that having sex with vigin would cue STDS Key words: HIV/AIDS, STDs, ICDS, Knowledge of CDPOs, Training needs assessment Introduction: capacity of care givers and communities and improved “The first case of HIV in India was reported in 1986 access to basic services atthe community evel’. It is now from Madras'. Since then there has been an increase in the one of the unique outreach programme to help achieve number of HIV infections over the years. As per the major national nutrition and health goal. 1t has reached out National AIDS Control Organisation (NACO), it is 49229 tac children under six years of age, 48 lac pregnant estimated that about 38 million people were living With © stectaiog meiner a cee HIV and AIDS in India in the year 2000. About 20,000 lactating mothers and 5 lakh ade girls through a cases of AIDS so farhave been reported to NACO by States t¥ork consisting of 4200 projects, covering nearly 75% tll 31st March 20017. Sudies conducted in various pans of of the country’s community development blocks and 273 the country have confirmed that HIV infection has shifted urban slum pockets** from high-risk population to general population in India’. In other words, the present seropositivity rate of 26 per ‘As the prevalence of HIV infection in India is onthe thousand is alarming in India. The predominant mode of rise, NACO has initiated the HIV/AIDS programme all over spread of HIV is through sexual route and about 839 of the the country in 1992 as 100% Centrally Sponsored Scheme OA A on account cf wansmision (CSS) and it was expeced that aftr cight years of ugh sexual route, The other routes of transmission implementation of CSS the grass root level functionaries inclide Blood and Blood products, intravenous drvBuse3n4 oud have beter knowledge of HIV/AIDS prevention as “The Iterated Child Development Service (ICDs) ¢0MPared to general public. With the above in view, need started on 2nd October 1975 in 33-sclected projects has tO undertake this study was felt to identify the areas related been specially designed to promote holistic development of to STDs and HIV prevention among ICDS workers who are children under six years of age through the strengthened very close tothe community requiring concept clarification, 1“Indian Journal of Community Medicine Vol. XXVI, No, Jul-Sept, 2001 Material and Methods: ‘The study was conducted on 188 Child Development Project Officers attending the Job training or refresher courses st NIPCCD. Only those CDPOs who had the ‘experience of working in ICDS programme for more than two years were included in the study. All subjects were ‘oriented about the objectives ofthe study in aclassroom. A pre-tested semi-structured open-ended questionnaire was administered to each one of the subjects. The questions ‘were also explained (0 the subjects in detail to ensure complete comprehension. The investigators clarified the ‘queries raised by the participants. Results and Discussion: The knowledge and attiudes of CDPOs, the main leaders of MCH care team of ICDS can play an important roe in changing the views ofthe mothers regarding various diseases. In most of the studies it has been seen that the ICDS functionaries have played a very important role in promotion of breast feeding, growth monitoring, ‘immunization and family planning programme. Wherever, ICDS is in operation the mortality and morbidity rates are better in these blocks as compared to non-ICDS blocks. If CDPOs are Knowledgeable about STDs including HIVIAIDS they can disseminate the information to the community. ‘Table I: Awareness regarding Sexually Transmitted Diseases (STDs) (n=88). ‘Statement of questionnaire ‘Responses Correct Incorrect No) Nod) ‘What is STD? 188(100.0) : ‘STDs are spread mainly through sexual contacts 184(98.0) 42.0) ‘STDs may be symptomless 1021543) 86(45.7) Foul smelling discharge from vagina is a symptom of STDs 123(65.4) 65(34.6) STDs can cause sterility 62(33.0) 126(67.0) STDs can cause repeated abortions 78(41.5) 110(58.5) Most of STDs are curable 12868.1) 60(31.9) ‘Condom use during intercourse can prevent STDs 176(93.6) 126.4) ‘Sex workers are main sources of STDS in the community 149(79.2) 39(20.8) ‘Sex with virgin female would cure STDs 144(76.6) 4423.4) ‘The treatment of STDs is available at health centers 112(60.0) 76(40.0) Partner treatment in STDs is important for its cure $0(26.6) 138(73.4) In the present study, it was found that CDPOs knew the meaning and mode of spread of STDs. Majority of them ‘could name major STDs such as syphilis, gonctthaea etc. A sizeable proportion of CDPOs revealed that condom use during intercourse could prevent sexually transmitted infections. ‘About two third of CDPOs were aware that foul smelling discharge from vagina is a symptom of STDs and Knowledge of COPOs about STDs Including HIV/AIDS ae that majority of STDs are curable. They were also aware that the treatment of STDs is available at health centers. However, their knowledge was poor regarding the complications of STDs like sterility and repeated abortions ‘and the importance of partner treatment in the management of STDs. About one-fourth of CDPOs still believed that having sex with virgin female could cure sexually transmitted infections. Paul D otallnxan Joumal of Community Medicine Vol. XXVI, No.3, ul-Sept, 2001 ‘Table TI: Knowledge regarding HIV/AIDS (n=188). ‘Statement Responses, Correct Incorrect No(%) _ No.(%) HIV infection is a new disease 188(100.0) 0(0.0) ‘What does HIV positive mean? 46(24.5)142(75.5) HIV is incurable disease 103(54.8) 85(45.2) Window period (4.8) 179(95.2) Symptoms of HIV infection -72(38.3)_116(61.7) Association of STDs and HIV 144(76.6) 44(23.4) ‘What is AIDS? 3217.0) 156(83.0) AIDS is a fatal disease 17.0) 171(91.0) All CDPOs were aware that HIV infection has emerged as new disease. About three-fourth of the CDPOs rightly pointed out the association between sexually transmitted infections and HIV/AIDS. However, about half of them (54.8%) reported that HIV is incurable while only 9% reported that AIDS is fatal. Only 17% of the CDPOs ‘ould tell the meaning of AIDS. Hardly about 5% of the CDPOs were clear about the concept of the window period. ‘Table IL: Top five sources of HIV related information. ‘Source of information No.(%)* Health worker 93(49.5) Radio 47(25.0) Ty. 2312.2) Newspaper 2011.2) Doctor 180.6) “*Multiple responses. ‘About half of the CDPOs reported health worker to be the main source of information about HIV. 12.2% CDPOs ‘mentioned TV to be the main source and only about 10% ‘mentioned the source to be a doctor. Knowedge of COPOs about STDs including HIVIAIDS. Modes of Responses transmission Correct Incorrect No(%) _No.(%) Mother to child transmission 30(160) _ 158(84.0) Sexual route 8947.3) 9952.7) ‘Through blood transfusion 9148.4) 9151.6) ‘Through infected needles 9349.5) 95(50.5) Sexual transmission, blood transfusion’ and use of infected needles as modes of spread of HIV/AIDS were mentioned by 47.3%, 484% and 49.5% CDPOs respectively. Only 16% of the CDPOs knew that HIV/AIDS ‘could be passed on from the mother tothe child. ‘Table V: Modes of prevention of HIV/AIDS. ‘Acceptable preventive Responses practices Correct Incorrect No(%) __No(%) ‘Using condom 176(93.6) 1266.4) Avoiding mult-partner sex 172915) 16(8.5) without condom Using disposable needle 167(88.8) 21(11.2) ‘Three correct ways to keep 527.7) 136(72.3) ‘oneself free from HIV Majority of the CDPOs were aware that using condom, disposable needle and avoiding mutli-partner sex Could prevent HIV/AIDS. Only 27.7% of the CDPOs were able to enumerate three correct ways of keeping oneself protected from HIV. ‘The present study revealed some grave lacunae in the ‘knowledge of the CDPOs like need for partner treatment in ‘STDs, complications of sexually transmitted infections, life Jong HIV positivity, AIDS as a fatal disease, window period for HIV detection and mother-to-child transmission of HIVAIDS, which need immediate conection. Since ‘majority of the CDPOs are getting information from health functionaries itis possible thatthe knowledge of ANMSs and us PauDeta