Measuring HIV awareness and knowledge: analyses of cross-sectional surveys with a focus on China

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Description/Abstract

HIV prevalence in China is currently less than one percent, but due to the large population
this translates into a large number of people. The number of people living with HIV is
growing and moving beyond high-risk groups to the general population. Ensuring adequate
HIV awareness and knowledge is important for the successful prevention of HIV. This
thesis investigates the evolution of HIV awareness and knowledge in China between 1997
and 2005. It also compares two methodological approaches to measuring HIV knowledge: a
simple score approach and a latent variable approach. Three papers are presented and each
addresses the main substantive issue using different methodologies. Various data sources
and techniques used in the thesis provide each paper with its own perspective on the main
substantive research question and unique insights into the main substantive and
methodological issues.

The first paper examines the evolution of HIV awareness among women in China between
1997 and 2005. The aim of this paper is to compare the levels of HIV awareness at various
points in time. A regression decomposition analysis technique is used in this paper in order
to disentangle the two main components driving a change in HIV awareness: the change in
a population structure and the change in effect sizes due to external factors such as political
environment, interventions and programmes. The results show that HIV awareness
increased over time in China. With time, lower awareness groups are catching up and gaps
between groups with initially different awareness levels are narrowing. The results suggest
that the main driver of the observed change in HIV awareness over time in China is the
change in the environment such as in political commitment, interventions and campaigns.

The second and third paper both focus on the evolution of HIV knowledge among women
in China between 1997 and 2005. The main aim of these papers is to assess whether China
has succeeded in improving women’s HIV knowledge over time, and if China is a relative
success story in improving women’s HIV knowledge when compared with other countries
in the world with generalised (Kenya and Malawi) as well as with non-generalised (India
and the Ukraine) HIV epidemics. The second paper uses a simple score approach to
measuring HIV knowledge, whereas the third paper uses a latent variable approach. Partial
proportional odds and multinomial logistic regression modelling techniques are employed
for the analysis of patterns of HIV knowledge in China over time and in other countries
included in the analyses. The main findings indicate that China has succeeded in improving
women’s HIV knowledge. HIV knowledge in China is comparable to HIV knowledge in
other countries with non-generalised epidemics. The HIV knowledge in China has become
more homogeneous over time across different groups. However, the gap between the groups
still exists and, therefore, more efforts should be directed towards improvement of HIV
knowledge among women in China as well as in other cultural and epidemiological contexts.
The main methodological findings show that both simple score and latent variable
approaches to measuring HIV knowledge are useful and provide unique insights into the
topic of the evolution of HIV knowledge in China