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

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.

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Identifiers

ORCID for Olga Maslovskaya: orcid.org/0000-0003-3814-810X

ORCID for Sabu S. Padmadas: orcid.org/0000-0002-6538-9374

ORCID for Peter W.F. Smith: orcid.org/0000-0003-4423-5410

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