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‘Let’s Think Positive’ Survey Questions 2015

Appendix 1

The survey was made up of the following 20 multiple choice questions:

1. Is HIV

  • Treatable
  • Curable
  • Neither
  • Unsure

2. Everyone living in the UK can get a free confidential HIV test

  • True
  • False
  • Unsure

3. Everyone living in the UK can get free medical treatment for HIV infection

  • True
  • False
  • Unsure

4. What is the most common way in which HIV is transmitted in the UK?

  • From mother to baby
  • Through unprotected sex
  • Through sharing needles to inject drugs
  • Unsure

5. HIV can be transmitted through sharing mugs with someone who is infected with HIV

  • True
  • False
  • Unsure

6. HIV can be transmitted through kissing

  • True
  • False
  • Unsure

7. There is an effective vaccine for HIV

  • True
  • False
  • Unsure

8. There are effective treatments for HIV

  • True
  • False
  • Unsure

9. People living with HIV should always disclose their HIV status to their co-workers

  • True
  • False
  • Unsure

10. People living with HIV should always disclose their status to their family

  • True
  • False
  • Unsure

11. People living with HIV should always disclose their status to their GP

  • True
  • False
  • Unsure

12. People living with HIV should always disclose their status to their sexual partners

  • True
  • False
  • Unsure

13. Treatment for HIV usually consist of taking more than 5 pills a day

  • True
  • False
  • Unsure

14. If you catch HIV through unprotected sex you only have yourself to blame

  • True
  • False
  • Unsure

15. If you catch HIV through sharing needles you only have yourself to blame

  • True
  • False
  • Unsure

16. Immigrants to the UK should have to declare whether they are HIV positive or not

  • True
  • False
  • Unsure

17. All school children should know the facts about HIV transmission

  • True
  • False
  • Unsure

18. All schoolchildren should know about safer sex and condom use

  • True
  • False
  • Unsure

19. How would you react if you knew that hairdresser had HIV?

  • I would change hairdressers
  • It would make absolutely no difference to me or to how I feel about my hairdressers
  • I would tell people I know not to go to that hairdresser

20. A prominent politician/celebrity finds out that they have HIV – should they:

  • Disclose their status publicly as this could help reduce the stigma around HIV and help to provide positive role models for other people living with HIV
  • Resign from their post/career and apologize publicly for the irresponsible behaviour which has led to their HIV infection
  • Keep this to themselves – it’s a private matter which is only relevant to people they want to tell

Let’s think Positive!

Survey of Knowledge and Attitudes around HIV

November/December 2015

Introduction

As part of National HIV Testing Week and World AIDS Day 2015 DHIVERSE decided to conduct a simple survey of attitudes and information around HIV. Although the regional and national media coverage of issues around HIV has declined significantly over the last decade there is still some media ‘presence’ around World AIDS Day, and this seemed a particularly appropriate time to conduct a simple poll of public attitudes.

An electronic questionnaire on Survey Monkey was promoted via the DHIVERSE website and social media – it was also promoted through DHIVERSE partners, contacts and service users. The poll opened at the beginning of National HIV Testing Week on 22 November 2015 and closed on 4 January 2016. 168 completed replies were received.

While the survey clearly doesn’t provide a statistically rigorous representation of local attitudes, nor was it intended to do so –it provides a heuristic snap-shot which enables DHIVERSE to conduct more focussed needs assessments on prevention and support over 2016/2017.

Design and Structure of Questionnaire

The questionnaire was designed to investigate the following broad themes:

HIV Prevention: Questions 2,7,17,18

HIV Transmission: Questions 4,5,6

HIV Treatment Questions 1,2,8,13

HIV Disclosure: Questions 9,10,11,12,20

HIV Stigma: Questions 14,15,16,19, 20

A breakdown of the questions can be seen in Appendix 1.

HIV Prevention

The vast majority of respondents (91%) were aware that anyone living in the UK can access a free and confidential HIV test – however, it was somewhat to disconcerting to note that 10% were unsure. Early testing is key to preventing morbidity and death from HIV infection, and given the high rate of ‘late diagnoses’ within the UK (40%) and the current recommendations that treatment begin as early as possible in all cases, this highlights the importance of raising awareness of HIV testing and challenging barriers to testing in communities where there is a poor uptake of testing (notably among Africans).

It was also interesting to note that almost 30% of respondent did not realise that there is no vaccine for HIV.

Participants were overwhelmingly in favour of raising HIV awareness and providing accurate up-to-date information on HIV to school age children (over 97%).

HIV Transmission

The majority of respondents (71%) were aware that most HIV transmitted in the UK is acquired through unprotected sex, though 18% (incorrectly) thought it was through sharing needles. An overwhelming 93% of respondents were aware that HIV could not be transmitted through sharing mugs, but 6% were unsure about this statement or thought it was true! There was a rather greater degree of uncertainty when it came to transmission through kissing. 82% of respondents were aware that HIV cannot be transmitted through kissing, but 18% thought this was possible or were unsure. This pattern correlates well with the experience of sexual health trainings delivered by DHIVERSE where there is often uncertainty about the role of saliva in HIV transmission.

HIV Treatment

Over 98% of respondents were aware that HIV is treatable – a highly significant result as this is one of the main motivators for accessing treatment. Over 93% of respondents were aware that treatment is ‘effective’ treatment. When it came to the details of treatment, respondents were less aware of improvements - 68% of respondents thought either that treatments routinely involved taking more than 5 pills a day or were unsure whether this was the case. This suggests that improved awareness of treatment options would be desirable.

HIV Disclosure

As medical treatments for HIV have improved enormously – support for People living with HIV (PLWHIV) has tended to focus on the social and psychological challenges of living with HIV – and developing strategies to build up self-esteem and confidence and challenge stigma. Knowing when and how to disclose their status is often a key issue for PLWHIV.

82% of respondents did not agree with the statement that ‘People Living with HIV should always disclose their HIV status to their co-workers’, the remaining 18% thought the statement was true or were unsure. When it came to disclosure to family members only 68% of respondents thought that the statement ‘People living with HIV should always disclose their status to their family’ was false, and when it came to disclosure to one’s GP, 77% of respondents thought that all people living with HIV should disclose their status. 91% of respondents agreed that ‘People living with HIV should always disclose their status to their sexual partners’. When it came to the issue of politicians/celebrities disclosing their HIV status, a majority (62%) though that this was a private issue, but a substantial minority thought that it would be a good idea to disclose one’s status publicly to increase visibility and reduce stigma around HIV.

These results raise some interesting questions and suggest the need for further educational work around HIV. In particular they suggest the need for further exploration of why 7% of respondents think that PLWHIV should always to disclose their status to co-workers. When respondents state that PLWHIV ‘should always’ disclose their status to family members, is this because they have a ‘duty to tell’ in order to avoid (imaginary) routes of transmission, or is it because respondents feel that PLWHIV need the support and solidarity of family members? Similarly, when 17% of respondent’s state that PLWHIV ‘should always disclose their status to their GP’ is this to ensure that they receive the best possible support and treatment, or to avoid transmission risks, or both? Are the 90% of respondents who declare that one should always declare one’s positive status to a partner aware of some of the barriers to disclosure, and also of the strategies to reduce/eliminate the risk of HIV transmission through sexual contact?

HIV Stigma

Historically HIV has been associated with high levels of stigma associated with fear of transmission, racism and homophobia (among other factors) and national and local evidence indicates that this continues to be the case. Fear and experience of stigma is a major barrier to accessing testing, treatment and support, and is a major cause of ill-health among people living with HIV.

Somewhat alarmingly, 19% of respondents thought that if you catch HIV through unprotected sex ‘you only had yourself to blame’, and 36% thought that if you caught HIV through sharing needles ‘you only had yourself to blame’. 32% of respondents thought that immigrants to the UK should have to declare whether they are HIV positive or not. On a slightly more cheerful note 98% of respondents declared that if they found out that their hairdresser had HIV it would make absolutely no difference!

Conclusions

This simple poll needs to be supplemented by further local needs assessments, which we hope to conduct during 2016-17, but strongly suggests:

  • There is still a need to promote the free and confidential availability of testing, and that although most respondents were aware that treatments were available and effective, further information needs to be made available on current improved modalities of treatment (decreased pill load etc.)
  • Information on HIV transmission seems to be generally robust, but with further work needed to clear up ambiguities around the role of saliva in HIV transmission (this correlates with feedback from DHIVERSE trainings)
  • Further work needs to be done around HIV disclosure – particularly around disclosure to sexual partners. In particular this needs to focus awareness on some of the challenges which can prevent people from disclosing status, and strategies to avoid transmission which do not depend on disclosure.
  • As there is very clear evidence for continued stigma around HIV – particularly in relation to how the infection is acquired (for example sharing needles or sex) there needs to be more educational work around challenging these assumptions, and more work to support people living with HIV to develop the self-confidence to challenge the fear and experience of stigma.

Dhiverse

January 2016