HIV/AIDS Knowledge and Awareness of Testing and Treatment -- Behavioral Risk Factor Surveillance System, 1990

Public health agencies and other organizations offer programs for prevention, counseling, testing, and early intervention for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). For these programs to be effective, persons who may require their services must have knowledge of the programs and services (1,2). To assess the knowledge and awareness of persons in the United States about HIV/AIDS testing and treatment, the 1990 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire included questions on knowledge about HIV/AIDS, treatment, and sources of testing.

In 1990, 44 states and the District of Columbia participated in monthly random-digit-dialed telephone interviews of adults aged greater than or equal to 18 years (3). Eleven questions were added to the BRFSS questionnaire regarding HIV/AIDS knowledge and awareness. Total sample sizes for states in 1990 ranged from 831 to 3420, for a total of 81,556 survey respondents. The median percentage of eligible respondents contacted providing complete interviews was 82%.

Respondents were asked, "Have you ever heard the AIDS virus called HIV?", "Do you think a person who is infected with the AIDS virus can look and feel well and healthy?", and "To your knowledge, are there drugs available which can lengthen the life of a person with the AIDS virus?" In every state, most respondents had heard the AIDS virus referred to as HIV (range: 74.7% (Kentucky) to 94.7% (Washington); median: 83.0%) (Table 1). Most respondents also knew that HIV-infected persons could look and feel healthy (range: 53.3% (Mississippi) to 79.6% (Utah); median: 67.7%). In most states, a limited proportion of respondents were aware of drugs that can lengthen the life of persons with AIDS (range: 31.4% (Mississippi) to 59.4% (Minnesota); median: 46.6%).

Respondents were asked, "There has been a lot of talk about how you can and cannot get infected with the AIDS virus. Do you think you can get infected from: a) giving blood; b) mosquitoes or other insects?" The percentage of respondents who erroneously believed that a person could become infected by donating blood ranged from 18.3% (Vermont) to 41.2% (Hawaii) (median: 27.8%). The percentage of persons who erroneously believed that infection can result from the bites of mosquitoes or other insects ranged from 9.3% (District of Columbia) to 23.6% (Mississippi) (median: 16.1%).

Respondents were asked, "Where could you go to be tested for the AIDS virus infection?"; if a response was given to this question, respondents were asked, "Where else could you go?" The most frequently specified sources in response to these two questions were "private doctor/health maintenance organization" (range: 40.1 (Vermont) to 70.3% (Arizona); median: 58.8%), "hospital/emergency room" (range: 23.5% (Oklahoma) to 69.0% (Maine); median: 39.7%), and "health department" (range: 2.3% (Maine) to 54.6% (Georgia); median: 21.1%) (Table 2). A limited number of respondents specified the public programs that offer counseling and testing, including "AIDS clinic/testing site" (range: 1.4% (Vermont) to 15.0% (Hawaii); median: 6.1%); "blood bank/plasma center/Red Cross" (range: 1.6% (Vermont) to 12.0% (Delaware); median: 5.1%); "family planning clinic" (range: 0.4% (Kentucky) to 23.2% (North Dakota); median: 1.5%); and "sexually transmitted diseases (STD) clinic" (range: 0.3% (Mississippi, Oregon, Pennsylvania, Tennessee, and West Virginia) to 4.9% (District of Columbia); median: 1.1%). Reported by the following state BRFSS coordinators: L Eldridge, Alabama; J Contreras, Arizona; W Wright, California; C Garrett, Colorado; M Adams, Connecticut; F Breukelman, Delaware; L Jones, District of Columbia; S Hoescherl, Florida; J Smith, Georgia; A Villafuerte, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; S Schoon, Iowa; K Bramblett, Kentucky; S Kirkconnell, Louisiana; J Sheridan, Maine; A Weinstein, Maryland; R Lederman, Massachusetts; J Thrush, Michigan; N Salem, Minnesota; E Jones, Mississippi; J Jackson-Thompson, Missouri; M McFarland, Montana; S Spanhake, Nebraska; K Zaso, New Hampshire; M Watson, New Mexico; O Munshi, New York; C Washington, North Carolina; M Maetzold, North Dakota; E Capwell, Ohio; N Hann, Oklahoma; J Grant-Worley, Oregon; C Becker, Pennsylvania; R Cabral, Rhode Island; M Mace, South Carolina; S Moritz, South Dakota; D Ridings, Tennessee; J Fellows, Texas; L Post-Nilson, Utah; S Rosenstreich, Vermont; J Bowie, Virginia; K Tollestrup, Washington; R Barker, West Virginia; E Cautley, Wisconsin. Behavioral Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion; Behavioral and Prevention Research Br, Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The BRFSS results indicate that more than half of all respondents in most of the states surveyed were unaware of drugs that can benefit persons infected with HIV. In general, persons who are unaware of therapies for HIV may be reluctant to seek counseling, testing, and treatment.

The findings in this report regarding misconceptions about transmission of HIV are consistent with previous reports (4-6)--in particular, a substantial proportion of persons erroneously believed that HIV infection can be transmitted through insect bites or blood donation. Although such beliefs do not increase risks directly for HIV infection, erroneous beliefs about blood donation hold the potential for exacerbating shortages of blood supplies. In addition, in some states, substantial proportions of participants did not believe that persons infected with HIV could not look or feel healthy; this belief could cause some persons at risk for HIV infection to delay seeking testing and treatment. Thus, the BRFSS results may be of particular use to public information programs in states where misperceptions of AIDS transmission were high and in which the incidence of AIDS is high.

BRFSS findings are also consistent with results of CDC's National Health Interview Survey (NHIS) regarding knowledge of sources for HIV testing. In June 1990, among respondents to the NHIS, the two most frequently specified sources where HIV tests could be obtained were private doctors/health maintenance organizations and hospitals/emergency rooms (6). Only a limited proportion of BRFSS and NHIS respondents specified AIDS clinics and counseling and testing sites, STD clinics, family planning clinics, and public health departments. However, approximately 20% of the nearly 1 million persons estimated to be infected with HIV have been identified by federally funded testing programs (7); in 1990, these sites performed most of the publicly funded HIV tests and counseling sessions reported to CDC (8,9).

References

1. CDC. Public Health Service guidelines for counseling and antibody testing to prevent HIV infection and AIDS. MMWR 1987;36:509-15.

2. CDC. Publicly funded HIV counseling and testing--United States, 1985-1989. MMWR 1990;39:137-40.

3. Anda RF, Waller MN, Wooten KG, et al. Behavioral risk factor surveillance, 1988. MMWR 1990;39(no. SS-2):1-21.

4. CDC. HIV-related knowledge and behaviors among high school students--selected U.S. sites, 1989. MMWR 1990;39:385-9,395-7.

5. NCHS. AIDS-related knowledge and behavior among women 15-44 years of age: United States, 1988. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1991. (Advance data no. 200).

6. NCHS. AIDS knowledge and attitudes for October-December 1990: provisional data from the National Health Interview Survey. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1991. (Advance data no. 204).

7. US General Accounting Office. AIDS-prevention programs: high-risk groups still prove hard to reach. Washington, DC: US General Accounting Office, 1991; report no. GAO/HRD-91-52.

8. CDC. CTS client record database: U.S. total, 1990 annual report. Atlanta: US Department of Health and Human Services, Public Health Service, 1991.

9. CDC. Publicly funded HIV counseling and testing--United States, 1990. MMWR 1991;40:666-9,675.

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