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General Population General Population National Behavioural Surveillance Survey (BSS) 2006 NACO Nat ional Behavioural Surveillance Survey (BSS) 2006 General Population General Population National AIDS Control Organisation Ministry of Health and Family Welfare Government of India National Behavioural Surveillance Survey (BSS) 2006 General Population NACO National AIDS Control Organisation Ministry of Health and Family Welfare Government of India © National AIDS Control Organisation Ministry of Health and Family Welfare Government of India Design, Layout and Printing by: New Concept Information Systems Pvt. Ltd. New Delhi - 110 076 E-mail: [email protected] Foreword National AIDS Control Programme (NACP-III) aims to halt and reverse the spread of HIV epidemic in the country. To ensure the achievement of the set targets, the programme is based on thorough understanding of the current situation of the HIV epidemic and the direction in which the efforts have to be channeled. Evidence-based planning of strategic interventions to control HIV/AIDS requires a strong surveillance, monitoring and research activities which provide crucial information on the patterns of spread of the epidemic. With the evolution of the National AIDS Control Programme (NACP) and its strategies, the need to focus on the more vulnerable population groups and communities with high risk behaviour has received greater attention. The second generation Surveillance for HIV emphasises the significance of understanding the behavioural patterns and trends that increase the emergence of the HIV epidemic. They give direction to the programmatic efforts by showing the impact of the interventions and areas that need focus of different initiatives. Behavioural Surveillance aids national as well as sub-national planners and administrators in planning, implementation as well as monitoring the interventions to tackle the HIV epidemic. In conformity with the National AIDS Prevention and Control Policy, National AIDS Control Organisation (NACO) commissioned the first Behavioural Surveillance Survey (BSS) in 2001 as a part of NACP-II. This provided the baseline information on high risk behavioural patterns, knowledge, awareness and practices related to spread of HIV/AIDS in the country. Towards the end of NACP-II, after a gap of five years since the first wave of BSS, NACO commissioned the second wave of BSS in 2006 to measure the changes in behavioural indicators. National Behavioural Surveillance Survey 2006 was conducted among general population and four high risk groups, Men who have Sex with Men (MSM), Injecting Drug Users (IDUs), Female Sex Workers (FSWs) and clients of FSWs. NACO has constituted a Technical Resource Group (TRG) comprising experts from different national and international organisations. The technical and methodological inputs provided by the TRG members, Dr. Arvind Pandey, NIMS-ICMR, Dr. D.C.S. Reddy, WHO-India, Dr. Gurumurthy Rangaiyan, UNAIDS-India, Dr. Virginia Loo, Bill & Melinda Gates Foundation, Dr. Vidya Ganesh, UNICEF, Ms. Deepali Nath, Clinton Foundation, Dr. Avina Sarna, Population Council and Ms. Anupama Appukuttam, RCSHA are invaluable. The TRG members have contributed substantially in monitoring and reviewing the study at every stage. An independent review of the BSS reports done by two international experts, Dr. Prabhat Jha, CGHR, Canada and Dr. Tim Brown, East-West Centre, USA is duly acknowledged. NACO would like to acknowledge the support provided by UNAIDS India in the preparation of these reports. Our special thanks to Dr. Gurumurthy Rangaiyan, UNAIDS for his support in coordinating and finalising these reports. I congratulate Dr. Jotna Sokhey, Additional Project Director, NACO, Dr. Ajay Khera, Joint Director (Basic Services and Surveillance) and the surveillance team at NACO for their efforts in bringing out this document. The survey was contracted to ORG Centre for Social Research, a division of ACNielsen ORG MARG Pvt. Ltd. which has experience of conducting the survey in 2001. The efforts of ORG Centre for Social Research to ensure quality at all stages of the study are deeply appreciated. A survey of this magnitude would not have been possible without the unstinted cooperation from the thousands of respondents who participated in the study. Each one of them is greatly thanked for their willingness, patience and time. I am sure this document would prove to be a rich source of information for national as well as state-level administrators for taking programmatic decisions and for planning interventions. Ms. K. Sujatha Rao Additional Secretary & Director General National AIDS Control Organisation Contents List of Tables vii-ix List of Figures x-xi List of Abbreviations xii Executive Summary xiii CHAPTER 1 Introduction 1 1.1 Background 1 1.2 Need for the Study 1 1.3 Behavioural Surveillance Survey 1 1.4 Objectives of the Study 2 CHAPTER 2 Methodology and Sampling Design 3 2.1 Consultative Process in Planning the survey 3 2.2 Target Population for the Study 3 2.3 Key Indicators 3 2.4 Coverage of the Survey 3 2.5 Development of Research Instruments and Manual 4 2.6 Sample Size Calculation 5 2.7 Sampling Procedure 8 2.8 Training of Research and Field Teams 9 2.9 Fieldwork and Field Monitoring 10 2.10 Data Management and Analysis 11 2.11 Quality Assurance Mechanisms 14 CHAPTER 3 Profile of Respondents 15 3.1 Background Characteristics of Respondents 15 3.2 Exposure to Mass Media and IEC related to HIV/AIDS 19 CHAPTER 4 Knowledge and Awareness about HIV/AIDS, HIV Transmission and Prevention 35 4.1 Awareness of HIV/AIDS 35 4.2 Knowledge of HIV/AIDS Prevention 51 4.3 Misconceptions about HIV Transmission 60 Contents v CHAPTER 5 Awareness and Prevalence of Sexually Transmitted Diseases and Treatment Seeking Behaviour 67 5.1 Awareness of STDs 67 5.2 STD Prevalence 74 5.3 STD Treatment Seeking Behaviour 79 CHAPTER 6 Sexual Behaviour and Condom Usage 85 6.1 Hetero-sexual Behaviour and Condom Usage 85 6.2 Men who have Sex with Men (MSM) 99 CHAPTER 7 Condom Awareness, Availability and Accessibility 106 7.1 Awareness about Condom 106 7.2 Awareness about Use of Condom to Prevent HIV/AIDS 107 7.3 Availability of Condoms 108 7.4 Access to the Nearest Source of Condoms 110 7.5 Condom Awareness, Availability and Accessibility by Background Characteristics 112 CHAPTER 8 Other Key Issues 114 8.1 Stigma against People Living with HIV/AIDS 114 8.2 Testing and Counseling Facilities 118 8.3 Awareness about HIV/AIDS Incidence 126 ANNEXURE I BSS 2006: Questionnaire for General Population 131 ANNEXURE II List of Selected Districts and Towns 150 vi BSS 2006 Among General Population List of Tables Table 2.1 : Achieved sample sizes 7 Table 2.2 : Sample weights 12 Table 2.3 : Proportion of state/group of states population to total population 13 Table 3.1 : Median age of respondents (in years) by residence and gender 16 Table 3.2 : Percentage distribution of respondents by age (in years) and residence 17 Table 3.3 : Percentage of currently married respondents by residence and gender 18 Table 3.4 : Percentage of literate respondents by residence and gender 20 Table 3.5 : Percentage of respondents who listened to radio at least once a week in the last month by residence and gender 21 Table 3.6 : Percentage of respondents who watched television at least once a week in the last month by residence and gender 23 Table 3.7 : Percentage of respondents who read newspaper/magazine at least once a week in the last month by residence and gender 24 Table 3.8 : Percentage of respondents who had exposure to any mass media during last one month 26 Table 3.9 : Percentage of respondents who received interpersonal communication on STDs/HIV/AIDS in the last one year by residence and gender 27 Table 3.10 : Percentage of respondents who received interpersonal communication on condom usage to prevent STDs/HIV/AIDS by residence and gender 29 Table 3.11 : Percentage of respondents reporting media as a source of information on HIV/AIDS/STI 31 Table 3.12 : Percentage of respondents reporting media as a source of information about condoms 32 Table 3.13 : Percentage of respondents who saw/heard/read any advertisement/ announcements on HIV/AIDS at least once in the last one month by residence and gender 33 Table 4.1 : Percentage of respondents who had ever heard of either ‘HIV or AIDS or Both’ by residence and gender 36 Table 4.2 : Percentage of respondents who had ever heard of ‘HIV’ by residence and gender (BSS 2006) 39 Table 4.3 : Percentage of respondents who had ever heard of ‘AIDS’ by residence and gender (BSS 2006) 40 Table 4.4 : Percentage of respondents who had ever heard of both ‘HIV and AIDS’ by residence and gender (BSS 2006) 41 Table 4.5 : Percentage of respondents reporting “HIV/AIDS can be transmitted through sexual contact” by residence and gender 42 Table 4.6 : Percentage of respondents reporting “HIV/AIDS can be transmitted through blood transfusion” by residence and gender 44 Table 4.7 : Percentage of respondents reporting “HIV/AIDS can be transmitted through needle sharing” by residence and gender 46 Table 4.8 : Percentage of respondents reporting “HIV/AIDS can be vertically transmitted” by residence and gender 47 Table 4.9 : Percentage of respondents reporting “HIV/AIDS can be transmitted through breast feeding” by residence and gender 49 List of Tables vii Table 4.10 : Percentage of respondents aware of HIV/AIDS and various modes of its transmission by selected background characteristics (BSS 2006) 50 Table 4.11 : Percentage of respondents stating that “HIV/AIDS can be prevented through consistent condom
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