HIV/AIDS - An Attitudinal Survey
Final Report

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1. Introduction

1.1 Context¹

The human immunodeficiency virus (HIV) is the cause of the acquired immune deficiency syndrome (AIDS). The virus attacks and damages the body's immune and nervous systems, rendering the host vulnerable to disease. Those infected with the virus may remain without symptoms for 10 years or more before actual symptoms appear.

HIV/AIDS is a major health issue currently facing Canadians. Every day, approximately 11 Canadians become infected with HIV, with an estimated 4,190 Canadians becoming newly infected in 1999. Moreover, the number of new infections in 1999 among men having sex with men has increased by 30 per cent over 1996 levels, though incidence has remained essentially unchanged in the overall population. The most current estimates indicate that, in 1999, 49,800 Canadians were living with HIV infection (including those living with AIDS), representing an increase of 24 per cent since 1996.²

Furthermore, the prevalence of HIV/AIDS is likely even higher owing to delayed and under-reporting. It is estimated that roughly 30 per cent of those living with the HIV/AIDS are unaware of their infection.³ As well, large numbers of those infected do not report their illness because of fears of discrimination and other reasons.

Although there have been considerable research advances leading to the development of new drug therapies, AIDS is still fatal. It is estimated that, by the end of 1999, 51,000 persons had tested positive for HIV since 1985, and, of these, 30 per cent had died.⁴ There is currently no vaccine to prevent the contraction of HIV and, while there are always new and evolving treatments that extend the lives of HIV/AIDS patients, there is still no cure. Treatment is complicated by the fact that the virus is mutating, rendering current drug therapies ineffective.

HIV is transmitted through several routes. Among the most prevalent of them are: having unprotected sexual intercourse with an infected person; sharing needles for injecting drugs with someone already infected; tattooing, body piercing or acupuncture with unsterilized needles; receiving infected blood or blood products; and, during pregnancy, at birth or through breastfeeding, an infected mother passing the virus to her child. The risk of HIV/AIDS is highest among men who have sex with men and among intravenous drug users.

HIV/AIDS is increasingly infecting more vulnerable segments of the Canadian population, many of whom are in the identified high-risk groups and are marginalized by socio-economic factors. These include: women living in poverty, Aboriginal communities, prison inmates, and young gay men. For example, there has been a 91 per cent increase in prevalent HIV infections between 1996 and 1999 in the Aboriginal population⁵. People from countries where HIV is endemic also run a high risk of being infected. As well, youth are vulnerable to HIV infection as a result of many factors, including risky sexual behaviour, substance use (including intravenous drug use), and perceptions that HIV is not a threat to them. According to the most recent UNAIDS report, half of all the new infections that are occurring worldwide are occurring among young people.

The emergence of HIV infection in diverse populations is placing new demands on the health care system⁶. Many of the newer populations face multiple disadvantages including mental illness, drug and alcohol addiction, abuse at the hands of family members, and living on the street. These groups need care and treatment that taxes the community's capacity to provide support. As well, the new drug therapies that extend the lives of HIV/AIDS patients place new demands on the AIDS support system in the areas of return to work, adherence to medications, and financial problems.

Incidence and prevalence remain high despite numerous education and health promotion initiatives and raise questions as to why. Among the hypotheses offered are: complacency or optimism related to the perceived success of drug therapies; condom fatigue; false assurance upon learning of a HIV-negative result; lack of direct experience of the AIDS epidemic among the younger gay generation; and a desire to escape the rigorous norms of safer sex.

The purpose of the current survey is to lay down a baseline measurement and to help inform the communications and social marketing activities related to HIV/AIDS that are designed to educate the public, raise awareness levels and decrease the incidence of risk related behaviours associated with contracting HIV. Future evaluations of initiatives designed with the overall objective of decreasing HIV infection rates in Canada can measure impacts in this area. The current survey will help to better measure any changes in public awareness, knowledge, behaviours and attitudes and will therefore serve as a benchmark, against which future change will be measured.

The survey was designed to create an overall picture of Canadians' awareness and knowledge, as well as attitudes and behaviour related to HIV/AIDS, and to isolate patterns of sub-group differences, including demographic and attitudinal patterns. The type of issues investigated in the survey include:

• levels of concern with contracting HIV/AIDS overall, and concern connected with specific risk factors associated with becoming infected;
• degree of awareness of the prevalence and seriousness of the issue and knowledge regarding contracting and treating HIV/AIDS, whether infection rates are increasing or decreasing and populations most at-risk in Canada;
• attitudes towards people with HIV/AIDS, and government programs related to HIV/AIDS in Canada;
• profile of past and current behaviour, in terms of obtaining information, as they relate to different segments of the public (with different awareness levels and attitudes); and
• frequency of specific risk-related behaviours (some directly related to factors associated with contracting HIV/AIDS.

1.2 Methodology

The survey included a total of 2004 completed interviews with Canadians over the age of 15. Residents of all ten provinces were included, although the territories were not included in the sample. The survey was conducted, by telephone, in March 2003. Telephone numbers were selected using a random digit dial (RDD) process to select households. No specific effort was made to randomize the selection of the respondent within the household The interview required an average of 19 minutes to administer, with trained, bilingual interviewers. The participation rate in the survey was 22 per cent (details in Appendix B). Twenty to 25 per cent is a typical rate of participation for a national public opinion survey based on a questionnaire of this length.

The survey was registered with the Canadian Survey Registration Centre (CSRC) in light of the sensitivity of some questions in the interview. Potential respondents were also given the EKOS Research toll-free number, as well as a contact and telephone number at Health Canada, when they asked for further information about the study (particularly regarding its purpose and the legitimacy of the study and individual questions). There were only a handful of calls made to the CSRC or the EKOS toll-free number to inquire about the survey. Also, no respondent who agreed to conduct the interview and proceeded most of the way through the questionnaire discontinued the interview when they were asked the more sensitive behavioural questions.

Overall survey results were weighted in the analysis to reflect population proportions in terms of gender, age and region. In the analysis of the findings⁷, a number of indices were created to represent multiple survey items (e.g., knowledge and comfort with people with HIV/AIDS indices. These were created with the assistance of factor analysis and were used as independent variables to examine relationships with other items in the questionnaire. They were also used in the creation of a multivariate typology of Canadians on the issue of HIV/AIDS (which is presented as Chapter Eight). In the report, the term "youth" described Canadians under the age of 25, while the term "senior citizens" describes individuals who are 65 or over.

The following table provides the sample sizes for major sub-groups used in the analysis, along with an associated margin of error for each.

	(n)	Margin of Error
Overall	2004	±2.2 %
Region
British Columbia	258	± 6.1 %
Alberta	187	± 7.2 %
Saskatchewan & Manitoba	146	± 8.1 %
Ontario	749	± 3.6 %
Quebec	496	± 4.4 %
Atlantic Provinces	162	± 7.7 %
Gender
Male	900	± 3.3 %
Female	1104	± 3.0 %
Age
Under 25	245	± 6.3 %
25-34	347	± 5.3 %
35-44	438	± 4.7 %
45-64	714	± 3.7 %
65 or older	230	± 6.5 %
Education
Less than high school	754	± 3.6 %
College	423	± 4.8 %
Some university	216	± 6.7 %
University graduate	592	± 4.0 %
Income
Less than $20,000	227	± 6.5 %
$20,000-$39,000	424	± 4.8 %
$40,000-$59,000	350	± 5.2 %
$60,000-$79,000	240	± 6.3 %
$80,000 or more	379	± 5.0 %

* Calculated at the 95% confidence level. That is, the overall results of the HIV/AIDS Awareness Survey are considered accurate to within ? 2.2 % nineteen times out of twenty.

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Footnote

1. Much of the context presented herein was based on evidence presented on the website: http://www.phac-aspc.gc.ca/ hast-vsmt/ , the Centre for Infectious Disease Prevention and Control, Health Canada, as well as the Statement of Work attached to the original Request for Proposals to undertake the current project.
2. Health Canada. "National HIV Prevalence and Incidence Estimates for 1999: No Evidence of a Decline in Overall Incidence" HIV/AIDS Epi Update, Centre for Infectious Disease Prevention Control, April 2002, pp. 2-3.
3. Health Canada. "Prevalent HIV Infections in Canada: Up to One-Third May Not Be Diagnosed" HIV/AIDS Epi Update, Centre for Infectious Disease Prevention Control, April 2002.
4. ibid.
5. Blaize Mumford, "Care and Support Challenges and Issues in a Spectrum of HIV/AIDS Affected Populations", prepared for the Canadian AIDS Society, May, 2002.
6. Blaize Mumford, "Care and Support Challenges and Issues in a Spectrum of HIV/AIDS Affected Populations", prepared for the Canadian AIDS Society, May, 2002.
7. Two statistical packages were used in the analyses. StatXp, the companion software to the data collection software Interviewer, was used to create banner tables for the analysis. SPSS was used for the segmentation.

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