Public Health Agency of Canada
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HIV/AIDS - An Attitudinal Survey
Final Report

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Executive Summary

i) Context and Methodology

The purpose of the current survey is to lay down a baseline measurement and to help design the communications and social marketing activities related to HIV/AIDS that are intended to inform the public, raise awareness levels and decrease the incidence of risk related behaviours associated with contracting HIV. The survey creates an overall picture of Canadians' awareness and knowledge, their attitudes and behaviour related to HIV/AIDS, as well as isolates patterns of sub-group differences, including demographic and attitudinal patterns.

The survey includes a total of 2004 completed interviews with Canadians over the age of 15 from all ten provinces. The territories were not included in the sample. The survey was conducted, by telephone, in March 2003. Overall survey results were weighted in the analysis to reflect population proportions in terms of gender, age and region.

ii) Knowledge

Canadians were asked in the survey if they know how HIV is transmitted and most people identified unsafe sexual intercourse. Almost half cited the sharing of drug needles and three in ten indicated that it could be transmitted through blood transfusions. Only nine per cent of Canadians cited that HIV could be passed from a mother to her unborn child, and six per cent cited tattoos/body piercing as a method of transmission. Six per cent of people believe that HIV can be transmitted by kissing and two per cent or less indicated mosquito bites, casual contact, coughing or sneezing.

Canadians most often perceive gay men and injection drug users as groups that have been most affected by HIV/AIDS (47 and 31 per cent, respecttively). Excluding these specific groups, respondents indicated a wide range of other members of the population who have been affected by the disease, including people engaging in unprotected sex, sex trade workers, youth in general, Aboriginal people and those requiring blood transfusions.

More than one third of respondents said the main reason for practicing safer sex would be to reduce the risk of sexually transmitted diseases and/or HIV/AIDS and one third said to reduce the risk of pregnancy.

When asked if they know how someone can determine if they have HIV/AIDS, eight in ten people cited a blood test as a method of testing for the existence of HIV/AIDS. Eight per cent cited a physical examination or a visit to the doctor.

Most Canadians are of the opinion that HIV/AIDS treatments have been at least somewhat effective in helping infected people lead normal lives. One in eight believes that HIV/AIDS treatments have not been very effective and two per cent said that treatments have not been effective at all.

Three-quarters of Canadians know that HIV/AIDS cannot be cured (even if treated early). Nearly one in five believe that it can be cured if treated early.

Eight in ten know that when a person has HIV/AIDS his/her body is unable to defend itself against common illnesses and diseases. Three-quarters agree that a person can have HIV for ten years or more without developing AIDS and six in ten understand that AIDS is always fatal.

Nearly four in ten Canadians are aware that there is an overall federal government initiative regarding HIV/AIDS. Only five per cent of Canadians know that it is called the Canadian Strategy on HIV/AIDS (CSHA). Four in ten Canadians indicated that Health Canada is primarily responsible for coordinating the CSHA.

When asked to rate their own level of knowledge about HIV/AIDS, one in four reported a high level of confidence in their knowledge and seven in ten said they have at least a moderate level of knowledge about the disease.

A factor analysis was conducted to summarize items that reflect respondents' knowledge of HIV/ AIDS, creating a knowledge index to be used in the analysis. The results were collapsed into a high, medium and low level of knowledge. One in five respondents scored low, one third scored in the medium range and almost half scored high on the knowledge index.

iii) Perceptions of Risk

Virtually all Canadians believe HIV/AIDS to be a somewhat serious or a very serious problem. Only three per cent believe that HIV/AIDS is not a very serious problem.

An overwhelming majority of Canadians believe their own personal risk of contracting HIV/AIDS to be low. Seven per cent believe their risk of contracting HIV/AIDS is moderate and a high risk is perceived by only one per cent.

In terms of overall perception of risk today, over half of Canadians do not believe that HIV/AIDS is much less of a problem today than it was 10 years ago. In fact, almost half of Canadians believe that the risk of contracting HIV/AIDS is higher today than it was five years ago. (Thirty per cent think the risk is about the same, and 19 per cent perceive less of a risk today.) The majority believes that the rate of HIV/AIDS infection is increasing compared to ten years ago. Related to this, just over two in three Canadians believe that the federal government should focus more attention on HIV/AIDS and that health groups have not exaggerated the seriousness of HIV/AIDS.

With respect to specific risk factors, about half of Canadians believe that those who have received blood transfusions have an increased risk of contracting HIV/AIDS, but two in three Canadians do not believe that blood donors have an increased risk. The majority of Canadians do not believe that HIV/AIDS is a disease that mostly infects third world inhabitants, gay people, and/or drug users.

A factor analysis was conducted to determine the risk-related items, which were answered in a similar way, with some interesting results. This series of responses that were included, taken together in a single index is interpreted as a "distancing factor". That is, the higher the score the more a respondent tends to distance him or herself from the issue of HIV/AIDS. One in four scored low on this index, that is, they tend not to think of HIV/AIDS as someone else's issue. One in three scored in the medium range and almost half scored high on this index (and tend to think of this as a very compartmenttalized issue, that likely would not affect them directly).

The majority of Canadians believe that more HIV tests are performed today. Only 15 per cent think that the rate of HIV testing is the same. Just under two in three Canadians believe that HIV/AIDS infected people do take the steps necessary to protect others from getting infected and 22 per cent believe that the frequency of steps taken has not changed over the last 10 years. Just over half of Canadians feel that safer sex practices have increased over the last 10 years, while 26 per cent believe the frequency of these practices has stayed the same and 11 per cent feel they have decreased.

iv) Information Sources

Canadians were asked where they have typically obtained their information about HIV/AIDS in the past. Television news and newspaper articles are the most common information sources. This is followed by health magazines, and then television health programs and school. Twelve per cent of Canadians have obtained information about HIV/ AIDS from family or friends and one in ten have received information from books or the library, doctors, or the Internet. Less common information sources include television advertisements and advertisements in general, AIDS organizations, radio health programs or Health Canada.

Information sources for general health matters are similar to the sources for HIV/AIDS-related information. The top four sources remain unchanged, although more people mentioned television news and newspaper articles as a source of information about HIV/AIDS relative to general health. School and family or friends are also more likely sources for HIV/AIDS information. Doctors and the Internet are relied upon for HIV/AIDS information much less frequently for HIV/AIDS information than they are for general health information.

The most preferred sources of information about HIV/AIDS among Canadians are websites or the Internet, doctors, and other health care professionals. This is followed by a preference for books and the library, and then Health Canada, and only six per cent prefer an AIDS organization as an information source. Relatively few Canadians prefer health journals, family or friends, school or various other media outlets.

Three-quarters of Canadians consider their family doctor and other health care professionals to be the most reliable sources of information. Seven in ten think that the scientific research community is reliable, while two-thirds consider Health Canada a reliable source. Less than half think that someone infected with HIV and the Government of Canada in general are reliable and one-quarter considers their own family and friends reliable sources of information. The media received the lowest reliability ratings among Canadians.

v) Tolerance

The vast majority of Canadians believe they could be friends with someone who has HIV/AIDS. Furthermore, over three-quarters do not believe that people infected with HIV/AIDS through sex or drug use have gotten what they deserve. Fewer than four in ten believe that people with HIV/AIDS should be allowed to serve the public in positions like dentists and cooks, while almost half of Canadians believe that they should not be allowed to serve the public in these capacities.

Canadians exhibit somewhat less tolerance or acceptance when asked to rate their level of comfort with direct contact with individuals who have HIV/AIDS. Findings from six different scenarios were used to form the basis of a "comfort scale", using factor analysis. Close to one in four Canadians demonstrate a low level of comfort with HIV/ AIDS (comfortable in only one or two of these six scenarios), 41 per cent demonstrate a moderate level of comfort (comfortable in two or three scenarios), and 35 per cent have a high level of comfort (comfortable in more than three of the six scenarios).

Four in ten Canadians know or have known someone with HIV/AIDS.

vi) Behaviour

Just over two-thirds of Canadians reported that they have been sexually active in the last twelve months. The majority have had only one sexual partner in that time, while twelve per cent have had two or more sexual partners in the last year. The majority have been in a regular relationship with this or these sexual partners, while 13 per cent reported a casual partner in the past year. Finally, seven per cent said that their relationships were homosexual.

Sexual activity is linked to gender and age. Men and youth are more likely to be sexually active, more likely to have had several partners, and more likely to report a casual partner. Individuals reporting casual or multiple partners are more likely to perceive themselves to be at moderate or high risk of contracting HIV, compared with other Canadians.

Close to half of Canadians reported that they never engaged in safer sex during the previous twelve months, while just over one-quarter always did. One in ten practiced safer sex rarely or some of the time over the last year, and a further 10 per cent did most of the time.

The vast majority of those who did not practice safer sex indicated that they did not do so because they have only one sexual partner. A small minority indicated that they are not at risk of STDs, that their partner(s) have been recently tested for HIV/AIDS, that they assume their partner(s) do not have HIV/ AIDS, that they were not prepared for safer sex, or that they were trying to get pregnant.

The most common method of safer sex used by Canadians over the last year is the condom (used by 72 per cent). Less than one in ten of those who reported using safer sex indicated they limited themselves to a single partner, or abstained from sexual intercourse. A further eight per cent said that they used the birth control pill. Risk of pregnancy was the primary reason for safer sex cited most often (by 35 per cent), followed by the risk of sexually transmitted diseases or the risk of HIV/ AIDS.

Under ten per cent said that they had changed their practice regarding safer sex in the past year. Just over one in four of those who had changed their practice indicated that they are more concerned now, while fewer say they are now better informed, have only one partner, have more partners, or are trying to get pregnant.

Just over one-quarter of Canadians indicated that they have been tested for HIV, excluding testing for insurance, blood donation and participation in research. Four in ten of those tested have not been tested in the past two years, while a similar number have been tested once in the past two years, and 18 per cent have been tested two times or more.

The most common location of their most recent test is in a doctor's office (63 per cent). One in ten have had their most recent test at a sexual health clinic, and seven per cent at an anonymous clinic. Close to two in ten had their most recent test performed somewhere other than these locations.

vii) Government Involvement

Nearly three-quarters are supportive of federal government involvement, 21 per cent are somewhat supportive, and only five per cent are not supportive of this involvement. Among the minority who do not support federal government involvement in HIV/ AIDS, the most common reasons for their stance include a lack of trust in the federal government (cited by 40 per cent), that they do not know anyone with HIV/AIDS (11 per cent), that federal funds should be channelled to more critical areas (12 per cent), and that HIV/AIDS prevention should be the responsibility of the individual (seven per cent).

Furthermore, close to two-thirds believe that the federal government should spend more on HIV/ AIDS now than it did ten years ago and 28 per cent believe the amount spent should be unchanged.

Currently, close to half do not know where the federal government is focusing its attention. Roughly three in ten Canadians believe that the federal government is focusing its attention on public education and research into treatment. Roughly one in ten believe the federal government is focused on finding a cure or vaccine for HIV/AIDS, or for caring for those infected. A minority believe the federal government is focusing programs and funding in other areas.

When asked where they believe the federal government should be focusing its attention, half the population states that public education should be a focus (although only 28 per cent believe it currently is). One-third believe the federal government should be conducting research into treatment (and 27 per cent believe it currently is). Canadians also believe that the federal government should be focusing attention on finding a cure/vaccine, caring for the infected and youth education and prevention.

viii) Typology of Canadians

In addition to the basic analyses cited throughout the report, a typology of Canadians was created to illustrate the manner in which knowledge and attitudes about HIV/AIDS coalesces most often in the general public. This was carried out using factor and cluster analysis as well as reliability analyses (leading to the computation of several indices presented earlier in the report).

  • Informed Concerned (42 per cent): This segment is the most knowledgeable and comfortable with people with HIV/AIDS. They also tend to view the problem as very serious and do not believe that it is diminishing with time. They tend to rely on health magazines and television health programs for their information and report a strong preference for websites as a source of additional information. They place considerable confidence in health professionals and authorities as reliable sources of information. Their support for government involvement is high and they believe that a strong focus should be placed on public education and prevention. They are most likely to know someone with HIV/AIDS. They do not tend to practice safer sex, even though they are the most active group, citing monogamy as the reason (and generally do not perceive themselves to be at risk).
     
  • Informed Unconcerned (24 per cent): This group is quite knowledgeable and generally comfortable with people with HIV/AIDS. They tend to minimize the seriousness of the issue, however, and see the problem as getting better over time. Their preferred focus for government attention is on treatment and they more often rely on television news, information from school and websites as reliable sources of information, which is not surprising given that this is the youngest segment of the Canadian population.
     
  • Moderately Informed Concerned (14 per cent): This group is generally middle of the road in most areas. They do, however, perceive HIV/AIDS to be a very serious issue and are very concerned about it, citing strong support for government involvement.
     
  • Moderately Informed Deniers (11 per cent): This group has fairly low knowledge and high discomfort around people with HIV/AIDS. They are characterized by a strong tendency to minimize the problem and risk. As such, they tend to view HIV/AIDS as someone else's problem and place blame fairly readily. As part of this tendency to compartmentalize the issue, they believe that the government focus should be away from Canada and on specific groups. As might be expected, they are least likely to know someone with HIV/AIDS. They place more faith in the media as a reliable source for information about HIV/AIDS than any other group.
     
  • Uninformed Uncomfortable (six per cent): This group is generally characterized by the lowest knowledge, greatest misinformation and misperceptions, a strong sense of discomfort, bordering on fear, of people with HIV/AIDS and, as a result, a somewhat elevated perception of their own risk. They are more skeptical of knowledge figures and organizations as sources of information than other Canadians and are generally less supportive of government involvement in HIV/AIDS. They are more often found among low income and education segments of society.

Summary

On the whole, Canadians are very knowledgeable about HIV/AIDS. Most generally understand the nature of the disease, as well as methods of transmission and testing. Relatively few are misinformed about how one contracts HIV/AIDS or how to detect HIV. They show a general appreciation of the fact that gay men and injection drug users are among the top at-risk groups in Canada. They also realize, for the most part, that while treatments are fairly effective, there is no cure for HIV/AIDS. There is very mixed appreciation, however, for the fact that AIDS is, in all cases, fatal. Even among the most knowledgeable, this fact is not well understood.

In spite of the high levels of knowledge about the disease, knowledge of government efforts in this area is quite weak. Very few know about the CSHA, or even what the government is focusing on. Nonetheless, they are quite supportive of government involvement in HIV/AIDS and generally place more of an emphasis on public education, prevention and research into treatment.

It is not surprising, given knowledge levels, that most Canadians view HIV/AIDS as a very serious issue, which is not diminishing over time. Relatively few Canadians view HIV/AIDS as a problem that belongs to someone else (e.g., third world, gay community, drug users). On the other hand, everyone reports an extremely low perceived personal risk of contracting HIV.

Most people report that they are generally comfortable with the idea of being around someone with HIV/AIDS; however, when it comes to serving the public or going to school with one's child, the discomfort increases.

The profile of information sources is generally reflective of where people get other health-related information, with a slightly greater emphasis on television news, newspaper articles, health programs and schools, and less reliance on doctors and the Internet. On the other hand, these later sources are exactly where the public would prefer to be able to obtain information about HIV/AIDS.

With respect to behaviour, safer sex is practiced by a minority of the sexually active and almost always as a result of casual or multiple partners. It is rarely practiced by people in regular, ongoing relationships.

In terms of testing, one in four have been tested, but almost half of those were not tested in the past two years. Among those who were tested in the past two years, they were typically tested only once.

Overall

Although knowledge levels are high, there is quite a knowledge gap with respect to the government's approach to HIV/AIDS. Support for government involvement, however, is high and Canadians would welcome learning about efforts concentrated on public education, prevention and research into treatment (as they view HIV/AIDS as a very serious issue that must be addressed).

While undoubtedly there is no shortage of information about HIV/AIDS on the Internet, it is interesting to note that Canadians report that they currently rely on the Net (and doctors) less for this issue than for others, but express a preference for getting their information this way. Perhaps future communications campaigns could highlight key websites where Canadians can find information about HIV/AIDS and the federal government strategy related to it.

While tolerance and comfort levels among Canadians are high in theory, they would likely be lower in practice, given the variation in responses to different questions and scenarios put forth in the survey.

From a behavioural point of view, messaging regarding safer sex is clearly a very tough issue to tackle, as even the most knowledgeable are quite complacent about the idea of risk of contracting HIV and the need for protective measures. Given that the fatal nature of HIV/AIDS is not well understood, messages regarding safer sex may have their strongest impact when coupled with the message of fatality (no matter how long after contracting the disease that death occurs).

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