Knowledge, Perceptions And Behavior Associated With Hiv/aids Among Somali Refugees On Transit Undergoing Medical Screening In Nairobi

Abstract

AIM: The study was conducted on urban Somali refugees on transit and undergoing HIV and AIDS counselling sessions as part of their medical screening process at the IOM's Migration Health Assessment Centre (MHAC) in Nairobi just before resettlement to other countries. The study's main objective was to establish and compare the knowledge, perceptions and behaviors of both before and after undergoing the sessions. METHODOLOGY: A descriptive cross sectional study was conducted to establish this. Both qualitative and quantitative methods were used to collect data. Consecutive sampling of respondent's who were of Somali origin, aged 15 years and above, who had never undergone counseling and those who gave informed consents was used to obtain the sample. A total of 377 respondents were interviewed before the counselling sessions, with 360 of them same respondents re-interviewed after. Also eight focus group discussions were conducted and 6 key informants interviewed. RESULTS: There was almost a balance between the genders, with male respondents slightly more. Most of the respondents were single, between 15 to 30 years old, having been displaced from their country for the last 15 years and had no form of education. The findings generally indicate that respondents had heard of HIV and AIDS and its emergence as a global challenge, with radio and television being the most common sources of information. However, knowledge on the various modes of HIV transmission and prevention was limited, with lots of myths and misconceptions existing among the respondents. HIV/AIDS related knowledge were quite low before the counseling sessions, but did slightly improve after from 6.1% to 15.6% respondents scoring adequately in HIV/AIDS related knowledge (75% and above scores). This change in knowledge though slight was statistically significant. However, some of the misconceptions like the spread of HIV through mosquito bites actually increased. Respondents' attitudes towards condom use, people living with HIV and AIDS and HIV testing before marriage were generally negative before counseling. Most of these attitudes changed significantly after counselling with more respondents willing to care for people living with HIV/AIDS and also go for HIV testing before marriage. In general, the community appears to be tolerant of their own HIV infected members, but regard outsiders who are already infected as immoral and sinners. More respondents were still not willing to use condoms for any reason in future after undergoing the counseling sessions. Overall this change in respondents' attitude was also statistically significant. Respondents with increased knowledge levels had more negative attitudes towards individuals with HIV/AIDS, condom use and even HIV testing before marriage. There was a significant improvement in the respondents overall HIV and AIDS related attitudes, with respondent's attitude scores increasing from 13.5% before counseling to 93.3% after. This is a significant finding and suggests that the pre-test counselling sessions offered to the refugees before resettlement are effective HIV/AIDS preventive strategies. There was the generalized belief that HIV/AIDS was not a threat to the community and that it did not affect this community, thus their perceived personal risk was low. Most believed that HIV/AIDS only affected immoral people who did not follow Islam and the will of God. CONCLUSION: This study suggests that knowledge about HIV/AIDS is low in this refugee population. The population receives little information on HIV/AIDS, while condom knowledge is particularly low with men and women having a negative attitude to condom use. It does not perceive HIV/AIDS as threat in its community and associates it with immorality. The findings indicate a need for targeted, culturally sensitive HIV/AIDS information program. A follow up long term study is also proposed to find out any behavioral changes resulting from information received during HIV and AIDS counseling sessions among this community.