Original Article KNOWLEDGE AND BEHAVIOR RELATED TO HIV AND STI AMONG FEMALE TEXTILE WORKERS IN SURAT CITY.

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1 Original Article KNOWLEDGE AND BEHAVIOR RELATED TO HIV AND STI AMONG FEMALE TEXTILE WORKERS IN SURAT CITY. B DESAI*, JK KOSAMBIYA**, B PATEL*** ABSTRACT Background: Surat city is vulnerable for transmission of STI/HIV due to its huge number of migratory population in Diamond and Textile Industries. The present study was undertaken to know about the knowledge of various Sexually Transmitted Infections (STIs) and HIV among the Females working in various Textile Markets of Surat city. Objective : To know about the knowledge of STI/HIV among women working in textile industries in Surat city and to study their risk behavior which increases their vulnerability in getting STIs/HIV. Methodology : 257 female workers working in various textile markets were enrolled in the present study. Data was collected by help of pretested, semi structured questioner and analysis was done by using Microsoft Excel and EPI info software. Result : Out of 257 study participants 25.29% had knowledge regarding any modes of transmission of HIV/AIDS where as 42.80% had knowledge regarding STIs. In the study 28.02% had reported that they had suffered from any of the STDs syndrome previously. Key words : Sexually Transmitted Disease, HIV, Behavior Introduction Surat has a glorious history dating back to 300 B.C. and owes its name to the old Hindu town "Suryapur". It has covering an area of sq. km. (with extended city limits in 2006) and having population of 4,462,002; of which male and female are 2,538,243 and 1,923,759 respectively as per provisional census 2011 figures. 1 The sex ratio of Surat city is 758 per 1000 males. Surat is one of the major industrial cities of India contributing a major share of export especially in Diamond and Textile sectors. Textile is one of the old industries in Surat. It is considered as the major backbone of Surat's economy. Textile *Assistant Prof., **Professor(Addl.), Deptt. of Comm. Medicine, Government Medical College, Surat- Gujarat ***Associate Professor, GMERS Medical College, Gotri, Vadodara- Gujarat. E mail : drbinitadesai@yahoo.co.in industry contributes 40% of the nation's man made fabric production, 28% of the nation's manmade fiber production, 18%of the nation's man made fiber export and 12% of the nation's total fabric production. 2 Surat city has become known for its industries of "Silk, Textile, and Diamonds," as well as its epidemic of "Sexually Transmitted Diseases" (STD).HIV prevalence of Gujarat and Surat as per sentinel surveillance is 8.4 among STD clinic attendee and 1.2 among ANC clinic attendees and that of Gujarat 3.65 and 0.2 respectively. 2 Factors like migration, state boundaries, jobs availability and opportunities contribute to the moderate vulnerability of the State as a whole. 3 Surat is the main industrial city in the Gujarat. It attracts people (more than 80% men) 22

2 B Desai & et al from different districts of Gujarat as well as from different states of India to work in its diamond cutting and textile industries. Nearly 3,00,000 men are working in these 2 industries. The majority of them are residing without their families whom they occasionally visit. Due to the poverty, and disparity in urbanization and economic development in different parts of India, migration of the rural poor to urban areas is common and is linked to an increase in HIV and STI prevalence. HIV acquisition appears to be enhanced by other intercurrent STIs. As cumulative data of Voluntary Counseling and Testing Center showed high positivity among textile workers, it was a need for the HIV prevention and control group to know the knowledge and behavior practices related to HIV and STI among this group. The objective of this study is to know the knowledge of STI/HIV among women working in textile industries in Surat city and to study their risk behavior which increases their vulnerability in getting STIs/HIV Methodology It was a cross sectional study conducted among females working in Textile Markets of city Surat. Ethical clearance was approved by Human Research Ethics Committee, Govt. Medical College, Surat prior to the study. The non government organization was working earlier for intervention for prevention of HIV/AIDS among textile workers group. But as this group is not a pure targeted group as per NACP III definition, this NGO had stopped working. There after there was a need to assess this group for HIV prevention activities in the city. Level of knowledge regarding STI and HIV was essential before linking this group to any intervention project or to establish a separate intervention activities. Therefore the study was planned. Total sample size was 250 as per HIV sentinel surveillance guideline for high risk group. 4 As there are large number of small and large textile markets were there in the city, it was decided to choose all the participants from 11 randomly textile markets. The selection of 11 markets was after initial listing of all the females of age group years working in these markets so we could get the desired sample size of 250. All the females of selected markets having age group of were enrolled for the study. Female members of these 11 markets were initially approached by field workers of study project. The need and purpose of the study was discussed with them before their enrollment. During this procedure the sample reached to 257. The study was conducted in a nearby Urban Health Center (UHC) so workers could have easy approach. So total 257 participants, of 11 randomly selected markets were invited for the study to get required sample size of 250. All invited participants could able to enroll them for study with written informed consent during the time of study period. As no invited participant denied for participation, data from all 257 were taken and analyzed. A quantitative study tool was developed and piloted before the actual study was undertaken. Questions regarding their socio demography profile, knowledge of STI/HIV and past episodes of STI, if any were asked in a study tool. Results In this study majority of the workers were in the age group of years (48.25%), while 16.73% were in the age group of years and 35.02% were belonging in the class of years.70% of females were migrated from other districts of Gujarat and from other states of India. So in textile markets high number of females 23

3 Knowledge and Behavior related to HIV and STI among Female Textile Workers in Surat city. reported history of migration. This study found that 89.06% female textile workers were married at the age less than 18 years which is considered as the legal age of marriage. Knowledge regarding HIV: When participants were asked about whether they had heard about HIV/AIDS, 47.28% participants said that they had previously heard about HIV/AIDS. Out of 257 study participants 25.29% had knowledge regarding any modes of transmission of HIV/AIDS. The distribution regarding knowledge of various modes of transmission of HIV among participants is shown in table 1. Table 1 : Distribution of female textile workers according to knowledge of modes of spread of HIV Mode of spread Number Percentage Unsafe Sex Infected blood Infected Syringe Mother to child When asked about modes of transmission, out of total 257 participants, unsafe sex was mentioned by 65 (25.29%), infected blood by 36(14.00%), infected syringe by 33 (12.84%) and mother to child by only 25(9.72%) participants. Awareness regarding mother to child transmission is least. Only 35 (13.61%) participants know at least one or more of the preventive methods of HIV/AIDS. The distribution regarding awareness of methods of prevention was among these 35 participants were as per table 2. Majority reported unsafe sex as mode of transmission and safe sex practices as a method was prevention. So awareness regarding sexual transmission is there while other modes of transmission are less known. Table 2 : Distribution of female textile workers according to knowledge of methods of prevention Method of prevention Number Percentage Safe sex Faithful relationship Use of condom Tested blood Disposable needle syringe Others (By drugs) Among methods of prevention, safer sex practice is the commonly mentioned by 13.22%, having faithful relation by 8.17%,use of condom by 9.72%,tested blood by 6.61%,disposable needle/syringe by 7.00% and other(by drugs) by 0.38% out of total 257 participants. Out of the total study participants 13.62% believed that healthy individuals cannot be infected while 4.28% believed that healthy person can be infected and 82.10% participant reported that they do not have knowledge in the matter. Knowledge regarding of STI : Out of total 257 study participants, 42.80% reported that they had knowledge regarding STIs. Table 3 : Distribution of female textile workers according to knowledge about symptoms of STI Knowledge about Number Percentage symptoms of STI Vaginal Discharge Lower abdominal pain Fluid filled vesicle at the genital area Ulcer over genital area Scabies over genital area Bubo over genital area Pus discharge in urine Genital warts When participants were asked about various symptoms of STI, out of total participants, 24

4 B Desai & et al most of the participants (41.24%) had knowledge about vaginal discharge as an STI symptoms, followed by lower abdominal pain(22.56%), fluid filled vesicles over genital area (11.28%),ulcer over genital area(9.72%),scabies over genital area (5.83%), inguinal bubo(1.94%),pus discharge in urine(1.55%) and lastly genital warts.(0.38%). The study showed that 58.75% females reported that they had sexual intercourse below the 18 years and 41.25% reported sexual intercourse at or after the attainment of age 18 years. High Risk Behaviors for Acquiring HIV/ STI : The study revealed that out of total 257 participants enrolled, 9(3.5%) were reported that they had sexual relation with other then their husband. Out of these 9 participants, 8 had knowledge regarding STI which is significantly higher than those who were not reported sexual relation with other than their husband (p<0.05). In this study 37.35% were reported that they had ever seen condom. Out of total 257 participants only 49 participants mentioned any of the places to procure condom. Out of 9 who had reported sexual relation with other than their husband, 8 reported that they had seen condom, which was higher than who were not reported high risk sexual behavior (p<0.05). The places mentioned by them were medical store, government hospital, Urban Health Centers (UHCs), local HIV project staff, Aanganwadi, private clinic and condom depot. In the study only 5 (1.95%) females reported alcohol consumption. Out of these 1 reported daily alcohol consumption while 1 reported consumption once in a week and 3 reported occasional alcohol consumption. Table 4 : Distribution of female textile workers according usage of condom with husband Condom use with Number Percentage husband Never Occasionally Sometimes Most of the times Every times 4* 1.56 Total 257* 100 (* One unmarried participant reported condom use with her partner.) The study revealed that 89.10% study participants had never used condom with their husband. Only 5.06% study participants had used condom sometimes, followed by 3.50% occasionally and 0.78% had most of the times. Only 1.56% out of 28 who were using condom with their husband used it every time. Among 9 Female workers who had reported of having multiple sexual partners, 7 (77.78%) were reported condom use with their partner other then husband. STD infection in past : After assessing participants knowledge on HIV/AIDS and STI they were asked about history of any symptoms suggestive of STIs in past. Table 5 : Distribution of female textile workers according to history of suffering from STDs in past Suffering from Number Percentage STDs in past Yes No No reply Total In the study 28.02% had reported that they had suffered from any of the STDs syndrome previously while 71.60% denied that they did not had the complaints previously and 0.39% did not replied. 25

5 Knowledge and Behavior related to HIV and STI among Female Textile Workers in Surat city. Table 6 : Distribution of female textile workers according to type of STD in past Type of STD Number Percentage Vaginal Discharge Scabies over genital area Fluid filled vesicle at the genital area Ulcer over genital area bubo over genital area Backache pus in urine Warts No reply Out of total 257 participants, majority (22.56%) had history of vaginal discharge. Out of those 72 participants, who had reported any of the STD syndromes previously, only 35(48.61%) had taken treatment and out of them only 7(20.0%) had taken treatment at the Government institutes and rest had taken treatment other then government institute. Discussion Knowledge about prevention of HIV/STI will empower the persons to reduce the risk of acquiring the infection. According to NFHS III, only 6 in 10 women aged years in India have heard of AIDS with 8 in 10 in urban area and 5 in 10 in rural area. DLHS III for the Surat city reported that 60.5% married females of years had ever heard about HIV/AIDS. 5 In the present study, 47.28% of the participants have ever heard about HIV/AIDS which is low as compared to NFHS III and DLHS III data. Comprehensive knowledge of HIV/AIDS is defined in NFHS III as Knowing that both condom use and limiting sex partners to one uninfected faithful partner are HIV/AIDS prevention methods; being aware that a healthy-looking person can have HIV/AIDS; and rejecting the two most common misconceptions in India-that HIV/AIDS can be transmitted through mosquito bites and by sharing food. 5 NFHS-3 results revealed that in India only 17 % women and 33 % men have comprehensive knowledge of HIV/AIDS prevention and transmission while in Gujarat the same was 20.3% in women with 28.3% in urban area. In the present study, only 3.50% participants had comprehensive knowledge of HIV/AIDS which is very low as compared to NFHS III figures. Knowledge and early diagnosis and treatment of STIs are primary prevention measures for HIV infection. Present study revealed that 42.80% participants had knowledge about STIs. DLHS III Surat revealed that 33.6% married females of age years had knowledge of STIs. 6 Condoms play a special role in combating the spread of HIV/AIDS because they are presently the only devices that protect against sexually transmitted HIV. However, high costs to users, limited availability and accessibility, and negative perceptions of condoms have created a gap between the number of condoms distributed and the amount needed for populations to protect themselves from HIV/STIs. Improved condom programming can help close the gap in condom supply and use, and reduce the spread of HIV. Because male and female condoms prevent pregnancy as well as infection, they offer people the convenience of dual protection. 7 Current study reported that only 37.35% had ever seen condom and only 10.9% had ever used condom. Among those who had multiple partners, 7 out of 9 (77.78%) participants reported use of condom with their partners. 26

6 B Desai & et al In this study, 49 participants out of 257 (19.06%) had knowledge about any condom source. According to NFHS III, knowledge about condom source among young women in India was ranged from 35% in women age years to 58% in women age years, while in Gujarat knowledge about condom source in women was 57.3% with 69.1% in urban area. 5 Lower knowledge about condom source in our study compare to NFHS III is may be due to that in our study age group of participants was years while NFHS III enrolled only young age group. Recommendations : Study shows that there are certain high risk behaviors which may increase vulnerability of this group in acquiring HIV/STI transmission and there are few behaviors like non use of condom, sexual relation with multiple partners which may keep on spreading the transmission of infection. Poor and incomplete knowledge regarding modes of transmission and ignorance related to preventive measures make them vulnerable to get HIV/ STI infection. A separate group working for them who can win their confidence and then offer them various services of STI/HIV like BCC (Behaviour Change Communication), is needed. So, the NGO which can understand their need and can work for them is needed to cut down the chain of transmission. Health care system should focus on awareness and an intensive IEC (Information, Education and Communication) among them. This can be done by identifying this group and their area and including them under the coverage of UJAAS (Urban Joint AIDS Awareness Special Interactive Program) project run by GSACS. ICDS workers can help them by providing information. UCD (Urban Community Development) department of Surat Municipal Corporation is providing efficient services for empowerment of women in urban slums. Under this scheme they are creating CBOs (Community Based Organizations) for women. Study group can be linked with this department to improve their knowledge and behavior. Counselor appointed at UHCs can frequently visit this female textile worker group Federation of Surat Textile Traders Association (FOSTTA) can take the responsibility as a part of "Corporate Social Responsibility" of contract laborers. Acknowledgement : Gujarat State AIDS Control Society for technical and financial support as well as PARAS -PSN NACP III project, working for Targeted Intervention for their field level support. References : 1. Census 2011, India. [Cited 27 th June 2012] Available from URL: census/city/343-surat.html 2. Gujarat State AIDS Control Society. HIV Sentinel Surveillance Report. GSACS, Ahmedabad; National AIDS Control Organization. HIV Sentinel Surveillance and HIV Estimation in India NACO and MOHFW,GOI, New Delhi, India: NACO; p National AIDS Control Organization Annual HIV Sentinel Surveillance Country Report 2006.NACO and NIHFW, India: NACO; p International Institute of Population Science. National Family Health Survey III (NFHS III- Gujarat). IIPS; p Ministry of Health and Family Welfare. District Level Household and Facility Survey under Reproductive and child Health project (DLHS-3), District Fact Sheet. MOHFW; United Nations Population Fund. Condom promotion for HIV prevention, An operational manual for programme providers. UNPFA, WHO and PATH; p. i-ii. 27