This survey revealed that considerable proportion of fishermen have in-appropriate knowledge, negative attitude and un-safe practice regarding HIV/AIDS and also identified several deficiencies in the knowledge, attitude and practices of HIV/AIDS in certain key areas, such as basic knowledge about the disease, transmission and ways to prevent it.
These results are in concordance with the level of HIV/AIDS knowledge found in other studies from developing countries like African and Asian pacific region [11–13], suggesting that knowledge among fishermen is very low which may perhaps be due to high level of illiteracy (Most of fishermen in this study reported that more than two third of participants were illiterate) and they have not heard about HIV/AIDS. This is in contrast to the findings of Pakistan Demographic Health Survey (PDHS 2006–2007) where, more than two third of population had heard about HIV/AIDS . In PDHS, general population literacy rate was around 40%. When they were asked about mode of spread and preventive strategies for HIV/AIDS, a high percentage did not know about the source through which the infection could spread, which is also quite dissimilar to the findings reported in a national survey of Pakistan , this may be because national survey represents the general population where literacy rate was high and they had more access to HIV information. Most of the participants believe that HIV/AIDS prevent by less sexual activity/ faithful to sexual partner, which is consistent with results of PDHS 2006–2007  and studies from other regions of the world including African countries [23–25].
In this study there was no significant difference of knowledge among different socio-demographic groups. This is perhaps due to the fact that the knowledge about HIV/AIDS, in general, is fairly poor across all study participants. This is in contrast to some others studies where education level, age categories were significantly associated with HIV/AIDS knowledge level among fishing communities [11, 12, 23]. One reason for the low level of sexual knowledge reported in these studies is that, as a conservative Muslim society, Pakistan has certain social and cultural barriers to discuss and address the problems pertaining to sexuality or STD, including HIV/AIDS. In this study major source of information of HIV/AIDS were electronic media, but fishermen were out of home for fishing purpose and HIV information was not accessible to them through electronic media .
Generally participants had negative attitude towards HIV/AIDS but they were sympathetic towards HIV/AIDS patient and against isolating the patient form society. Other investigators have reported consistent presentation for negative attitude towards HIV/AIDS among fishermen [11, 12]. Social and culture attitude play an important role-play in the perception and response to danger. Study found that fishermen had no perception of such type of danger of HIV/AIDS and believes that everything come from nature and solved with time . The denial of danger and fatalism are common themes among fishermen . In this study only significant difference of attitude was observed among those who were literate compared with illiterates This is in line with the findings of other studies [28, 29].
No participant reported that he has gone through screening test of HIV/AIDS and this is due to unawareness about the disease, access and availability of such services . The Condoms uses among study participants were very low (25.6%) which is consistent with the findings of other studies [24, 31]. The reason for not using condoms because they have no access to information and social marketing companies are not allowed to work in this particular area due to culture barriers. In this study, one quarter of the men reported extra-marital sex, this sexual practice could be high and may be underreported, therefore it should not be ignored as a potential risk factor while another study had reported that nearly half of men had extra-marital sex . Men with higher income appeared to have unsafe sexual practices in this study, this may be perhaps reflecting that those who have higher income more likely to contact paid-sex workers [33–35].
There are several strength of this study, finding of this study determine the high risk group which was previously ignored, fishermen may act as a bridging population because they have social contact with the general population which may lead to transfer of infection from high risk group to low risk group (general population). Fishery plays an important role in Pakistan's economy, during the year 2000, Rs.7.9 billion valued of fish and fishery products were exported . Loss of human resources will jeopardize the economy of Pakistan. The findings of this study should be considered in light of the following limitations. We relied on self-report to assess the sensitive health risk behaviors. Due to social and cultural reasons, participants may have hidden some risk behaviours, our measures of association may be an underestimate of the true effect. We couldn’t observe any statistically significant differences in knowledge, attitude and practice scores, this may be because majority of participants had poorer knowledge, negative attitudes and unsafe practices related to HIV and AIDS, so the numbers in high knowledge, positive attitude and safe practice groups were smaller to observe any convincing associations. A larger cross-sectional survey, using multiple cities and centers may provide further insights and identify some high-risk groups. Finally, our study did not cover distribution of multiple sexual relationships, mobility, and port based IDU among fishermen, which are the risk factors of HIV among fishermen, so this remains a limitation of the study.
Despite these limitations, appropriate health education should be given to the fishermen in a generalized way to bring behavioral change targeting at all health-risk behaviors in relation to HIV and AIDS. Electronic media appeared to be the only source which was utilized by at least one third of the populations, so behavior change interventions may be executed through local radio/TV channels to improve the knowledge and practices.