Study population
A total of 226 pregnant women participated in our study. Their ages ranged from 18 to 47 years, with a mean age of 26.8 and a median age of 25. Thirteen women did not answer the question about their age; therefore these women were excluded when we referred our results to age. Parity ranged from 0 to 4 children, with a mean of 0.68 and a median of 1 child. Eighteen women did not answer the question about parity.
Of the 226 women, 76.2% (170/223) were Kazakh, 18.4% (41/223) Russian, 2.2% (5/223) Tatar, 1.8% (4/223) German and 1.3% (3/223) others. The three women who did not answer the question about their ethnicity were excluded when we referred our results to ethnicity. Religion is closely linked with ethnicity. Of the Kazakh women who answered the question about religion, 100% were Muslim. Among the Russian women who answered the question about religion, 93% were Christian Orthodox. Of the whole group 79.7% (173/217) were Muslim, 18.9% (41/217) Christian Orthodox and 1.4% (3/217) other. No significant association was found between occupation and ethnic origin. When it comes to education among the women we refer to additional file 1.
Russian women significantly more often attended Special College (66%; 95% CI 51–80%) compared to 35% (95% CI 28–41%) for Kazakh women. Kazakh women had a tendency to more often attend University/Institute/Academy.
General knowledge
Ninety-six percent (215/225) of the women had heard of HIV/AIDS.
The majority, 52.1% (111/213), of the whole group had first heard about it from the media, 40% (85/213) knew it from school, 2.8% (6/213) from their parents, 1.9% (4/213) from friends and 3.3% (7/213) from other sources. Two women did not answer this question. The older women (> 30 years old) had significantly more often, 80% (95% CI 68–91), heard about HIV/AIDS from the media than the younger women at age 20–30 on 47% (95% CI 39–55). In contrast the younger women (age < 20 and 20–30), had significantly more often heard about the disease at school, 64% (95% CI 35–92) for women age < 20 and 46% (95% CI 37–54) for women age 20–30, as compared with women with age over 30, for whom the corresponding figure was 16% (95% CI 6–27). Only one out of the 56 women who correctly answered yes to the statement that there are differences between HIV and AIDS was able to specify those differences, but the 21 women we interviewed with open questions were better at specifying the differences between HIV and AIDS. Among those who specified, many answers were unclear and difficult to interpret. However, we did obtain some more or less correct answers like: "HIV is the causative agent of the disease AIDS", "HIV means you are a carrier, while AIDS means you are sick" and "with HIV you live longer than with AIDS".
Knowledge about transmission and symptoms
To the open question regarding the main way HIV/AIDS is spread from one person to another many women gave several answers, the most common being "sexual contact" given by 76% (122/160). The second most common answer was blood transfusion, with 30% (48/160). Nineteen percent (30/160) wrote intravenous drug use/needle sharing and 3% (5/160) wrote they didn't know.
To discover misconceptions about transmission about HIV/AIDS the women were asked to include/exclude ways that HIV/AIDS can or not can be transmitted. These answers, with reference to the women's level of education [see Additional file 2]
In general women, with higher levels of education were better than women with low education at correctly excluding and including transmission routes of HIV/AIDS. The differences were significant for "shaking hands/hugging/living in the same house", "changing clothes with someone who has HIV/AIDS", "sexual intercourses with condom", and "sharing needles while injecting drugs". For details, see Additional file 2.
As many as 76% (157/206) answered correctly, with no, to the statement you can not tell, by looking at a person, whether he/she is infected with HIV/AIDS. Younger women (age < 20) significantly more often, 100%, answered no to the statement that by looking at a person you can see if he/she is infected with HIV/AIDS, as compared with women aged 20–30 years, 76% (95% CI 69–83) and women aged over 30 years, 70% (95% CI 57–84).
The open question "Do you know any symptoms of HIV/AIDS" was left blank by 111 women. Of the responders, 66% (69/104) answered no. Among the women who could mention any symptoms the most common answers were fever/sub febrile 37% (13/35), loss of immunity 34% (12/35), weakness 29% (10/35) and cahexia/weight loss 17% (6/35). When the women's ability to mention symptoms of HIV/AIDS were refered to educational level, the women with low education levels significantly more often, 95% (95% CI 85–100), answered that did not know any symptoms, as compared with women with higher levels of education, 60% (95% CI 50–70).
Knowledge about treatment
A total of 14% (28/201) believed that there is a medicine to cure HIV/AIDS, and nearly the same number, 15% (30/202) stated that there are other ways to cure HIV/AIDS. Many more, almost one out of three, stated that there are possible ways to slow the progression of the disease.
Having HIV/AIDS
Of the whole group 41% (88/215) of the women wanted to be tested for HIV/AIDS. Fifty-nine percent (124/211) of the women said they would tell the healthcare personnel if they were found to be HIV positive, 35% (74/211) that they would tell their mothers and 32% (68/211) their partners. Fifteen women left the question blank. Statistically significantly more Russian women, 51% (95% CI 36–66) said they would tell their partner as compared with the Kazakh women, 26% (95% CI 19–33), but on the other hand there was a tendency among the Kazakh women to say more often that they would tell their friends than among the Russian women. There was also a tendency for the Russian women to say more often that they would tell their mothers, but the difference was within the margins of error.
Regarding from whom the women thought they would get support if they were found to be HIV positive, the far most common answer was mother, with 51%. Only 45% thought that they would get support from healthcare personnel, and even fewer, 21%, said they would get support from their fathers, partners 33% or friends 23%. Sixteen women (7%) did not answer the question. A comparison between Kazakh and Russian women showed that more Russian women expected to get support from mothers and partners, while Kazakh women more often mentioned friends and healthcare personnel. Note that the women could tick several alternatives.
Attitudes to PMTCT, prevention of mother-to-child transmission
Seven women said they would want to have more children even if they were found to be HIV positive. Among the women who said no to have more children 82% (176/216), the main reason given was the risk of infecting the baby. Significantly more highly educated women said no, 87% (95% CI 81–92), to having more children as compared with the less educated women, 66% (95% CI 53–79). Of the responders 83%, were prepared not to breastfeed their baby if they were found to be HIV positive. Somewhat more, 86%, were prepared to take medicine, but fewer women, 68%, were prepared to accept Caesarean section to prevent mother-to-child transmission.
Risk behaviour and protection
Ninety-six percent (179/186) had had one sexual partner during the last sixth months. The three questions about condom use were as follow: "Use of condom in steady relationship?", "Use of condom with casual partners?" and "Who has the responsibility for condom use?" Of the women who answered the first question 21% (42/201) answered always, 40% (80/201) never and 39% (79/201) sometimes. Of the responders to the second question, as few as 57% (78/137) answered always, 34% (47/137) never and 9% (12/137) answered sometimes.
About two thirds, 68% (141/206), of the women stated that men and women have equal responsibility to make sure a condom is used during sexual intercourses. Of our responders 65% (134/206) answered that there are ways to protect oneself against sexually transmitted HIV/AIDS. Of the women who answered yes to this question, 55% (74/134) specified ways to protect oneself. Note that the women were allowed to give more than one way of protection.
The far most common answer was to use condoms, 82% (61/74). Other answers were "avoiding casual sexual contacts" and "use of clean syringes". When the women were asked if they had sufficient information to protect themselves against HIV/AIDS, 42% (89/211) answered no and nearly the same number, 42% (88/211) answered yes. Russian women answered to a significantly higher degree 63% (95% CI 49–78) that they had sufficient information compared to Kazakh women 36% (95% CI 28–43).
HIV epidemic
Of our responders 47% (93/198) answered that certain groups of people are more often infected with HIV than others. The far most common group was drug addicts/intravenous drug users, mentioned by 88% (49/56) of the responders. Other groups, given by less than 10% each, were people with many sexual partners, prostitutes, homeless people, homosexual people, medical people, people with low social status, and people without knowledge about the disease and blood donors/recipients. One misconception was that 11% (6/56) of the responders answered that people with poor immune defence systems/organisms are more often infected.