A Study on Aids Awareness and Condom Intention Among a High Risk Group in India

EXTENDED ABSTRACT - The object of the study was to determine some of the antecedents of intention to use a condom among truck drivers in India. Does awareness of AIDS lead to condom intention or is this relationship mediated by beliefs about condoms and feelings about AIDS? Do individual level variables like age, education, income and frequency of sexual episodes with prostitutes have direct or indirect effects on condom intention? The answers to some of these questions may help the social workers and communication specialists who are currently fighting the pandemic in India. Personal intervention and message strategies in place today may, perhaps, be better targeted as a result of the findings of this study. The role of feelings, in particular, may play a pivotal part in such strategies in the future.

Citation:

Arjun Chaudhuri (1998) ,"A Study on Aids Awareness and Condom Intention Among a High Risk Group in India", in AP - Asia Pacific Advances in Consumer Research Volume 3, eds. Kineta Hung and Kent B. Monroe, Provo, UT : Association for Consumer Research, Pages: 218-219.

Asia Pacific Advances in Consumer Research Volume 3, 1998      Pages 218-219

A STUDY ON AIDS AWARENESS AND CONDOM INTENTION AMONG A HIGH RISK GROUP IN INDIA

Arjun Chaudhuri, Fairfield University, U.S.A.

EXTENDED ABSTRACT -

The object of the study was to determine some of the antecedents of intention to use a condom among truck drivers in India. Does awareness of AIDS lead to condom intention or is this relationship mediated by beliefs about condoms and feelings about AIDS? Do individual level variables like age, education, income and frequency of sexual episodes with prostitutes have direct or indirect effects on condom intention? The answers to some of these questions may help the social workers and communication specialists who are currently fighting the pandemic in India. Personal intervention and message strategies in place today may, perhaps, be better targeted as a result of the findings of this study. The role of feelings, in particular, may play a pivotal part in such strategies in the future.

The model used in this study attempted to examine the process by which AIDS awareness and individual characteristics lead to condom intention. Specifically, the model proposes that awareness of AIDS leads to perceptions of vulnerability to AIDS, beliefs about the benefits of condoms in AIDS and feelings about AIDS. These, in turn, lead to condom intention. Sociodemographic factors are also expected to influence perceptions and beliefs. Lastly, the model includes an individual level variable (number of sexual episodes with prostitutes) as an additional exogenous variable since it is likely that variance in this variable will be related to differences in perceptions, beliefs and feelings about AIDS.

A study was conducted to test the model among two hundred and fifty truck drivers in Calcutta, India. Interviews were conducted in six locations in the Greater Calcutta area using six interviewers and two supervisors for a total of five days. All the interviewers were males in their early twenties. A quota sampling method wa employed according to an estimate of the total universe of trucks in these areas as provided by the field agency which conducted the interviews. A English questionnaire was translated into Hindi and Bengali versions since these languages are the most widely spoken in the Calcutta area. A "card" with a five point scale (1= not at all; 5= a lot) was used for most of the questions. The card was made to resemble a petrol gauge with which truck drivers are familiar.

Truck drivers in the sample were all male and the average age was 35.36 years, ranging from 17 to 70 years. 79.6% were married and 89.2% had 0-9 years of schooling. 63.9% spoke Hindi, 19.3% spoke Punjabi (but understood Hindi as well) and 12.4% spoke Bengali. 41.8% of the sample had at least one sexual encounter with a prostitute every month, ranging from 1 to 16 episodes per month.

All measures were obtained from the information provided by the subjects in the questionnaire described above. Condom intention was measured as the sum of two five point scale items ("If in the future you were to visit a prostitute, what are the chances that you would use a condom?", and "How much do you intend to use condoms in the future to guard against the AIDS disease?"). Perceived vulnerability was measured as the product of two five point scale itemsBperceived severity of the threat ("to what extent do you think the AIDS disease is a threat to your life?") and perceived susceptibility to AIDS ("to what extent do you think that your occupation may expose you to AIDS?"). Feelings about AIDS was measured by the same five point scale (1=not at all; 5= a lot). Subjects were asked to describe how they felt when they thought about the AIDS disease. Specifically, they were asked six separate questions: how sad do you feel, how afraid do you feel, how ashamed do you feel, how irritated do you feel, how lonely do you feel, how hopeless do you feel. Beliefs about condoms in AIDS was measured as the sum of two items which asked subjects for their level of agreement (same five point scale as above) with two statements (a) "Using condoms during sex can help prevent AIDS" (b) "Wearing a condom while having sex with a prostitute brings down the risk of AIDS". AIDS Awareness was measured by two five point scale items ("How much have you heard of the AIDS disease?" and "How much do you know about the AIDS disease?"). Since the two items had reliability (coefficient alpha) less than .50, they were not summed together but treated separately as single item constructs in the analysis. Number of Sexual Episodes was measured by a single indicatorB@On the average, how many sexual encounters do you have with prostitutes every month?". The actual number of encounters reported was used as the measure for this variable. Age and Income variables were also measured by the actual number of years and the amount in Indian Rupees provided by the subjects towards the end of the interview. Education was treated as a continuous variable and measured by a six point classification ranging from illiterate (no schooling at all) to college graduate.

Covariance structure analysis using LISREL8.14 (Joreskog and Sorbom 1996) was employed to test the data for the direct and indirect paths from the exogenous variables to the endogenous variables. The analysis of the data involved a two step procedure. First the just identified model (all possible paths, direct and indirect, between constructs) was tested. Next, paths that were non-significant (t value<1.96, p >.05) were deleted from the model. Then the final model was tested once again. The final model fits the data well as indicated by the non-significant chi square (chi square=16.00, d.f. 17, p=.52, GFI=.98, AGFI=.97, RMSR=.05) and the other indices of fit. Note that only age was retained as a demographic variable in the final model since income and education were seen to be unrelated to any of the constructs of interest.

We can note the following significant results from the study:

(a)  Hearing about AIDS is positively related to feelings about AIDS.

(b)  Knowing about AIDS is negatively related to feelings about AIDS but positively related to beliefs about condoms in AIDS.

(c)  Age is negatively related to condom intention.

(d)  Beliefs about Condoms in AIDS is positively related to Condom Intention.

(e)  Feelings about AIDS is positively related to Condom Intention.

(f)  Number of Sexual Episodes is positively related to Perceived Vulnerability.

The results of the study appear to favor a mediated model of the effect of AIDS awareness on condom intention. Awareness of AIDS leads to beliefs and feelings about AIDS and these, in turn, lead to condom intention. Awareness does not directly lead to condom intention but there is an indirect relationship routed through beliefs and feelings. Thus, beliefs and feelings about AIDS are intervening variables which help to explain why greater awareness of AIDS among truck drivers may lead to greater intention to use a condom during sexual encounters with prostitutes.

On the surface at least, the results imply that AIDS campaigns on television etc. will be effective since greater awareness and beliefs and feelings about AIDS lead to greater intention to use condoms. However, the results also suggest that the real problem may still lie unaddressed. As expected, the number of sexual episodes was strongly and positively related to perceived vulnerability. However, perceived vulnerability was not significantly related to condom intention. Note also that although the path coefficient between number of sexual episodes and condom intention was non-significant (t <1.96, p >.05), the simple correlation between the two constructs was significant and negative (r=-.14, p <.05). This is a terrible riddle. Why do people who see themselves greatly at risk, not intend to use a condom on their next visit to a prostitute? One answer from the results of this study is that these people may also have low beliefs about the benefits of condom usage in AIDS. Thus, AIDS and condom awareness campaigns currently may not be reaching the people with the highest risk of the diseaseBfrequent users of prostitution.

Another possibility is that these "addicts" of prostitution knowingly opt for the pleasure of sex without a condom, in spite of knowledge about the consequences, just like heavy smokers, drinkers and heavy users of drugs continue to use products which they know can kill them. If indeed these people are addicted to sex, then their treatment must match that of any other addiction. Mass media strategies promoting the use of condoms will not work for heavy users of sex, just like they do not work for heavy users of cigarettes, drugs and alcohol. Personal intervention methods, similar to those that are used for alcoholics, for instance, must be used to help them to overcome their addiction. Some form of "sexual rehabilitation" may be needed for these people.

Thus, there may be a "crossfire" between certain dimensions of affect such as the reptilian and negative dimensions. [The inclusion of the reptilian dimension substantially increases the range of affective responses that are usually considered. In accordance with MacLean's (1990) "triune" theory of the brain, it is suggested that affective outcomes represent the workings of the "old mammalian" (limbic system) as well as the "reptilian" portions of the brain. The dimension of positive affect, comprised of such elements as happiness, affiliation, etc., is generally identified with the septal area of the limbic system and conforms to the "social" emotional systems which are concerned with the preservation of the species. Another dimension of affect comprised of anger, fear, etc., is associated with the amygdala in the limbic system and confoms to the "individualistic" emotional systems concerned with self preservation. A third dimension comprised of sex, aggression, power, etc., conforms to the older, "reptilian" structures in the brain comprised of the brain stem, midbrain and basal ganglia. Such a multidimensional and hierarchical view of specific emotion systems that is grounded in current neurophysiological theories of the brain, offers significant potential for understanding the structure of affect and its impact on persuation.] This needs to be studied further and a follow up study is currently being designed to this end. Additional questions in the next survey will measure two new constructs "Positive Feelings Without a Condom" and "Negative Feelings Without a Condom". The reptilian and negative individualistic subscales of the CASC scale (Chaudhuri and Buck 1995) will be used in this regard. It is expected that reptilian (pleasure, arousal, power) feelings during sex without a condom will be negatively related to condom intention and that negative (fear, etc.) feelings during sex without a condom will be positively related to condom intention. This explanation envisages an emotional "crossfire" along he lines suggested by Swann et al. (1987) for cognition and affect. However, the crossfire in this case is between two affective systems. It is expected that the more primal reptilian feelings will outweigh negative feelings in matters of sexual behavior. As discussed earlier, this has important implications for intervention strategies in AIDS prevention.

More data also needs to be collected on condom awareness and availability as an exogenous variable. This was not done in the present study and may offer a "rival" hypothesis that needs to be assessed. Perhaps condom intention is low because of perceptions of price or availability of the condoms. Similarly, media viewing habits may also explain some of the variance in the endogenous variables and need to be statistically controlled. Television dependency, for example, has been related to belief structures regarding Indian social issues in the past (Brown and Cody 1991).

REFERENCES

Brown, W. J. and M. J. Cody (1991), "Effects of a Prosocial Television Soap Opera in Promoting Women’s Status," Human Communication Research, 18 (1), 114-142.

Chaudhuri, A. and R. Buck (1995), "Affect, reason and persuasion: Advertising Strategies That Predict Affective and Analytic-Cognitive Responses," Human Communication Research, 21, 422-441.

Joreskog, K. and D. Sorbom (1996), LISREL8: User’s Reference Guide, Chicago, IL: Scientific Software International, Inc.

MacLean, P. D. (1990), The Triune Brain in Evolution: Role in Paleocerebral Functions, New York, NY: Plenum Press.

Swann, W. B., J. J. Griffin, S. C. Predmore, and B. Gaines (1987), "The Cognitive-Affective Crossfire: When Self-Consistency Confronts Self-Enhancement," Journal of Personality and Social Psychology, 52 (5), 881-889.

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