Changes in knowledge and attitudes

Investigation of the effects of HIV-prevention campaigns on the knowledge and attitudes of the target population was one of the first measurements of effectiveness to be adopted by researchers. It was considered to be a crucial first step in determining whether or not information about HIV and AIDS had been received and understood by the target population.

During the 1980s, knowledge and attitudes surveys carried out in the UK showed wide and rapid dissemination of messages about HIV infection and AIDS, but also showed alarming levels of miscomprehension of these basic messages. These surveys tended to investigate the impact of basic HIV-awareness campaigns, and provided useful baseline data.

Such surveys are of limited usefulness today, except in situations where new concepts are being introduced to a population. For example, knowledge and attitudes surveys amongst gay and bisexual men in the UK over the past decade have repeatedly demonstrated high and unvarying levels of knowledge about AIDS, HIV, modes of transmission and safer sex. However, when a new intervention (post-exposure prophylaxis, also known as PEP) was introduced and became the subject of an awareness campaign by the Terrence Higgins Trust, Sigma Research reported considerably increased knowledge and use of PEP after the campaign.¹ Between 2003 and 2005, the proportion of respondents to the annual Gay Men’s Sex Survey who had heard of PEP increased from 22.2 to 38.5% and the proportion who had ever taken it doubled from 0.6 to 1.2%.

There is also no automatic relationship between levels of knowledge and behaviour. Whilst UK samples of gay men consistently demonstrate very high levels of knowledge about HIV risks, a significant proportion practise unprotected anal intercourse with regular partners.

In some studies, an inverse relationship has been observed between knowledge and risk behaviour. It is older gay men who are well educated about HIV risks who are having the most unsafe sex, perhaps because knowledge can be used at the service of rationalising risks (as in decisions to have unprotected sex based on a person’s viral load – see Serosorting, sexual harm reduction and disclosure), or perhaps because older gay men are more likely to have been through traumatic experiences and multiple loss due to AIDS.²

In other cases, more knowledge about HIV can be a surrogate marker for higher levels of sociability and extraversion, which in some studies have been linked to more risk-taking behaviour.^3,4

Another form of ‘knowledge and attitudes' research which may be more relevant is the evaluation of skills acquisition, although this can be difficult to measure. The skills acquired might be condom use or the ability to raise the topic of safer sex with prospective partners, and skill acquisition is usually measured by self-report.