HIV/AIDS-Related Knowledge Among Malaysian Young Adults: Findings From a Nationwide Survey

Li-Ping Wong; Caroline-Kwong Leng Chin; Wah-Yun Low; Nasruddin Jaafar


Medscape J Med. 2008;10(6):148 

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The overall response rate of this survey was 82.2%. The total number of respondents who completed the survey questionnaire was 2604, with 1075 respondents aged 15-24 years.

Of the 1075 young respondents in the sample, about half were aged 15-19 years ( Table 1 ); the mean age was 19.4 years (SD ± 2.8). A majority of the respondents reported that they were currently working and almost half were still attending school. About three quarters of the respondents reported secondary school as their highest education level. Only about 12% of the respondents were married. The male to female ratio was 1.34, which was somewhat higher than the male to female ratio of 1.03 in the general Malaysian population. A substantial percentage of the respondents fell in the low and lower-middle income categories, with incomes below 550 US dollars (USD) per month.

General HIV/AIDS knowledge. The survey found that 4.3% of respondents (n=46) had never heard of HIV/AIDS; most of these individuals (n=30) were from rural areas and nearly half of these (n=16) were students. Of those that had heard of HIV/AIDS (n=1029), when further asked to define HIV and AIDS, many (64.9%, n=668) were unable to correctly differentiate HIV from AIDS. Misconceptions were still noted relating to HIV/AIDS, with 13.9% (n=143) having no idea whether HIV-positive people could be recognized by their appearance and 28.7% (n=295) believing that HIV-positive people could be so recognized. Surprisingly, 18.1% (n=186) believed that there was a cure for AIDS, and only 69.8% (n=718) reported that HIV/AIDS could not be cured. Only 50.6% (n=521) believed early detection could prolong life. The majority (82.9%, n=853) knew about blood-based HIV testing; however, 17.1% (n=176) had no knowledge about how a person could be tested for HIV. Many (80.5%, n=828) had never heard of anonymous HIV testing, which has been made available in the country.

The mean (± SD) and median of the total correct general HIV/AIDS knowledge scores of all respondents on a 7-item test were 4.6 ± 1.4 and 5.0, respectively. The mean total score among respondents from Peninsular Malaysia (4.8 ±1.4) was higher than the score among respondents from East Malaysia (4.2 ± 1.5, P < .001). Female respondents had a significantly (P < .01) higher total mean score (4.7 ± 1.4) than male respondents (4.5 ± 1.5). Statistically significant differences were noted among the ethnic groups (4.8 ± 1.3, P < .001), with the Malays having the highest score. Older respondents had significantly higher scores than younger respondents (4.7 ± 1.3 among those aged 20-24-years vs 4.4 ± 1.5 among those aged 15-19-years, P < .001). Urban respondents had a significantly (P < .05) higher mean total score (4.7 ± 1.3) than rural respondents (4.5 ± 1.5).

Knowledge of modes of transmission. Table 2 shows that, on questions about mode of transmission, most of the respondents knew that HIV is transmitted via sharing injecting needles with an infected person (94.8%), having sexual intercourse with an infected person (93.7%), receiving a transfusion of infected blood or receiving an organ from an infected person (91.9%), having sex with multiple sexual partners with unknown HIV status (91.4%), and from an infected mother to her fetus (85.6%). Most were also aware that HIV infection is not transmitted by casual contacts (90.8%), sitting on public toilets (90.5%), and using a public swimming pool (89.7%). However, a smaller majority were aware of other modes of transmission, such as tattooing and piercing (63.3%), sharing personal items (60.8%), and breast-feeding from an infected mother (54.8%). Transmission via breast-feeding was the mode of transmission about which the highest percentage of respondents (28%) was "unsure."

The mean (± SD) and median of the total scores on mode of transmission on a 14-item test were 9.7 ± 2.2 and 10.0, respectively. Female respondents had a higher mean total score (10.0 ± 2.2) than male respondents (9.6 ± 2.3) (P < .01). The mean total score was 10.0 ± 2.1 for the older age group (20-24 years) and (9.5 ± 2.3) for the younger age group (15-19 years) (P < .001). There were significant differences in the scores among people of different ethnicities (10.2 ± 2.0, P < .001), with the Malays having the highest score, followed by the Chinese and Indians.

Knowledge of HIV prevention. In response to the question asking whether HIV infection could be prevented, 79.1% of the respondents believed that it could. As shown in Table 3 , the most well-known modes of prevention were: (1) to avoid taking drugs, (2) to not share injecting needles and syringes, and (3) to have sex with only one faithful uninfected partner. Only 79.5% of the study population knew that HIV/AIDS could be prevented by using condoms. Some misconceptions were noted, with 41.9% of respondents believing incorrectly that washing the genital area with soap after sexual intercourse could prevent HIV infection and 36.1% believing that avoiding touching HIV positive people could do so, thus indicating an inadequate awareness about the prevention of HIV/AIDS in our study subjects.

On the whole, the mean (± SD) and median of the total scores on HIV prevention on a 6-item test were 4.3 ± 1.2 and 4.0, respectively. The mean total score was 4.5 ± 1.2 for the older age group (20-24 years) and 4.2 ± 1.2 for the younger age group (15-19 years) (P < .01). There were significant differences in the scores among different ethnicities (4.5 ± 1.1, P < .05), with the Malays having the highest score. Rural respondents had a significantly higher average mean score than urban respondents (4.4 ± 1.1 vs 4.2 ± 1.2, P < .05).

Knowledge of HIV testing. It is interesting to note that the majority of the respondents were aware that blood tests (94.7%), DNA tests (68.3%), and urine tests (63.0%) can all be used for detecting HIV infection, but that only 35.1% of the respondents knew that an oral fluid test can also be used for testing.

On the whole, the mean (SD) and median of the total overall knowledge scores (calculated by adding the scores from each section of the test) were 20.1 (SD = 6.0) and 21, respectively, out of a total of 32 points. Significant differences were observed between female and male scores (20.6 [SD = 5.7] vs 19.7 [SD = 6.1], P < .05). Significantly higher scores were also shown for older respondents compared with the younger respondents (20.9 [SD = 5.2] for the older group vs 19.3 [SD = 6.5] for the younger group, P < .001).

The ANOVA showed that the mean total overall knowledge score was significantly correlated with average household income (F = 2.65, df = 5, P < .05). As shown in Figure 2, those from households with higher incomes were significantly more knowledgeable. Significant differences were also found between respondents from different educational levels (F = 20.45, df = 3, P < .001). The higher the educational level, the higher the mean score obtained by the respondents. Differences in mean total score were also observed among the ethnicities, with Malays obtaining the highest mean total score (F = 9.201, df = 3, P < .001).

Figure 2.

Relationship between mean total overall HIV/AIDS knowledge score and average household income.

Knowledge on the availability of healthcare services. Respondents were also queried on their knowledge of the availability of HIV/AIDS-related health services (HIV/AIDS testing, HIV-related counseling, and treatment for HIV/AIDS). When asked about where a person could obtain HIV/AIDS-related health services, the overwhelming majority noted that they could obtain HIV testing (94.6%), HIV-related counseling (91.2%), and treatment (93.8%) from government hospitals. This shows that the majority recognized that government health facilities offer HIV/AIDS-related services. In addition to government hospitals, a small minority of respondents thought that the services were also available at private hospitals and clinics in the country. Surprisingly, some respondents thought that traditional or folk healers could also provide such services (HIV testing [4.5%], HIV counseling [7.0%], HIV treatment [6.9%]).

The respondents obtained HIV/AIDS-related information from various sources. Television (95.6%) was by far their primary source, followed by newspaper (86.1%), radio (76.6%), and printed material from the Ministry of Health Malaysia (51.6%). Nearly 40% reported having received HIV/AIDS-related information from friends and family, and one-third (33.8%) of the respondents obtained HIV/AIDS-related information from the Internet. Only 23.3% (n=397) of the respondents mentioned PROSTAR (the Healthy Adolescents Without AIDS program) as a source of information about HIV/AIDS.


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