Maputo — A new national survey on HIV and AIDS "destroys the myth that everybody already knows about AIDS", Mozambican Health Minister Ivo Garrido declared on Thursday.
Although there has been an increase in knowledge over the past few years, the survey, he noted, shows "that the majority of Mozambicans still do not possess the indispensable minimum of knowledge".
"It is crucial to step up health education", urged Garrido, "since a large percentage of Mozambicans still don't know what we regard as basic".
He was speaking at a meeting unveiling the preliminary results of the National Survey on Prevalence, Behavioural Risks and Knowledge about HIV and AIDS in Mozambique (INSIDA).
The survey, undertaken jointly by the Ministry of Health and the National Statistics Institute (INE) in 2009 took a sample from across the country of 6,097 households, in which 6,413 women aged between 15 and 64, 4,799 men of the same age group, and 2,016 adolescents aged between 12 and 14 were interviewed.
The survey showed that the vast majority of the sample had heard about HIV and AIDS - over 95 per cent amongst all those over the age of 15, but falling to 84 per cent among 12 year olds.
Yet, despite massive advertising campaigns, around a quarter of the population is still unaware that the use of condoms can prevent HIV infection. Even more surprising is the large number, particularly of women, who did not know that abstinence from sexual relations is a way of avoiding AIDS.
Thus only 57.2 per cent of women aged 15-24 and 63.2 per cent of men in the same age group understood that abstinence eliminates the risk of HIV infection.
Worse still, only around a third of adults have an acceptable level of general knowledge about HIV and AIDS - that is, they know that condom use and fidelity to one, uninfected sexual partner can reduce the risk of HIV transmission, they know that an apparently healthy person can be carrying the HIV virus, and they reject the two most common misconceptions about AIDS (that the disease is spread by mosquito bites, or by supernatural means).
Only 35.7 per cent of women aged 15 to 24 responded correctly to all of these points, and 33.7 per cent of 15-24 year old men. Some of the older age groups are even less informed. Only 25.9 per cent of women aged 40-49 had the correct combination of knowledge.
In general, people in the countryside are much less knowledgeable about AIDS than those living in the cities. 40.2 per cent of urban women and 46 per cent of urban men had acceptable general knowledge about the disease, compared with 27.8 per cent of rural women and 29 per cent of rural men.
As for the battle against stigma and discrimination against HIV-positive people, the great majority of correspondents in all age groups said they would be prepared to take a relative infected with HIV into their own home and look after him or her. Rather fewer, but still over two thirds of the sample, believed that HIV-positive teachers should continue teaching. About two thirds also said they would be willing to buy vegetables from an HIV-infected vendor.
But when it came to breaking the silence surrounding AIDS, the great majority rejected the idea, and insisted that the HIV-status of their relatives should be kept secret. Less than 40 per cent of the sample, in all age groups, both men and women, believed that there was no need to keep the illness of an HIV-positive relative a secret.
Despite the stress by AIDS campaigners on the need to delay the onset of sexual activity, the survey found that around a quarter of the respondents had experienced sexual relations before the age of 15.
25 per cent of urban men began their sex life before they were 15 - exactly the same figure as found by the last comparable survey, the Demographic and Health Survey of 2003. The number of women who embarked on sexual relations before the age of 15 in the cities fell slightly - from 21 per cent in 2003 to 20 per cent in 2009.
There was a greater fall in rural areas - from 33 to 29 per cent among women, and from 28 to 25 per cent among men.
Among the 12 to 14 year olds, the great majority had not had any sexual relations. But 14.8 per cent of the 14 year old girls admitted to sexual relations with one partner and 3.8 per cent with two or more partners. 2.8 per cent of the 12 year old girls had had sex - one per cent with more than one partner.
Of those who had multiple sexual partners in the 12 months prior to the survey, only 23 per cent of the women and 20 per cent of the men said a condom had been used the last time they had sex.
Four per cent of urban women and 2.5 per cent of rural women reported multiple partners. But for men the figures were 22.4 per cent in the cities and 18.1 per cent in the countryside.
This huge difference cannot be accounted for by a large number of men using the services of a small number of prostitutes, since only eight per cent of the male sample admitted to paying for sex in the previous 12 months.
For reasons that have yet to be explained, paying for sex is most prevalent in the north of the country - 36.8 per cent of men aged 15 to 64 in Cabo Delgado province, 16.3 per cent in Niassa and 12.6 per cent in Nampula said they had paid for sex. Even in Maputo city the figure was only 7.9 per cent, and in every other southern or central province it was less than five per cent.
As for HIV testing, only 31 per cent of the women and 16.6 per cent of the men had ever taken a test. Thus the great majority of Mozambicans have no idea what their HIV status is.
The lead researcher on the survey team, Dr Francisco Mbofana, said the HIV prevalence rates are still being worked out from the blood samples taken during the survey. He hoped to publish these results by June.
INSIDA is the first truly national survey of HIV prevalence. Previous estimates of HIV prevalence come from epidemiological surveillance rounds limited to sentinel sites - health units where the blood of pregnant women is tested. There are mathematical methods to extrapolate these results to the general population, and the latest round, in 2009, gave an estimated HIV prevalence rate of 15 per cent among people aged between 15 and 49.