Asymptomatic Transmission

Some investigators report that local concepts of disease may not encompass the idea of a healthy carrier (Irwin et al., 1991; Hogsborg and Aaby, 1992). Among women questioned by Lindan et al. (1991), 70 percent believed that everyone infected with HIV was clinically ill, and one in five thought one could tell if someone was seropositive by looking at him or her. A study of AIDS-related knowledge in Zimbabwe, undertaken in 1994, revealed that while virtually all Zimbabwean men and women have heard of AIDS, 15 percent of men and 26 percent of women do not believe that a healthy-looking person can carry the AIDS virus (Central Statistical Office [Zimbabwe] and Macro International Inc., 1995). It is surprising, then, to find such high levels of awareness of asymptomatic transmission among respondents to the WHO/GPA surveys. This awareness, however, may be more apparent than real as a result of bias in the question.13

Severity and Perceived Threat

Although most people who know of AIDS consider it a dangerous disease, a substantial proportion believe it is curable. This is the case even in countries such as Lesotho, where there is broad access to AIDS information. In Kigali, Rwanda, one of the highest HIV-prevalence areas in the world, over one-third of women said they thought AIDS was curable or possibly curable (Lindan et al., 1991), while in Zaire, the vast majority of subjects in a study of factory workers said they thought a cure was available (Irwin et al., 1991). The WHO/GPA surveys show that high proportions of those who think most people infected with AIDS will die of it also think that a cure is available, presumably because most people will not be able to get access to it.

A large proportion of respondents in most WHO/GPA survey countries spontaneously mentioned AIDS as a major health threat to both the world and their nation. Some respondents thought the problem less pressing in their own regions. High proportions in Guinea-Bissau and Burundi said AIDS was a national threat, but only around 1 person in 10 in those countries thought it an immediate threat to his or her community, although more thought the danger would grow over the next few years. Respondents in some heavily afflicted areas (e.g., Tanzania and Lusaka, Zambia), though very much aware of the immediate threat AIDS poses to their community, appeared not to fully understand the implications of the epidemic; lower proportions saw it as a medium-term rather than a current concern.

13  

 In the standard protocol, the surveys asked people "whether someone who has the AIDS virus but looks healthy can transmit the virus to others" (response options: yes/no/don't know), wording that assumes the person's infection. For discovering the determinants of behavior, a more accurate picture might be given by a question such as "Can you get AIDS from someone who looks healthy?"



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