Knowledge, Attitude, and Practices Regarding HIV and TB Among Homeless People in Tehran, Iran

Document Type: Original Article

Authors

1 Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

3 Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran

4 Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran

5 Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran

6 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

7 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background
Homeless people are at high risk of HIV and tuberculosis (TB) infection due to living in poor sanitary conditions and practicing high-risk behavior. The aim of this study is to assess the knowledge, attitude, and practice (KAP) of homeless people in Tehran regarding TB and HIV.

 
Methods
Using a convenience sampling, we performed a cross-sectional study on homeless people in Tehran from June to August 2012. Participants aged 18-60 years having at least 10 days of homelessness in the preceding month to the study period were included. All required data were collected through face-to-face interviews conducted using a researcherdesigned questionnaire. Each score in KAP of TB and HIV was separately divided by the maximum score and multiplied by 100 to attain percentage scores. The mean scores were compared using analysis of variance (ANOVA) and student’s t test. A Tukey test was used for post hoc analysis and two-by-two comparisons.

 
Results
In this study, 593 participants consisting of 513 men and 80 women were included. The mean age of the participants was 41.74 ± 0.45 years. Moreover, the total mean score of KAP toward HIV was 79.24 (95% CI: 77.36, 81.12), 57.13 (95% CI: 55.12, 59.14), and 21.14 (95% CI: 18.35, 23.93), respectively. The total mean score of knowledge and practice regarding TB was 62.04 (95% CI: 59.94, 64.14) and 42.57 (95% CI: 40.36, 44.78), respectively. 
 
Conclusion
Although a relatively acceptable knowledge was detected in this high-risk population, practices regarding TB and HIV showed some weaknesses. Developing special programs to improve the healthy behavior of this population is highly recommended.

Keywords

Main Subjects


  1. Tavoosi A, Zaferani A, Enzevaei A, Tajik P, Ahmadinezhad Z. Knowledge and attitude towards HIV/AIDS among Iranian students. BMC Public Health. 2004;4:17. doi:10.1186/1471-2458-4-17
  2. Gallo RC, Montagnier L. The discovery of HIV as the cause of AIDS. N Engl J Med. 2003;349(24):2283-2285. doi:10.1056/NEJMp038194
  3. Skevington SM, Sovetkina EC, Gillison FB. A systematic review to quantitatively evaluate 'Stepping Stones': a participatory community-based HIV/AIDS prevention intervention. AIDS Behav. 2013;17(3):1025-1039. doi:10.1007/s10461-012-0327-6
  4. Aaron L, Saadoun D, Calatroni I, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect. 2004;10(5):388-398. doi:10.1111/j.1469-0691.2004.00758.x
  5. Pawlowski A, Jansson M, Skold M, Rottenberg ME, Kallenius G. Tuberculosis and HIV co-infection. PLoS Pathog. 2012;8(2):e1002464. doi:10.1371/journal.ppat.1002464
  6. Getahun H, Kittikraisak W, Heilig CM, et al. Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLoS Med. 2011;8(1):e1000391. doi:10.1371/journal.pmed.1000391
  7. Havlir DV, Getahun H, Sanne I, Nunn P. Opportunities and challenges for HIV care in overlapping HIV and TB epidemics. JAMA. 2008;300(4):423-430. doi:10.1001/jama.300.4.423
  8. World Health Organization. Working together with businesses: guidance on TB and TB/HIV prevention, diagnosis, treatment and care in the workplace. Geneva: WHO; 2012.
  9. Salarzadeh AN, Mohammadi B. Investigating the effects of socio-economic factors on homeless people of Tehran. Social Development and Welfare Planning. 2010;1(1):93-110.
  10. Safiri K, Khadem R. An evaluation of life expectancy status among homeless women in tehran city (case of study: a temporary holding center for homeless women of tehran municipality, “samansraye lavizan”). Journal of Iranian Social Development Studies. 2014;6(1):51-70.
  11. Amiri FB, Gouya MM, Saifi M, et al. Vulnerability of homeless people in Tehran, Iran, to HIV, tuberculosis and viral hepatitis. PLoS One. 2014;9(6):e98742. doi:10.1371/journal.pone.0098742
  12. Amiri FB, Sedaghat A, Mostafavi E. Gender differences among homeless people in Tehran, Iran. J Public Health. 2014;22(5):461-465. doi:10.1007/s10389-014-0633-8
  13. Corneil TA, Kuyper LM, Shoveller J, et al. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place. 2006;12(1):79-85. doi:10.1016/j.healthplace.2004.10.004
  14. Kidder DP, Wolitski RJ, Pals SL, Campsmith ML. Housing status and HIV risk behaviors among homeless and housed persons with HIV. J Acquir Immune Defic Syndr. 2008;49(4):451-455. doi:10.1097/QAI.0b013e31818a652c
  15. Akaberi A, Seyyed Alinaghi SA, Rahmani R, Rahmani S, Mahmoudi Farahani M, Hosseini SM. Frequency of risk factors of HIV and hepatitis infections among the homeless in Tehran, Iran (2005-2007). Journal of Sabzevar University of Medical Sciences. 2011;18(4):296-301.
  16. Garfein RS, Laniado-Laborin R, Rodwell TC, et al. Latent tuberculosis among persons at risk for infection with HIV, Tijuana, Mexico. Emerg Infect Dis. 2010;16(5):757-763. doi:10.3201/eid1605.091446
  17. Story A, Murad S, Roberts W, Verheyen M, Hayward AC. Tuberculosis in London: the importance of homelessness, problem drug use and prison. Thorax. 2007;62(8):667-671. doi:10.1136/thx.2006.065409
  18. Etemad K, Eftekhar Ardabili H, Rahimi A, Gouya MM, Heidari A, Kabir MJ. Attitudes and knowledge of HIV positive persons and high risk behaviors groups in Golestan, Iran. Iran J Epidemiol. 2011;7(1):23-31.
  19. Ramezani Tehrani F, Malek-Afzali H. Knowledge, attitudes and practices concerning HIV/AIDS among Iranian at-risk sub-populations. East Mediterr Health J. 2008;14(1):142-156.
  20. Khajehkazemi R, Haghdoost A, Navadeh S, et al. Risk and vulnerability of key populations to HIV infection in Iran; knowledge, attitude and practises of female sex workers, prison inmates and people who inject drugs. Sex Health. 2014;11(6):568-574. doi:10.1071/sh14165
  21. Amiri FB, Gouya MM, Saifi M, et al. Vulnerability of homeless people in Tehran, Iran, to HIV, tuberculosis and viral hepatitis. PLoS One. 2014;9(6):e98742. doi:10.1371/journal.pone.0098742
  22. Shokoohi M, Karamouzian M, Mirzazadeh A, et al. HIV Knowledge, attitudes, and practices of young people in Iran: findings of a national population-based survey in 2013. PLoS One. 2016;11(9):e0161849. doi:10.1371/journal.pone.0161849
  23. Haghdoost A, Pourkhandani A, Motaghipisheh S, Farhoudi B, Fahimifar N, Sadeghirad B. Knowledge and Attitude concerning HIV/AIDS among Iranian Population: a Systematic Review and Meta- Analysis.  Iran J Epidemiol. 2011;6(4):8-20.
  24. Ghabili K, Shoja MM, Kamran P. The Iranian female high school students' attitude towards people with HIV/AIDS: a cross-sectional study. AIDS Res Ther. 2008;5:15. doi:10.1186/1742-6405-5-15
  25. Mazloomi-Mahmoodabad SS, Abbasi-Shavazi M. Knowledge and attitude survey of high school students of Yazd province of Iran about HIV/AIDS. Tabib-e-Shargh. 2006;8(1):53-63.
  26. Montazeri A. AIDS knowledge and attitudes in Iran: results from a population-based survey in Tehran. Patient Educ Couns. 2005;57(2):199-203. doi:10.1016/j.pec.2004.05.014
  27. Liverpool J, McGhee M, Lollis C, Beckford M, Levine D. Knowledge, attitudes, and behavior of homeless African-American adolescents: implications for HIV/AIDS prevention. J Natl Med Assoc. 2002;94(4):257-263.
  28. Martinez-Donate AP, Hovell MF, Blumberg EJ, et al. Gender differences in condom-related behaviors and attitudes among Mexican adolescents living on the U.S.-Mexico border. AIDS Educ Prev. 2004;16(2):172-186.
  29. Allahqoli L, Abed Saeedi Z, Azin A, Hajaan S, Alavi Majd H, Molavi N. Socially damaged women’s perception of sexually transmitted infections: a qualitative study. Life Sci J. 2014;11(4s):244-250.
  30. Fallahi H, Tavafian S, Yaghmaie F, Hajizadeh E. Attitudes of HIV/AIDS patients towards condom use manuals: a qualitative research. Journal of Isfahan Medical School. 2012;30(179):1-13.
  31. Razieh L, Ramezani Tehrani F, Farideh Y, Ebrahim H. Social and environmental barriers to condom use among women at risk for HIV/ AIDS: a qualitative study. Payesh. 2012;11(5):669-678.
  32. Razzaghi EM, Rahimi-Movaghar A, Mohammad K, Hosseini M. A qualitative study of risky sexual behaviour in injecting drug users in Tehran.           Journal of School of Public Health. 2004;2(2):1-10.
  33. Nyamathi A, Stein JA, Schumann A, Tyler D. Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults. Health Psychol. 2007;26(1):68-76. doi:10.1037/0278-6133.26.1.68
  34. Peterson Tulsky J, Castle White M, Young JA, Meakin R, Moss AR. Street talk: knowledge and attitudes about tuberculosis and tuberculosis control among homeless adults. Int J Tuberc Lung Dis. 1999;3(6):528-533.
  35. Nyamathi A, Sands H, Pattatucci-Aragon A, Berg J, Leake B. Tuberculosis knowledge, perceived risk and risk behaviors among homeless adults: effect of ethnicity and injection drug use. J Community Health. 2004;29(6):483-497.
  36. Lee HJ, Moneyham L, Kang HS, Kim KS. Peer supporter experiences of home visits for people with HIV infection. HIV AIDS (Auckl). 2015;7:233-239. doi:10.2147/hiv.s89436