World Journal of AIDS, 2011, 1, 50-61
doi:10.4236/wja.2011.12009 Published Online June 2011 (http://www.SciRP.org/journal/wja)
Knowledge, Attitudes and Beliefs on HIV/AIDS
among Tertiary Students in Papua New Guinea
Orathinkal Jose1*, Keri Totona2, Alphonse Begani2, Tuka Andew2, Bob Tombe2, Rose Begani2
1Divine Word University, Madang, Papua New Guinea; 2Department staff of the Environmental Health, Divine Word University,
Madang, Papua New Guinea.
Received April 27th, 2011; Revised May 26th, 2011; Accepted May 30th, 2011.
ABSTRACT
This cross-sectional study among 1597 tertiary level students, 757 (48%) males and 832 (52%) females (9 respondents
no mention of gender), from 12 institutions, across Papua New Guinea, examined their level of knowledge, attitudes
and beliefs about HIV/AIDS. The study revealed that the majority of the students have a very good knowledge of
HIV/AIDS; in general students have a considerate and compassionate attitude towards those infected with HIV/AIDS;
and the students have positive and healthy attitudes and beliefs regarding HIV/AIDS. Among the demographic variables
of gender, province and the institution of their study a significant difference showed in their levels of knowledge and
also a statistically significant association was found between beliefs and knowledge. Interestingly, about 58% of the
students think that HIV/AIDS is a punishment from God. Almost half (46.5%) of the respondents think that learning
about sex and the use of condoms could also encourage young people to engage in more frequent sex. Although, in
general the students have a very good knowledge, they indicate the need for more sex education and awareness pro-
grams about HIV/AIDS that could be given in high schools.
Keywords: HIV/AIDS, Sex Education, Tertiary Students
1. Introduction
Acquired Immune Deficiency Syndrome or Acquired
Immunodeficiency Syndrome (AIDS) is a disease of the
human immune system caused by the human immunode-
ficiency virus (HIV). The HIV was first recorded in 1981
in gay men in USA. Since then it has sp read to a number
other countries. Statistics, as provided by UNAIDS and
WHO in 2007, show that over 33 million people through-
out the world are now with HIV/AIDS causing it to be
one of the most devastating diseases mankind has ever
faced [1].
The threat posed by HIV/AIDS to the socio-economic,
demographic and medical dimensions continues to in-
crease. Since the first case of HIV/AIDS was identified
in 1981, the number of officially reported cases increased
to 43,587 by the end of 2000. Within this period, the vi-
rus has been identified among people in the entire world
and among all socio-demographic groups [8].
The first case of HIV infection in Papua New Guinea
(PNG) was detected in 1987. In 2006, there were about
18,500 confirmed cases by blood test and the best latest
estimate, in 2007, of people living with HIV/AIDS in
PNG is about 56,175. Estimated AIDS related deaths in
PNG so far is 6000 and estimated AIDS orphans are-
about 3730. The number of people un der Anti-Retroviral
Therapy (ART) is about 3000 [7].
According to the 2009 STI, HIV and AIDS Annual
Surveillance Report, issued by the National Department
of Health as reported in Papua New Guinea: National
HIV and AIDS Strategy, 2011-15, (pp. 15-19), in De-
cember 2009 [8], the total number of people living with
HIV in PNG was estimated to be 34,100 (31,000 adults
aged 15 or more and 3100 children and adolescents).
This was equivalent to a national prevalence of 0.9% in
the 15 to 45 age group. It was estimated that approxi-
mately 3200 people were infected with HIV in 2009,
while around 1300 people were estimated to have died
from AIDS in the same year. To the end of 2009, a cu-
mulative total of 11,520 people were estimated to have
died because of HIV-related illness and 5610 children
had become orphans, (losing one or both of their parents),
as a result of the epidemic.
Based on the 2010 estimates and projections, the pe-
riod of the most rapid increase in new HIV infections
was between 1999 and 2005. Since 2006, there has been

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea51
a continued upward trend in national prevalence, but at a
less rapid rate. It is estimated that the national HIV pre-
valence among adults will be 1.0% in 2015. The HIV
epidemic has not followed the same pattern in all four
regions of PNG. Estimates of adult prevalence were de-
veloped for the four PNG regions: Highlands: adult
prevalence was estimated to be 1.02% in 2009, with in-
dications that a plateau may have been reached. South-
ern: adult prevalence was estimated to be slightly higher
at 1.17%, while the epidemic may also have started to
level off. This data is largely derived from the National
Capital District and is not indicative of prevalence in
other parts of the region. Momase and New Guinea
Islands: prevalence is estimated to be substantially lo wer
than in the Highlands and Southern regions, at 0.63% in
Momase and 0.61% in New Guinea Islands [10].
In 2009, 90% of all new case reports of HIV infection
were from five provinces, Port Moresby and one large
town. This included all Highlands provinces Western
Highlands (26.3%), Eastern Highlands (11.2%), Enga
(11.0%), Southern Highlands (6.1%), Simbu (5.7%),
National Capital District (NCD) (20.7%) and Morobe
(9.0%). The breakdown of HIV case reports by region in
2009 was: Highlands Region 60%; Southern Region 26%,
including 21% from National Capital District; Momase
Region 11%, and New Guinea Islands Region 2%.
From 1987 to 2009, females accounted for 56% of all
reported cases of HIV infection (excluding cases where
sex was not reported), and males for 43%. The higher
number of reports of HIV in females may reflect the na-
ture of the surveillance system, which is heavily reliant
on case reports from antenatal centres (ANC), or a genu-
inely higher prevalence among women. The latter ap-
pears to be the more likely explanation as the HIV case
detection rate among clients o f volun tary coun selling and
testing (VCT) centres in 2009 was 4.7% in women com-
pared to 3.7% in men.
Under the National Strategic Plan a number of key
achievements have been made within this short of span
of time. Some of the key achievements are: approval of
PNG’s first National HIV Prevention Strategy; signifi-
cant progress in mainstreaming HIV prevention in the
key government sectors of education, law and justice,
and transport; 100% of schools provid ed life skills based
HIV and AIDS education in 2009; Rapid roll-out of ART:
75% of people in need of ART on treatment in 2009,
compared to 23% in 2006; significant expansion of HIV
service delivery through civil society, particularly for
care, support and treatment services provided by faith
based organizations; increase in the number of condoms
distributed by non-government organisations (NGOs)
from 3.3 million in 2007 to 8 million in 2009; in crease in
the number of HIV testing sites from 35 in 2006 to 251
in 2009. The number of HIV tests increased from around
15,000 in 2006 to more than 123,000 in 2009; a rapid
increase in the knowledge pattern of HIV/AIDS [11].
Although knowledge of the pattern of the HIV epi-
demic in PNG has improved, there is still a lack of qual-
ity epidemiological and behavioural data to guide the
planning of the national response, particularly prevention
programming. Improving the availability and quality of
epidemiological and behavioural data so the response can
be tailored to the reality of the epidemic is a high priority
for the NHS.
This research aimed to examine how well the tertiary
students across the country are being informed or igno-
rant of this dreaded disease, because knowledge is the
best tool for prevention of diseases as it has the power to
influence change in attitudes and practices. If all tertiary
students are better informed on HIV/AIDS, this will en-
hance the principle of prevention thus greatly helping the
nation in combating the epidemic. The fact that tertiary
students are at risk of AIDS has important implications
for the wellbeing of the nation as a whole, simply be-
cause PNG, being a young nation with very few tertiary
graduates, is urgently in need of qualified personnel for
its development.
The majority of prev ious studies on HIV/AIDS (in the
USA) at tertiary institutions focused on knowledge,
awareness and practices of students. All of the studies
indicated that students were generally knowledgeable
about the causes and modes of transmission of HIV/
AIDS. They were able to specify the activities that con-
stitute high-risk behaviour as well as the best ways to
protect themselves from HIV infection [3]. They also
tended to recognize HIV/AIDS to be a problem on cam-
pus [6].
A study done in Nigeria, has shown that youths are the
most vulnerable to sexually transmitted diseases, includ-
ing HIV/AIDS, since they are the most sexually active
and have been shown to have multiple sex partners and
engage in unprotected sex without condoms [4]. The es-
timated prevalence of HIV among youths, ages 15 - 24 in
Nigeria was between 4.4% - 5.9% for females and from
1.7% - 3.3% for males [12] indicating that females were
more easily infected than males.
Some studies from the US have shown that tertiary
students are not concerned about AIDS and do not per-
ceive themselves to be at risk [2]. But do the tertiary stu-
dents in PNG have the same attitude and beliefs towards
HIV/AIDS? It is critical for the AIDS campaigners to
have the relevant information regarding tertiary students’
attitudes toward people with AIDS, students’ beliefs
about AIDS in relationship to themselves, and tho se risky
behaviors students engage in.
Alcohol use and peer pressure were two important

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 52
factors impacting on the tendency towards casual sex
combined with the absence of safe sex practices. Studies
also showed that students generally did not consider
themselves to be at a serious risk of contracting HIV/
AIDS. This belief is largely a result of students indulging
in “othering” the disease, that is the belief that people
like drug users, male homosexuals, uneducated people,
rural people, black people (in the view of white people)
or residential students (in the view of students living at
home) are more likely to be infected. Related to this be-
lief is the tendency to stigmatize and avoid those who are
known to be HIV-positive [3].
In the absence of an effective treatment or cure for
AIDS, a preventive strategy is seemingly the best option
that we are left with in preventing the spread of this pan-
demic. Educational awareness has been one of the most
commonly used approaches across the globe. However,
there is evidence to suggest that among adolescents and
tertiary students an accurate knowledge about AIDS
transmission does not necessarily lead to the implemen-
tation of safer sexual practices [6]. Health education may
be a vital tool that can be used to tackle ignorance, fight
prejudice and empower communities to change behavior
and even, may be the best way to contain the disease [5].
This research aimed to document tertiary students’ at-
titudes, beliefs and knowledge of HIV/AIDS. This re-
search could support the implementation of PNG’s mul-
ti-sectoral National Strategic Plan for HIV and AIDS
(NSP). There are existing awareness campaigns by all
stakeholders concerned such as the National Government
through the establishment of the National AIDS Council
Secretariat, Non-Government Organizations (NGOs)
such as World Health Organization (WHO) and faith
based organizations such as Anglicare, who have one aim
and that is to fight this dreadful disease. The findings of
this study could better inform them regarding the know-
ledge and attitudes of educated youth of the country and
if needed to reorganize their policies and programmes. It
could also serve as a baseline for educators including
teachers at all levels of education, peer educators and
health professionals at all sector s within the country. This
study had the following objectives:
a) to document tertiary students’ attitudes towards
people with AIDS;
b) to assess students’ level of knowledge about HIV/
AIDS;
c) to document students’ beliefs about HIV/AIDS;
d) to investigate if there is a relationship between some
demographic variab les such as age, gender, study institu-
tion and know ledge about AIDS.
In order to achieve the above objectives this study at-
tempted to answer following research questions:
1) What is the level of knowledge of tertiary students
on HIV/AIDS?
2) What is the attitude of tertiary students towards HIV
victims?
3) What are beliefs of tertiary students regarding
HIV/AIDS?
4) Is there an association between the gender, and
study institution of the students and their knowledge
about HIV/AIDS?
2. Methodology
2.1. Study Design and Participants
A cross sectional survey conducted was conducted
among tertiary students in Papua New Guinea. The par-
ticipants of this study were 1597 tertiary students: 757
males and 831 females (9 respondents had no mention of
gender), from 12 different tertiary institutions across the
country (see Table 1 for details).
2.2. Instruments
The main mode of gathering information was through a
researcher-made questionnaire (refer to 1). Besides some
demographic questions such as age, gender, religious
affiliation, province of origin, institution of study etc.,
the questionnaire contained a total of 40 statements, 28
of them relating to knowledge and 6 each to beliefs and
attitudes of students. Knowledge was categorized into
three levels such as very good (A) a score ranging from
85 to 100, good (B) a score between 75 to 84.99, poor (C)
score from 60 to 74.99, an d very poor (D) a score of 0 to
59.99. Although originally it was coded with 1, 2, 3 re-
spectively for “Yes”, “No”, “I do not know”, for classi-
fication of different levels, the raw score was trans-
formed into a score out of 100. Higher scores indicate
better knowledge.
A content analysis of the completed questionnaire was
undertaken and a pilot test was conducted among 20
randomly selected first year students in DWU. This was
done to ascertain the face validity and comprehensibility
in drafting the final questionnaire. The corrected spilt-
half reliability of scale is 86, with an alpha coefficient of
91. This also served as a validity check which identified
obvious errors that were omitted and ambiguous ques-
tions were reformulated. The questionnaires were group
administered with prior appointments with respective
institutions.
2.3. Sampling Method and Procedure
A stratified sampling method was used to collect the d ata
for this study. The stratum was the first year students of
every tertiary institution across the country. The propor-
tion of the simple size was about 25% to 30% of the first
year students from each tertiary institution.
Formal letters were written to each of the selected in-

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 53
stitutions to seek approval and assistance from staff
and/or lecturers for this study. Upon the receipt of proper
response, the researchers travelled to respective institu-
tions to collect the d a ta.
2.4 Data Management and Analysis
As soon as all the questionnaires were collected, the re-
sponses were coded and analyzed at a DWU computer
laboratory using SSPS-15. The main parameter for anal-
ysis that was measured between the two categories of
students was the different levels of knowledge they had
on HIV/AIDS and their attitude towards HIV/AIDS vic-
tims. Data was analyzed using descriptive and correla-
tional statistics (t-test, Cross Tabulations, ANOVA, Post
Hoc-Duncan).
3. Results
3.1. Profile of the Sample
Table 1 shows the demographic profile of the partici-
pants.
3.2. Level of Knowledge
Table 2 shows the level of knowledge of the participants
in four different levels. The level of knowledge was ca-
tegorized into four levels such as very good (A) a score
ranging from 85 to 100, good (B) a score between 75 to
84.99, poor ( C) score fro m 60 to 74.9 9, and v ery poor (D )
a score of 0 to 59.99.
Table 1. Demographic Profile of the participants.
Male Female Total
Gender 757
(48%) 831
(52%) 1588 (100%)
Age range 16 to 48 years (mean age 21)
Religion percent Province percent
Catholic 607 38 Central 78 5
Lutheran 191 12 Gulf 35 2
United Church 121 8 Milne Bay 45 3
SDA 181 11 Western 31 2
AOG 103 6 Oro 20 1
Christian Revival 343 22 Morobe 111 7
Nazaren 1 .1 Madang 160 10
Anglican 8 1 East Sepik 159 10
CRC 3 .2 West Sepik 54 3
Baptist 12 1 Eastern Highland 59 4
Aposotlic 2 .1 Simbu 89 6
Total 1572 100 Western Highland 150 9
Institutions Enga 73 5
DWU 291 18 Sothern Highland 60 4
UPNG 261 16 Manus 47 3
UNITECH 181 11 West New Britain 33 2
UOG 218 14 East New Britain 183 12
UoVudal 94 6 New Ireland 54 3
SMVunapope 78 5 ARB 68 4
Holy Trinity 149 9 Jiwaka 33 2
SBKaindi 96 6 Mixed parentage 22 1
MTC 90 7 other countries 14 1
LSoN 62 4 NCD 2 .1
MATECHCO 36 2 Central 78 5
Maritime 30 2
Total 1586 100

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 54
Table 2. Level of knowle dge of the respondents.
Knowledge Level Frequency Percent
A (very good) 702 45.9
B (good) 468 30.6
C (poor) 295 19.3
D (very poor) 64 4.2
Total 1529 100.0
Missing 68
Total 1597
As Figure 1 shows, about 46% of the students have a
very good knowledge of HIV/AIDS, about 31% good
knowledge, around 19% fall within the category of poor
and only around 4% of students have a very poor know-
ledge.
The level of knowledge was determined by the re-
spondents’ answers to 28 statements regarding HIV and
AIDS. Given below are the separate answers to each of
Figure 1. Level of knowledge of respondents.
those statements.
Six statements were meant to examine the attitude of
students. Table 3 summarizes the findings on attitude.
3.3. Attitudes in Regard to HIV /AIDS
As Table 4 shows, in general the students depict a posi-
tive attitude towards those infected with HIV/AIDS.
Table 3. Student’s knowledge on HIV/AIDS.
Statement on HIV/AIDS with regard to Knowledge Responses
Yes Nos. (%) No Nos. (%) Do not know Nos. (%)
HIV and AIDS are the same thing. 285 (18) 1228 (77) 81 (5)
One can be infected with HIV from an insect bite. 68 (4) 1437 (90) 91 (6)
One can tell if someone is infected by HIV just by looking at them. 210 (13) 1303 (82) 77 (5)
AIDS is when your immune system has been damaged by HIV. 1229 (81) 77 (5) 212 (13)
There is no cure for HIV in Papua New Guinea. 1174 (74) 269 (17) 147 (9)
Women are more vulnerable to HIV than men. 704 (44) 469 (30) 408 (26)
If you touch HIV infected blood with your hands you will become infected
(even if there is no cut on your finger). 249 (16) 1120 (70) 219 (14)
One could get AIDS by being coughed/sneezed on by the people who are
infected. 32 (2) 1429 (90) 120 (8)
One could get HIV/AIDS by speaking with those infected. 13 (1.5) 1567 (98) 7 (0.5)
The use of condoms during intercourse greatly reduces the risk of transmitting
AIDS. 681 (43) 681 (43) 223 (14)
AIDS can be transmitted by holding the hands of those infected, 13 (0.8) 1562 (98.3) 14 (.9)
AIDS is caused by bacteria . 339 (21) 996 (62) 244 (17)
One can get HIV/AIDS by cleaning sick peoples vomit /pekpek wara/tears. 89 (6) 1238 (78) 256 (16)
AIDS can be transmitted by sharing tattoo blades or needles from an infected
person. 1517 (95) 45 (3) 26 (2)
AIDS is caused by the same bacteria that cause gonorrhea. 168 (11) 933 (58) 487(31)
By hugging HIV infected people one could get it. 49 (3) 1505 (94) 34 (3)
You can get AIDS from sharing plates, forks, or glasses with an AIDS in-
fected person. 60 (4) 1474 (92) 54 (4)
People infected with HIV die quickly. 238 (15) 1201 (75) 152 (10)
You can get AIDS from sharing clothes and the same toilet facilities with
those infected with HIV. 65 (4) 1381 (87) 147 (9)
AIDS can be transmitted through/by blood. 1530 (96) 32 (2) 26 (2)
AIDS can be transmitted through/by semen. 1417 (89) 58 (4) 111 (7)
AIDS can be transmitted through/by vaginal fluid. 1449 (91) 62 (4) 77 (5)
AIDS can be transmitted through/by feces. 91 (6) 1178 (74) 318 (20)
AIDS can be transmitted through/by tears. 50 (3) 1372 (86) 166 (11)
AIDS can be transmitted through/by sweat. 51 (3) 1338 (84) 195 (13)
AIDS can be transmitted through/by urine. 129 (8) 1112 (70) 333 (21)
AIDS can be transmitted from mother to child. 1474 (92) 74 (5) 39 (3)
AIDS can be transmitted through/by saliva. 287 (18) 888 (56) 411 (26)
N = 1597

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 55
3.4. Respondents’ Beliefs Regarding HIV/AIDS
Six statements with “Yes” (agree), “No” (do not agree),
and “I don’t know” response categories were used to
investigate students' b eliefs abou t AIDS in relationsh ip to
themselves. Responses to belief statements were not as-
signed a point value. Therefore, subjects did not receive a
score for their beliefs about AIDS; instead, each state-
ment was assessed individually. Table 5 presents the
summary of these findings.
3.5. Association between Knowledge and Some
Demographic Variables
The fourth objective o f this study was to examine wheth-
er there is a diff erence in the knowledge scor e depending
on the demographic variables. Tables 6 and 7 show the
knowledge score according to the respondents’ province,
institutions and religiou s affiliation.
As Table 8 shows, a one way ANOVA was used to
test for knowledge on HIV/AIDS difference among 22
provinces. Knowledge on HIV/AIDS significantly dif-
fered across 22 provinces, F(22, 1554) = 1.95, p = .005.
Post hoc analyses were performed using the Scheffé tests
to identify where differences exist. But the analyses
could not identify where the exact difference lies; it
could be due to the fact that the difference is moderate.
As the same Table 8 shows, a one way ANOVA was
used to test for knowledge on HIV/AIDS difference
among 12 institutions. Knowledge on HIV/AIDS sig-
nificantly differed across 12 Institutions, F(11, 1574)=
3.73, p = .000. Post hoc analyses were performed using
the Scheffé tests to identify where differences exist. The
analyses revealed that University of Vudal (UoV) dif-
fered significantly from Holy Trinity (p = .004), MTC (p
= .002) and MADTECHC (p = .001) and no other dif-
ferences were found.
ANOVA test for knowledge on HIV/AIDS difference
among different religious affiliations as well as Occupa-
tions of the parents did not indicate a statistically signifi-
cant difference. Th e F value for religious affiliatio ns was
F(10, 1561) = .591, p = .823 and for the Occupation of
the parents was F(5,1524) = 1.788, p = .134.
Chi-squared (2) test showed statistically significant
[

2 (1, n = 1588) = 23, p < .000] but moderate diff erence
between the level of knowledge of male and female stu-
dents. As the graph in Figure 3 shows the males are
slightly better informed than their female counterparts.
3.6. Association between Beliefs and Knowledge
A one way ANOVA tested (Table 8) whether knowledge
on HIV/AIDS differed according to the beliefs of the
respondents. An analysis on the statement’ “People with
HIV should be separated from normal community”,
showed that knowledge on HIV/AIDS significantly dif-
Table 4. Students’ attitude toward HIV/AIDS.
Responses
Questions/Statements on Attitudes Yes
Frequency (%) No Frequency (%) Do not know Frequency (%)
I am afraid of getting AIDS. 1505 (94) 56 (4) 31 (2)
Due to awareness of HIV/AIDS, I would be
careful in choosing my partner. 1507 (94) 50 (3) 33 (3)
People with HIV should be separated
from the normal community life. 272 (17) 1226 (77) 96 (6)
Have you ever had a blood test for HIV/AIDS? (although you never had sex) 362 (23) 1201 (75) 29 (2)
I think I have heard enough about HIV/AIDS. 496 (31) 937 (59) 157 (10)
I prefer to keep away from those infected with HIV. 539 (34) 786 (49) 265 (17)
Table 5. Responses regarding student’s belie f tow a r ds HIV/AIDS.
Responses
Statements/questions Yes
Frequency (%) No Frequency (%) Do not know Frequency (%)
AIDS is a punishment from God. 771 (48) 363 (23) 455 (29)
AIDS is created by someone in the laboratory. 136 (9) 913 (57) 543 (34)
Condom promotion does not reduce HIV/AIDS, instead it promotes it. 1197 (75) 209 (13) 182 (12)
Condom promotion has no real effect on the spread of this sickness. 737 (46) 604 (38) 248 (16)
Young people should be taught
about sex, HIV/AIDS already in high school. 1428 (89) 99 (6) 60 (5)
Teaching young people about sex
and use of condoms encourages them to have sex. 828 (52) 556 (35) 210 (13)

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 56
Table 6. Knowledge score according to the province.
Province N Mean Std.
Central 80 79.73 14.60
Gulf 33 81.17 16.28
Milne Bay 45 80.63 12.33
Western 31 78.34 20.53
Oro 20 84.64 14.20
Morobe 111 80.05 14.33
Madang 160 76.72 13.12
East Sepik 159 76.36 14.28
West Sepik 54 78.90 14.99
Eastern Highland 59 78.93 14.85
Simbu 89 85.47 11.25
Western Highland 150 79.36 13.79
Enga 73 78.62 14.05
Sothern Highland 60 80.77 12.44
Manus 47 81.23 13.70
West New Britain 33 79.00 15.30
East New Britain 183 79.68 11.10
New Ireland 54 78.70 12.94
Autonomous Region of B 68 79.78 12.06
Jiwaka 33 81.17 10.49
Mixed parentage 22 78.41 10.93
other countries 11 80.194 16.31
NCD 2 62.50 12.62
Total 1577 79.40 13.61
Table 7. Knowledge score according to the Religious affiliation and institution.
Religion N Mean Std.D.Institutions N Mean Std. D.
Catholic 607 79.25 13.64 DWU 291 80.2612.37
Lutheran 191 79.09 13.85 UPNG 261 80.7314.13
United Church 121 78.66 14.51 UNITECH 181 78.8015.01
SDA 181 79.83 13.20 UOG 218 80.6013.25
AOG 103 80.33 12.26 UoVudal 94 83.9611.71
Christian-Revival 343 79.49 13.35 SMVunapope 78 80.5411.47
Anglican 8 82.14 13.49 Holy Trinity149 76.8213.84
CRC 3 78.57 3.571 SBKaindi 96 77.9012.91
Baptist 12 85.41 15.56 MTC 90 75.7513.32
Apostolic 3 82.14 5.05 LSoN 62 77.4114.44
Total 1572 79.43 13.52 MATECHCO36 72.7115.90
Maritime 30 77.8513.73
Total 1586 79.4013.58
Table 8. Analysis of variance of knowledge score by province.
Source df F η2 p
province 22 1.95 356.78 .005
Within Groups 1554
error
Analysis of variance of knowledge score by for institution
institution 11 3.738 676.964 .000
Within Groups 1574
error
Analysis of variance of knowledge scores by and belief that people with HIV should be separated
Source df F η2 p
province 2 16.239 2900.819 .000
Within Groups 1591
error 1593
Analysis of variance for the knowledge score and belief that AIDS is punishment from God
institution 2 15.533 2822.783 .000
Within Groups 1586
error 1588

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 57
male female
25.00
50.00
75.00
100.00
Knowledge score



















Knowledge score
Figure 2. Box plot of the knowledge score of male and female students.
sex
fered among the three categories of respondents, F(2,
1591) = 16.24, p = .000. Post hoc analyses were per-
formed using the Duncan test to identify where differ-
ences exist. The analyses revealed that respondents with
a “No” answer differed significantly from those an-
swered “Yes” and “Do not Know” (p = .05). The box
plot, Figure 3, gives a graphic picture of the difference.
As Table 8 further shows, an analysis on the statement
“AIDS is a punishment from God”, showed that knowl-
edge on HIV/AIDS significantly differed among the
three categories of respondents, F(2, 1586) = 15.53, p
= .000. Post hoc analyses were performed using the
Duncan test to identify where differences exist. The ana-
lyses revealed that the knowledge of respondents with a
“No” answer differed significantly from those who an-
swered “Yes” and “Do not Know” (p = .05). Figure 4
gives a graphic picture of the difference.
4. Discussion
4.1. Knowledge Regarding HIV/AIDS
Overall the responses of the students indicate that they
are well informed about HIV/AIDS, as Figure 1 shows
more than 75% of the students have good to very good
knowledge of HIV/AIDS. However, when a specific
question was asked, whether men or women were more
vulnerable to HIV/AIDS interestingly 44% responded
that women were more vulnerable than men, 30% did not
agree, while 26% were not sure. This could be due to
various factors, such as, first of all, culturally in Papua
New Guinea, men view women to be there to serve them
and this also extends to satisfying men’s sexual needs.
Women were socialized to serve men and in many cases,
women feel obliged to submit to their husbands’ de-
mands for sex. Secondly, when men are drunk, they be-
come aggressive in forcing women to submit to sex. This
puts women in a very vulnerable position as very often,
they fear being beaten up, or chased out of the house and
this could create a scene in the community. Sometimes
women submit to their husbands to protect their children.
It could also be that women tend to be more concerned
about their health to consult clinics and find out about
their health status than men, hence, more “women cases”
are reported and known compared to men. It is also
commonly talked about that women in the sex trade
sometimes do not use condoms because the men who pay
them demand them not to use condoms and so they are
vulnerable to HIV/AIDS infection more than their male
counterparts.
There have been reports that condoms are not 100%
safe when they are not used appropriately and constantly
and therefore do not greatly reduce the risk of transmit-
ting AIDS [13]. In this study, perhaps the most divided
opinion (43% each stated “Yes” and “No” and the re-
maining 14% stated “do not know”) was on the statement
that “the use of condoms during intercourse greatly re-
duces the risk of transmitting AIDS”. With regard to
condom promotion, students were to respond to two

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 58
YesNoDo not know
with HIV should be se
p
arated from normal communit
y
25.00
50.00
75.00
100.00
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Knowledge score
Figure 3. Box plot of the difference in the knowledge in relation to belief and attitude.
People with HIV school be separated from normal community
YesNoDo not know
25.00
50.00
75.00
100.00
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Knowledge score
AIDS is a punishment from God
Figure 4. Box plot of the difference in the knowledge in relation to belief.
separate statements, one positive and the other negative,
for instance, about 75% of the students said “Yes” to the statement that “condom promotion does not reduce HIV/AIDS, instead it promotes it”, while in another

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea59
statement, “condom promotion has no real effect on the
spread of HIV/AIDS”, 46% stated “Yes” and 38% re-
ported “No” and about 16% were not sure about the an-
swer.
Does the role of religion affect the result of these
findings on condoms? A cross tabulation showed no sig-
nificant differences in the opinion of 11 religious groups
that were part of this study. Furthermore, although no
studies were reported, it is widely known that the teach-
ers find it difficult to explain the use and effectiv eness of
condom as a preventive measure of HIV/AIDS in a
classroom setting. Therefore, perhaps the respondents
lack a convincing and a scientific presentation on the
effectiveness of condoms on the prevention of
HIV/AIDS.
When asked if they ever had a blood test for HIV
(even if they never had sexual intercourse), only 23% of
the students answered that they had a test while about
76% had not tested. Perhaps this is one area where use-
fulness of this study could find its significance. All the
tertiary institutions across the country could make it a
matter of priority perhaps during the orientation week for
the first year students.
4.2. Attitudes of Respondents with Regard to
HIV/AIDS
This study has shown that in general the students depict a
positive attitude towards those infected with HIV/AIDS.
Although the great majority (94%) of the students is
afraid of getting the disease, only about 49% say that
they prefer to keep away from those infected with the
disease. When asked if people with HIV should be sepa-
rated from the normal community life, 77% disagreed,
which may well be considered a very h ealthy attitude an d
approach towards the victims. It could also be an indica-
tion of th e good know ledge on H IV/AIDS. In sp ite of the
various seminars, classes and inputs on HIV/AIDS, more
than 59% of the students still think that they have not
heard enough about this disease yet. Due to the aware-
ness of HIV/AIDS, if they would be careful in choosing
their partner, a vast majority (94%) of students responded
“Yes”. Although there are clear indications of a rather
good knowledge on HIV/AIDS, a lot more can be done
and needs to be done, particularly more of educational
programs, because about 89% of the respondents, in this
study, stated that young people already in high schools
should be taught abou t sex and HIV/AIDS.
4.3. Beliefs in Regard to HIV/AIDS
Interestingly, this study has revealed that nearly half of
the students at the tertiary level believe that AIDS is a
punishment from God (48%) and about 29% are not sure
while only about 23% say “No” with certainty. Is there a
possibility of the influence of religion in these findings?
Although we may never know the real impact of reli-
gious influence on the attitude of the peop le, an ANOVA
test has clarified that there is no significant difference
F(7,1558) = .557; P = .791, between different religious
groups with regard to their belief that the HIV/AIDS is a
punishment from God.
When asked if they believed whether AIDS was cre-
ated by someone in a laboratory, only about 9% thought
so, 57% did not think so and 34% did not know. Al-
though about 89% think that young people should al-
ready be taught about HIV/AIDS in high school, about
52% think that teaching young people about sex and the
use of condoms would encourage them to have sex,
while 35% disagreed to that view and about 13% were
not sure.
4.4. Knowledge in Relation to Demographic Va-
riables
Perhaps one of the interesting findings of this study was
that male students showed slightly better knowledge of
HIV/AIDS than female students. One of the possible
reasons could be that there is perhaps more peer educa-
tion among the boys than the girls and that the males find
it comfortable talking and learning about HIV/AIDS
more than females who may be a bit shy or uncomfort-
able to talk about such an issue
The researchers expected that there could be a differ-
ence in the knowledge level between the institutions be-
cause of the nature of a study program such as health
sciences or nursing programs, or other health related
programs offered in some institutions. But the analysis of
data showed a significant difference, and interestingly it
was not within any institutions that offered health related
programs. It was the University of Vudal that had a sig-
nificant difference in level of knowledge compared to
other institutions. It could be that the students from the
Vudal probably had an awareness program in the recent
past.
The ANOVA test also showed a moderate difference
in the knowledge level of the students between the prov-
inces. However, no significant difference was found on
the basis of religio us affiliation or occupation of the par-
ents. Perhaps these findings are an indication of the fact
that the HIV/AIDS awareness programs, education and
information on HIVAIDS are more effectively done at
the level of provinces no matter what religious or family
background one comes from.
It also appears that the students’ attitude towards peo-
ple infected with the disease is more accepting and com-
passionate. For example, the majority of the students did
not agree with the idea that those infected with HIV+
should be separated from their communities. It is also

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 60
important to note that more than half of the students do
not agree that they would keep away from those infected.
Such an attitude should be seen as a very healthy ap-
proach and needs to be further encouraged in confronting
this pandemic.
When asked if they ever had a blood test for HIV
(even if they never had sexual intercourse), about 23%
answered that they did get tested for HIV while a major-
ity of the students (75%) had not had any blood test.
Perhaps here is an area where the administration of the
different tertiary institutions could offer assistance;
rightfully motivating stud ents in order to undergo the test
and to undergo necessary medication if necessary.
It is also very encouraging to note that a majority of
tertiary students have a considerate and compassionate
attitude toward those infected with HIV/AIDS. The re-
spondents were asked if those that were infected should
be removed from normal community life, most of the
student’s disagreed with this idea. This could well be due
to the correct understanding of the nature and transmis-
sion of HIV/AIDS, i.e., there is nothing to be afraid of to
live with or to go near the people who are infected.
Overall, the high level of knowledge of tertiary stu-
dents about the transmission and causes of HIV/AIDS
and a considerate and compassionate attitude towards
people who are infected, signals, to a large extent, rather
positive and healthy attitudes and beliefs regarding
HIV/AIDS among the young educated people of Papua
New Guinea, and are indeed signs of hope for a better
future.
4.5. Implications of the Findings
Educators at all levels, be it primary, secondary or terti-
ary, play crucial roles in disseminating the right knowl-
edge, healthy attitudes and beliefs regarding HIV/AIDS
among the young people. Perhaps, the findings of this
study could be used as guidelines in the development of
an effective curriculum and education programs in edu-
cational institutions of at all levels. The following are
some of the suggestions:
More than half of the students think they did not have
enough information on HIV/AIDS and about 75% think
that education on sex, HIV/AIDS should already be giv-
en at the high school levels. Therefore, we recommend
that new educational strategies and programs regarding
sex education and HIV/AIDS should be planned and im-
plemented at all schools throughout PNG, if it is not al-
ready begun.
One of the most divided opinions of students in this
study was on the effectiveness of use of condoms to pre-
vent the spread HIV/AIDS. We recommend that doctors
or other trained health workers be invited to give a more
scientific and convincing presentation of the effective-
ness of the use of condoms as a preventive measure for
HIV/AIDS.
Based on this study’s data, less than 25% of the stu-
dents ever had a blood test; it is recommended th at all the
tertiary students at the time of their entry into tertiary
institution be subjected to a compulsory HIV/AIDS test,
which could pave way for preventive measures.
Since the study has also shown that nearly 50% of the
tertiary students believe that AIDS is a punishment of
God, and this belief tends to affect the basic knowledge
on HIV/AIDS, we recommend that educators and health
workers be made aware of such a reality and they should
be prepared to give a clinical and scientific explanation
of the origin of this pandemic.
Since a vast majority of the students have expressed
their fears of getting AIDS and that they will be careful
in choosing their partners, it is recommended that nego-
tiation skills for discussing sexual behaviours and op tions
with partners be taught in the classroom along with sex-
ual decision-making strategies.
5. General Conclusions
In the light of above findings we draw the following
conclusions:
The research showed that most of the students have a
good level of knowledge regarding HIV/AIDS, which is
to be taken as a good sign, however, th is shou ld no t be an
excuse to reduce the massive awareness campaigns being
conducted throughout the country. If more people are
aware of the basic information on the root causes of the
disease, they would have informed opinions about sexual
behaviors and positive attitudes towards HIV/AIDS vic-
tims. The findings also indicate that the tertiary students
are aware of the seriousness of the disease and it is the
responsibility of the educators to keep the momentum
going. Perhaps the most encouraging fact is that students
overall show a considerate and compassionate attitude
towards those infected. Students also indicate a positive
and healthy attitude towards those infected with
HIV/AIDS, which could be due to accurate knowledge of
this disease. Regardless of the study institution there is
no significant difference in the level of knowledge of the
students on HIV/AIDS. This perhaps implies almost all
the tertiary level institutions have good HIV/AIDS
awareness classes or campaigns.
5.1. Limitations
Although, this study is the first of its kind to be con-
ducted among the tertiary students and it has revealed
many interesting facts, this study has its limitations. First
of all, the questionnaire was a researcher made, although
with due consideration and consultation, it still could be
improved with different factors clearly distinguished.

Knowledge, Attitudes and Beliefs on HIV/AIDS among Tertiary Students in Papua New Guinea 61
Secondly, since the questionnaire was a “self-report
measure” the possibility o f bias cannot be ruled out, per-
haps a personal interview might give much more
in-depth information. Thirdly, there is a possibility of
selection bias as only first year students were selected for
this study.
5.2. Recommendations
It is highly likely that HIV/AIDS will still dominate as
one of the main health concerns of the nation for years to
come. As education has been found to be one of the most
powerful tools to contain this pandemic, educators
should take professional and moral responsibility to pro-
actively implement HIV/AIDS education and prevention
strategies in their respective institutions. As this study
has shown there is a momentum and it is equally the re-
sponsibility of educator s to keep it going.
The findings of this study clearly indicate that educa-
tors must provide more than just accurate information
about HIV/AIDS. They must be aware of the differences
between men and women’s attitudes and behav iours with
regard to HIV/AIDS. It is important for future research to
focus on: a) the level of knowledge of the staff or other
educators on the same issue, in order to ensure that they
impart right knowledge and attitude; and b) methods
which help students to realistically assess their risk for
HIV/AIDS.
6. Acknowledgements
This research was funded by the National AIDS Council
of PNG.
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