Advances in Infectious Diseases, 2013, 3, 274-280
Published Online December 2013 (
Open Access AID
HIV/AIDS-Related Knowledge among Secondary School
Students in Bangladesh: A Cross-Sectional Study
Md. Nazmul Huda1, Dr. Asm Amanullah2
1Department of Sociology and Anthropology, Green University of Bangladesh, Dhaka, Bangladesh; 2Department of Sociology, Uni-
versity of Dhaka, Dhaka, Bangladesh.
Received July 23rd, 2013; revised August 23rd, 2013; accepted August 30th, 2013
Copyright © 2013 Md. Nazmul Huda, Dr. Asm Amanullah. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background and Aim of the Study: HIV/AIDS is best viewed as a major epidemic which poses serious challenges to
mankind on a global scale. The aim of this study was to assess the HIV/AIDS-related knowledge among secondary
school students in Bangladesh and investigate the association between secondary school students’ socio-demographic
characteristics and their level of knowledge about HIV/AIDS. Methods: Following multistage random sampling tech-
nique, a total of 384 students aged 11 - 17 years were sampled from eight secondary schools and interviewed through a
predesigned semi-structured questionnaire. Data analysis was done at three stages including descriptive statistics, biva-
riate analyses, and multivariate logistic regression. Results: The findings of the study revealed that more than half
(55.26%) of the students were above 14 years of age and their ages ranged from 11 to 17 years. This study also found
that around three-fourths of the students (75.78%) watched television. With regard to knowledge, this study demon-
strated that around two-fifths of the students (36.98%) had very good knowledge about HIV/AIDS and their main
sources of HIV/AIDS information were television, newspaper, radio, textbooks, and teachers. The bivariate results of
the study indicated that students’ age, gender, type of school, household income, fathers’ and mothers’ literacy, and
watching television were significantly associated with level of knowledge about HIV/AIDS. In addition, students’ age,
mothers’ literacy, and watching television were found as the significant predictors of knowledge about HIV/AIDS.
Watching television was documented as the best single predictor. Conclusion: The results of the study strengthen the
assumption that there is an influence of students’ socio-demographic characteristics upon their knowledge about HIV/
AIDS. Moreover, this study suggests that more information on HIV/AIDS should be included in the textbooks of sec-
ondary school students in Bangladesh to enhance their knowledge about the taboo subject.
Keywords: HIV/AIDS; Knowledge; Secondary School Students; Socio-Demographic Factors
1. Introduction
Since its emergence in 1981, the HIV/AIDS pandemic,
which poses a serious challenge to mankind, without
doubt, has become one of the most serious infectious dis-
eases [1]. Again, HIV infection, which has increased
among young people aged 15 - 24 years, is a develop-
ment problem [2-4]. Recent UNAIDS report on the glob-
al AIDS epidemic estimates that globally, 34.0 million
[31.4 million - 35.9 million] people were living with HIV
at the end of 2011. It also asserts that an estimated 0.8%
of adults aged 15 - 49 years worldwide are living with
HIV [2]. In 2011, it is estimated that almost 5 million
people are living with HIV in South, South-East and East
Asia combined. Five countries (namely India, Indonesia,
Myanmar, Nepal, and Thailand) account for the majority
of HIV infections [2]. Bangladesh is geographically vul-
nerable to HIV/AIDS due to its close proximity to India,
Myanmar, Nepal, and Thailand having various degrees of
the epidemic [5]. In 2011 the National AIDS and STD
Program (NASP) in Bangladesh informed that there were
445 newly reported cases of HIV and 251 new AIDS
cases, out of which 84 people had died [6]. Thus, the
cumulative number of reported HIV cases to date in
Bangladesh stands at 2533, AIDS cases at 1101 and death
toll at 3258 [7]. However, the actual number of HIV/
AIDS cases is still unknown due to limited and incom-
HIV/AIDS-Related Knowledge among Secondary School Students in Bangladesh: A Cross-Sectional Study 275
plete surveillance facilities [8].
Though knowledge regarding HIV/AIDS is an impor-
tant part of HIV/AIDS prevention [9], this has not been
examined among secondary school students in Bangla-
desh. However, a very few notable studies have been car-
ried out to examine the knowledge about HIV/AIDS
among the adolescents in Bangladesh. For example, Ud-
din et al. (2010) [10] documented the Bangladeshi ado-
lescents’ level of knowledge about HIV/AIDS. The find-
ings of their study revealed that adolescents had fair level
of knowledge about HIV/AIDS. Again, the results of the
studies of Shirin and Ahmed (2007) [11] and Rahman et
al. (2009) [12] showed that respondents had average
knowledge regarding HIV/AIDS. Moreover, Khan (2002)
[13] examined the HIV/AIDS knowledge among the fe-
male adolescents of four divisions namely Dhaka, Chit-
tagong, Rajshahi, and Sylhet in Bangladesh. The results
of his study indicated that only one (17%) in six adoles-
cents had ever heard of AIDS. Almost similar finding
was found in the study accomplished by Rahman et al.
(1998) [14] among the Commercial Sex Workers (CSWs)
in Bangladesh—18 percent of CSWs had heard of AIDS.
Furthermore, to evaluate the rural people’s knowledge
about AIDS in Bangladesh, Fulton et al. (1998) [4] did a
study on them. The findings of their research demon-
strated that of the total population of 3834 women and
2272 men, only 7.4% (256) of the women and 16.0%
(364) of the men had heard of the disease AIDS. Thus,
the results of the majority researches mentioned above
showed poor or average knowledge about HIV/AIDS
since most of these studies had been carried out among
those who were mostly uneducated or unaware of the di-
sease. This cross-sectional study, therefore, identified the
knowledge related to HIV/AIDS among secondary school
students in Bangladesh.
Some previous studies on HIV/AIDS suggest that
knowledge about HIV/AIDS varies by socio-demogra-
phic factors of the respondents. For instance, Lal et al.
(2000) [15] studied the association between gender and
type of students and knowledge about HIV/AIDS. The
results of their study revealed that boys’ and urban stu-
dents’ knowledge was better than that of girls and rural
students respectively. Again, the results of the study car-
ried out Wong et al. (2008) [16] showed that older and
urban respondents and those having higher level of in-
come demonstrated greater level of knowledge about
HIV/AIDS. Furthermore, Tee and Huang (2009) [17]
examined the factors such as age, education, and monthly
income that influence respondents’ knowledge about
HIV/AIDS. Therefore, the following research hypothesis
guided this study.
Secondary school students’ knowledge about HIV/
AIDS varies by their socio-demographic characteristics
such as age, gender, type of school, education, household
income, fathers’ literacy, mothers’ literacy, watching te-
levision, and religiosity.
2. Methods (Figure 1)
2.1. Participants
A cross-sectional questionnaire survey was conducted
among the students of grade six to ten in some educa-
tional institutions in Bangladesh. The heads of the sam-
pled institutions were duly informed and their consent
was taken before approaching the respondents. From the
selected sampled schools, 384 students from grade six to
ten were surveyed using self-administered questionnaire
and all students voluntarily participated in this study.
2.2. Procedure
A standard set of questionnaire was distributed among
the students. Before administering the questionnaire, the
nature of the study was explained to the students and
they were assured of the anonymity of the survey and
secrecy of his/her personal answers. The survey was car-
ried out during the regular school hours. Students were
made to sit apart and asked not to communicate with
each other during the administration of the questionnaire
so as to encourage honest responses. After collecting the
completed questionnaires, students were thanked for their
The present study focused on secondary school stu-
dents’ knowledge about HIV/AIDS by analyzing the
strength of their agreement or disagreement with a vari-
ety of twelve statements related to HIV/AIDS knowledge.
These twelve items initially had a four-point response
options (strongly agree, agree, strongly disagree and dis-
agree) which were later dichotomized into “0 = false”
and “1 = true” for the purpose of data analysis. The sum
Exposure to mass media
Type of school
Household income
Fathers’ literacy
Mothers’ literacy
Exposure to television
Sources of
Mass media
Friends etc.
Knowledge about HIV/AIDS
Figure 1. Conceptual framework of the study (self-design-
Open Access AID
HIV/AIDS-Related Knowledge among Secondary School Students in Bangladesh: A Cross-Sectional Study
of the scores was used as a composite score ranging from
0 to 12 with a higher score indicating a greater level of
knowledge about HIV/AIDS. Based on the pooled scores
for each respondent, they have been classified into three
groups, viz., poor knowledge (0 - 4), good knowledge (5
- 8), and very good knowledge (9 or more). Cronbach’s
alpha coefficient was used to measure the internal con-
sistency of the twelve items defining the dependent vari-
able, knowledge about HIV/AIDS. These twelve ques-
tions demonstrated good internal consistency (Cron-
bach’s alpha = 0.80). Cronbach’s alpha is the most com-
mon measure of internal consistency (“reliability”). It is
most commonly used when we have multiple Likert
questions in a survey/questionnaire that forms a scale and
we wish to determine if the scale is reliable [18].
2.3. Sampling Design
Multistage random sampling design was used to identify
the students. At first, we selected eight secondary schools
from four divisions namely Dhaka, Khulna, Barisal, and
Rajshahi in Bangladesh. These four divisions were cho-
sen out of seven randomly. After collecting the lists of
secondary schools of each division from Bangladesh Bu-
reau of Educational Information and Statistics (BAN-
BEIS) office, we selected equal number of schools (four
schools from urban and four from rural area) randomly
for the purpose of the study. Finally, 48 students aged 11
- 17 years were chosen using lottery method from the
student list of each school. Therefore, each participant
had the same probability of being chosen. Once the de-
sired 48 respondents from each school were selected, the
investigators moved to next sampled school. In total, 384
secondary school students of grade six to ten from the
eight sampled schools were chosen using Fisher’s for-
mula. In this study, 10 - 12 percent of the students re-
fused to participate in some of the classes. This was tak-
en into account by moving to the next student until the
desired sample was obtained.
2.4. Data Analysis
All data were entered using the Statistical Package for
the Social Sciences (SPSS) software (Version 16). The
analysis was done at three stages: descriptive statistics,
bivariate analyses and multivariate logistic regression. In
this study, descriptive statistics were used to examine the
students’ socio-demographic characteristics, exposure to
mass media, knowledge about HIV/AIDS, and its sources
of knowledge. The scores on the socio-demographic cha-
racteristics, exposure to mass media, knowledge about
HIV/AIDS, and its sources of knowledge were in fre-
quency and percentage form of categorized responses. In
the process of analysis, relationships supporting or refus-
ing the pre-formulated hypothesis were subjected to sta-
tistical tests of significance. Test statistics like Pearson
Chi-square and Cramer’s V were used to measure the
magnitude/strength of relationships among the variables.
In addition, a binary logistic regression model was em-
ployed to explore the possible effects of each predictor
variable on knowledge about HIV/AIDS.
3. Results and Discussion
Of 380 secondary school students who participated in the
current study, 55.26 percent of the students were above
14 years of age and their ages ranged from 11 to 17 years
with a mean of 13.87 years and a standard deviation of
2.001. The study also found that male students consti-
tuted more than half of the respondents (52.08%). Again,
approximately one-fifth of the students (21.35%) were
studying in grade six whereas a little less than one-fifth
of them (18.75%) were in grade ten. The percentage of
grade six students was slightly bigger than those of other
grades. Not surprisingly, most of the respondents
(75.53%) were the followers of Islam and irrespective of
religious affiliation, a little more than half of the students
(53.65%) performed religious activities every day.
Parents’ literacy is a significant determinant of stu-
dents’ knowledge about HIV/AIDS. This study demon-
strated that an overwhelming number of students’ fathers
(92.11%) were literate whereas for mothers it was 90.53
percent, indicating fathers were more literate than moth-
ers. Their mean family size was 5.23 and more than half
of the students’ (51.84%) family incomes were less than
15,000 taka monthly. Urban school students, which con-
stituted half of the sample, mostly belonged to the higher
income group.
3.2. Students’ Exposure to Mass Media
This study assessed exposure to media by asking students
whether they watch television (TV), and read newspaper.
However, viewership of TV and readership of newspaper
depend on the availability of, and access to, those either
at home or in the neighborhood. This study found that
around three-fourths of the students (75.78%) watched
television whereas 38.28 percent students replied that
they read newspapers. Again, TV viewership and news-
paper readership was sharply higher among the students
of urban schools. Moreover, there was a great variation
among them with regard to frequency of watching televi-
sion and reading newspaper—around three-fourths of the
students (76.05%) said that they watched television daily
whereas only a negligible number of the respondents
(10.26%) reported that they read newspaper regularly.
3.3. Sources of HIV/AIDS Information
The multiple responses of the main sources of informa-
tion about HIV/AIDS were the mass media, with televi-
Open Access AID
HIV/AIDS-Related Knowledge among Secondary School Students in Bangladesh: A Cross-Sectional Study 277
sion (65%) ranking the first, followed by newspaper
(60%), and radio (53%). These findings are consistent
with those of the studies carried out by Shirin and Ah-
med (2007) [11]; Islam et al. (2002) [19]; Asekun-Ola-
rinmoyem et al. (2011) [20]; Khan (2002) [13]; Oyo-Ita
et al. (2005) [21]; Lal et al. (2000) [15]. The second im-
portant source of HIV/AIDS information was textbooks
(58%), followed by teachers (47%), parents (45%), and
friends (43%). Messages written on vehicles (37%), se-
minar (8%) were the least-reported sources of informa-
tion regarding HIV/AIDS.
3.4. Students’ Knowledge about HIV/AIDS
Figure 2 displayed that a substantial number of students
(36.98%) had a very good knowledge about HIV/AIDS.
This finding of this study was moderately consistent with
the findings of the studies carried out by Uddin et al.
(2010) [10] on Bangladeshi adolescents and UNESCO
(2007) [22] on the students in Cameroon. The latter study
found that 48 percent of the respondents in Cameroon
had good knowledge about HIV/AIDS. The study which
was conducted on the adolescents of Bangladesh display-
ed that half of the adolescents had fair level of knowl-
edge regarding HIV/AIDS. By contrast, this finding of
the current study was not consistent with the findings of
the studies conducted by Shirin and Ahmed (2007) [11]
and Amanullah and Huda (2012) [23]. According to their
study, a very few respondents were found to have a good
understanding of AIDS. Again, the results of this cross-
sectional study demonstrated that a little more than one-
third of the students (34.37%) had good knowledge while
around 28 percent students fell within the category of
poor knowledge (Figure 2).
The level of knowledge was determined by the stu-
dents’ answers to twelve statements regarding HIV and
AIDS (Table 1). Given below are the separate answers to
each of those statements.
3.5. Association between Selected
Socio-Demographic Factors and Knowledge
about HIV/AIDS
Table 2 showed the evidence of clear relationships be-
tween a set of socio-demographic factors and students’
level of knowledge about HIV/AIDS. The findings of the
study indicated that knowledge about HIV/AIDS was
significantly associated with some socio-demographic
variables, and the results indicated that older respondents
(χ2 = 18.90, p < 0.01) and male students (χ2 = 4.36, p <
0.01) displayed higher level of knowledge about HIV/
AIDS. These associations were consistent with the find-
ings of the report of Ministry of Health and Family Wel-
fare, Bangladesh (2009) [24] and those of the study con-
ducted by Uddin et al. (2010) [10] among the adolescents
Frequency Percent
kn o wledg e
kn o wledg e
kn o wledg e
Figure 2. Students’ knowl edge about HIV/AIDS.
Table 1. Students’ knowledge about HIV/AID S .
Correct answer
Statement on HIV/AIDS with
regard to Knowledge Response
Frequency Percent
HIV/AIDS is a great threat
for Bangladesh True 328 85.42
HIV/AIDS has a positive
relation with STDs True 238 61.98
A person can get AIDS by
kissing someone on the
mouth or through hugging
False 322 83.85
People living with HIV/AIDS
should keep separate from othersFalse 261 67.97
A pregnant woman who has
AIDS can transmit it to her babyTrue 186 48.44
Mosquito bites is one possible
cause of infection False 316 82.29
Most people who get AIDS
usually die from the disease True 248 64.58
AIDS is a viral infectious diseaseTrue 181 47.14
One can get HIV infection having
unprotected sex only one timeTrue 182 47.40
AIDS is a curse from God False 327 85.16
AIDS is a foreign disease False 249 64.84
AIDS can be cured through
herbal treatment False 241 62.76
in Bangladesh. The important factor of the association
between age and knowledge about HIV/AIDS in this
study was that older students showed higher level of cu-
riosity to learn about the taboo subject and this, in turn,
encouraged them to discuss HIV/AIDS with each other.
Moreover, results of this cross-sectional study showed
that type of school and household income were seen to
be significantly related to knowledge about HIV/AIDS.
Data showed that students of urban school (χ2 = 9.16, p <
0.01) and those having high household income (V = 0.77,
p < 0.05) showed greater tendency to have high knowl-
edge about HIV/AIDS and these associations were mod-
erately consistent with the findings of the studies accom-
plished by Lal et al. (2000) [15] and Tee and Huang
(2009) [17]. The crucial reasons behind these types of
association were that students of urban school and those
Open Access AID
HIV/AIDS-Related Knowledge among Secondary School Students in Bangladesh: A Cross-Sectional Study
Table 2. Summary table of chi-square and Cramer’s V val-
ues on level of knowledge regarding HIV/AIDS by sociode-
mographic characteristics.
Level of knowledge about HIV/AIDS
characteristics Chi-square and Cramer’s V values
Age χ2 = 18.90**, df = 4
Gender χ2 = 4.36**, df = 1
Type of school χ2 = 9.16**, df = 2
Level of education V = 0.45
Household income V = 0.77*
Fathers’ literacy χ2 = 9.48**, df = 3
Mothers’ literacy χ2 = 12.91***, df = 5
Watching television χ2 = 16.21***, df = 7
Religiosity χ2 = 8.56, df = 4
***p = 0.001; **p = 0.01; *p = 0.05.
having higher household income had greater degree of
exposure to mass media including television and news-
paper. Furthermore, literacy, either of their fathers (χ2 =
9.48, p < 0.01) or of their mothers (χ2 = 12.91, p < 0.001),
had a linear and positive relationship with having knowl-
edge about HIV/AIDS. Similar association was found in
case of watching television (χ2 = 16.21, p < 0.001), that is,
students who watched television regularly were more
likely to have higher degree of knowledge about HIV/
AIDS (Table 2).
3.6. Binary Logistic Regression Analysis for
Knowledge about HIV/AIDS
Age of the respondents, their mothers’ literacy, and wa-
tching television emerged as important determinants of
knowledge about HIV/AIDS in binary logistic regression
analysis as presented in Table 3. The dependent variable
considered in this model was knowledge about HIV/
AIDS and was coded as dummy; 1 (high knowledge) and
0 (low knowledge). Results of the binary logistic regres-
sion analysis demonstrated that older students were al-
most two times more likely to have higher degree of
knowledge about HIV/AIDS (OR = 1.923, p < 0.05)
compared with younger respondents. This finding was
moderately consistent with that of the study done by
Rahman et al. (2009) [12], who showed that older ado-
lescents aged 15 - 19 years were significantly more likely
to know about AIDS than their younger counterparts (OR
= 1.4).
With respect to mothers’ literacy, students having lit-
erate mothers had higher odds ratio of having higher de-
gree of knowledge about HIV/AIDS (OR = 3.579, p <
0.01) compared with those who had illiterate mothers.
This model also found watching television as one of the
Table 3. Results of logistic regression analysis on knowledge
about HIV/AIDS.
Determinants of
knowledge Coefficient Standard
error Significance Odds
Age (in years)
Type of school
Urban school
Rural school
Father’s literacy
Mother’s literacy
Household income (in taka)
Watching television
Constant 1.605 2.603 0.538 4.976
Cox & Snell R2 = 0.231
N = 384 Hosmer and Lemeshow Test: χ2 = 16.99, df = 8, p = 0.005
** and * are significant levels at 1% and 5%, respectively.
significant predictors of knowledge about HIV/AIDS,
that is, students who watched television regularly were
significantly more likely to have high knowledge about
HIV/AIDS (OR = 4.078, p < 0.01) as compared with
those who hardly watched television, a vital component
of promoting awareness regarding HIV/AIDS [25]. How-
ever, there were no statistically significant relationships
between knowledge about HIV/AIDS and some inde-
pendent factors like gender, type of school, fathers’ lit-
eracy, and household income in this model (Table 3).
4. Conclusion
Despite the current low prevalence, HIV/AIDS is in-
creasingly being viewed as a major threat for the devel-
opment of Bangladesh since it can weaken economic grow-
th, educational institutions, governance, and social stability
etc. Recognizing this threat, Government of Bangladesh in
association with PIACT Bangladesh, a local NGO, includ-
ed a chapter on HIV/AIDS in the textbooks of secondary
school students in 2007 [26] with a view to providing
fundamental knowledge of the epidemic. HIV/AIDS
knowledge is considered as the most important weapon to
fight against HIV/AIDS [27] and all efforts to curb its
spread will be in vain [28] unless adolescents including
Open Access AID
HIV/AIDS-Related Knowledge among Secondary School Students in Bangladesh: A Cross-Sectional Study 279
students are knowledgeable about it. Therefore, this cross-
sectional study assessed the secondary school students’
level of knowledge about HIV/AIDS. This exploratory
study clearly showed students’ high level of knowledge
regarding HIV/AIDS and some modes such as television,
newspaper, textbooks, teachers etc. of disseminating
HIV/AIDS information. The bivariate results of the cur-
rent study indicated that male students, urban school stu-
dents, older students, students having high household in-
come, students with literate parents, and those who wa-
tched television regularly demonstrated greater propen-
sity to have higher degree of knowledge about HIV/
AIDS. Moreover, results of the binary logistic analysis
displayed that older students, students having literate mo-
thers and those who watched television regularly were
more likely to have higher degree of knowledge about
HIV/AIDS. Watching television was found as the best
single predictor of knowledge about HIV/AIDS. Our find-
ings of the current study suggest that more information
on HIV/AIDS should be included in the textbooks of
secondary school students in addition to teachers’ train-
ing that can facilitate the teaching process of this taboo
subject. Finally, findings of this study may be of signifi-
cant value for educators, researchers, health professionals,
teachers, counselors, and government officials in the Mi-
nistry of Education in Bangladesh.
5. Acknowledgements
The authors would like to express their heartfelt gratitude
to Abeer Noor, lecturer of Green University, Bangladesh
for her guidance and suggestions. The authors are also
grateful to Lipi Akhter for her cordial assistance in field
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