World Journal of AIDS, 2013, 3, 367-377
Published Online December 2013 (
Open Access WJA
Towards Developing Communication Strategies for
HIV/AIDS Control among the Scheduled Tribes and
Scheduled Castes Women in Three Northeastern
States of India
Kalyan B. Saha1, Damodar Sahu2, Uma C. Saha3, Ravendra K. Sharma1, M. Muniyandi1,
Prabhaker Mishra4, Chhanda Mallick5, Jyotirmoy Roy1, Amal K. Bhunia6,
Samiran Bisai1, Arvind Pandey2
1Regional Medical Research Centre for Tribals (ICMR), Jabalpur, India; 2National Institute of Medical Statistics (ICMR), New Delhi,
India; 3Xavier Institute of Development, Action & Studies (XIDAS), Jabalpur, India; 4Department of Community Medicine, M. M.
Institute of Medical Sciences and Research, Ambala, India; 5Department of Biomedical Laboratory Science & Management, Vid-
yasagar University, Midnapore, India; 6Department of Anthropology, Vidyasagar University, Midnapore, India.
Received November 1st, 2013; revised December 1st, 2013; accepted December 8th, 2013
Copyright © 2013 Kalyan B. Saha et al. 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.
HIV/AIDS spread has opened a Pandora of medical and health problems apart from creating serious socio-psycholog-
ical trauma for the victims and their families. Despite the governmental effort to curve the growing infection, very little
success has been achieved. The northeastern region of India presents a very peculiar situation due to recurrent insur-
gency in all its states for long time and thus it became instrumental in paralyzing the social and health machineries to an
extent, which still deteriorated the futile national effort to check the deadly infection. The study tried to understand the
level of awareness and correct knowledge among the underprivileged scheduled tribes and scheduled castes women in
the age group 15 - 44 by exploring data from district level of Rapid Household Reproductive and Child Health Project
Phase I (1998) and Phase II (1999) for Assam, Manipur and Nagaland and suggested a strategy to control the infection
in the region. It is found that HIV/AIDS awareness was 59% among the women in all the three states with very few
among them who had correct understanding of its prevention. A pronounced difference in the level of awareness was
observed with respect to age, economy and residential status of the respondents.
Keywords: AIDS Awareness; Transmission; Prevention & Misconception; Communication Strategy
1. Introduction
1) The alarming spread of HIV/AIDS is a serious con-
cern for the nation. HIV is thought to have entered India
in the early 1980s, but only in March 1986 the first case
of HIV infection was detected [1]. However, the initial
response of the nation to AIDS was to hide behind the
mantle of Indian morals. After acknowledging the pro-
blem seriously in early 1990s, efforts are made to treat
the diseases victims and prevent further infection but
they have been hampered by a lack of reliable data and a
glut of ill-conceived or under-funded programmes.
2) According to the National Intelligence Council re-
port of September 2002, HIV infection in India is likely
to go up to 20 - 25 million by 2015. The estimated
number of people living with HIV/AIDS in India during
2006 was 2 million - 3.1 million [2]. Northeastern region
of India poses a serious matter of concern. The officially
reported AIDS cases in the three states of northeast India
i.e., Assam (372), Manipur (2866) and Nagaland (736)
together are comprised of the highest number of AIDS
cases in the region [3]. The characteristics of having
porous borders, infested with drug trafficking, flourishing
call girl market, insurgency and unrest related syndromes
have pushed northeastern India into the AIDS epidemic.
However, these figures may not represent the exact
situation due to under-reporting of AIDS cases. Experts
believe that these cases represent only a small portion of
Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India
actual cases of AIDS in the region. But it definitely
indicates the gravity of the problem. In spite of such
seriousness of the problem in an orthodox Indian society,
an average person in the street seems to be unconcerned
and is not willing to discuss the consequences of un-
protected sex, one of the major vehicle for the spread of
3) What is currently very disturbing is the growing
proportion of women specifically married women infected
with HIV. It is predicted that over 15,000 women
become infected with HIV every week [4]. Women in
India being the vulnerable group are more prone to any
type of STDs because majority of them are illiterate and
have a low social status, and they are also tied to the four
walls of the kitchen, managing other household cores and
satisfying the sexual drives of their male counter part.
She has no right on her own body and freedom for
exercising her willingness and choice [5]. The situation is
more disadvantageous among the Scheduled Tribes and
Scheduled Castes women who compose a sizeable
proportion of the country’s population and rest in the
bottom of the social hierarchy with poor quality of life
and thus signal a potential risk group for the society and
need immediate intervention to protect them.
4) Now the big question is how the infection can be
prevented? In the absence of any vaccine, education
through communication is imperative for influencing
personal behaviour and lifestyles to minimize the ravages
of AIDS throughout our population [6]. Despite the
national commitment towards communication of HIV/
AIDS related messages, not much has been achieved so
far. Adequate resources have been allocated, STD clinics
have been set up and distribution of free condoms has
been taken up albeit with limited success. Furthermore,
the entire northeastern India is under the grip of recurrent
insurgency of one form or the other for long, and it
paralyzes the medical set-up and social life to such an
extent, which aggravates the above situation neutralizing
the nation’s fight against HIV/AIDS completely.
5) In this paper, an attempt has been made to study the
level of awareness of HIV/AIDS among the currently
married women of the state of Assam, Manipur and
Nagaland and suggest a broad communication strategy
for controlling the infection in northeastern India.
2. Methods and Materials
The data for the present paper has been drawn from a
large scale Rapid Household Reproductive and Child
Health Survey conducted during 1998-1999 and spon-
sored by the Ministry of Health and Family Welfare,
Government of India. The new approach requires decen-
tralization of planning, monitoring and evaluation of the
services at the basic nucleus level, which is district. Thus
government of India for the first time felt the need and
generated district level basic data on utilization of ser-
vices provided by Government health facilities and peo-
ple’s perception on quality of these services. The survey
also accumulated data on people’s awareness and per-
ception on HIV/AIDS infection in the country. In a dis-
trict, 1100 Households in 50 locations and all currently
married women in the age group 15 - 44 years available
in the households were covered. Regarding details of
sampling design refer to Rapid Household Survey RCH
project reports Phase-I and II for Assam, Manipur and
Nagaland (Figure 1). For the present study three states
out of seven sister states of northeastern India viz., As-
sam, Manipur and Nagaland were selected purposively,
together which comprises of highest number of AIDS
cases in the region.
Altogether data have been collected from 38 districts in
the above three states. The data were collected by specially
trained investigators locally recruited and trained for this
purpose. The survey covered 13,141 women in Assam
[7], 4658 in Manipur [8] and 6779 in Nagaland [9]. From
the total a sample of 24,578 respondents, 16,739
Scheduled Castes and Scheduled Tribes respondents
from the three states were extracted for the present study.
Generally speaking scheduled tribes and scheduled castes
refer to backward section of the society and are identified
and mentioned in the scheduled list of the Indian
Constitution to extend national privileges for their
development. Besides bivariate analysis, multivariate
logistic regression analysis has been attempted to under-
stand the controlled effect of the predictor variables on
the dependent variables viz., 1) ever heard of HIV/AIDS
and 2) ever use of condom.
In the analysis an attempt was made to highlight the
S tudy Area
Figure 1. The study area.
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Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India 369
current level of information about HIV/AIDS amongst
these respondents and check for differences if any, by
religion, age and education, type of house of the women
which act as a proxy variable in understanding the effect
of economic background of the women. “Puccha” house
refers to better economic group while “Kaccha” house
signifies a poor economy. Analysis also seeks their
sources of information about HIV/AIDS, knowledge
about the route of transmission and methods of prevention
of HIV/AIDS. These variables are based on multiple
responses and were asked only to those who were heard/
aware of HIV/AIDS. The existing misconceptions about
HIV/AIDS have been included. The results of the present
study are supplemented with facts from other studies in
different occasions.
3. Results and Discussion
3.1. Respondents Characteristics
Scheduled Tribes dominate the sample. Scheduled Castes
presence in the sample in all three states put together is
little over 43%. About 64% respondents are Christians,
35% are Hindus and the remaining one % belongs to
other religion (Table 1).
About 42% respondents are illiterate and the remain-
ing is literate with education ranging from standard I to
X and above. The literacy rate, it seems, in the three
states taken together is much above the national female
literacy rate, that too among younger age groups and
signals a positive step in the endeavor to curve the spread
of deadly infection (Table 2).
Majority of the women live in kaccha houses (64%)
followed by semi-pucca houses (29%) (Table 3). Re-
garding interstate variation Assam women reflects rela-
tive poverty as compared to those in Nagaland and Ma-
Table 1. Distribution of scheduled tribes and scheduled
castes women by age and re ligion.
Age groups
Christian Hindu Others*
15 - 19 1.9 2.8 2.0 2.2
20 - 29 35.6 37.7 34.2 36.3
30 - 39 39.5 42.8 39.7 40.6
40 - 49 23.0 16.7 24.1 20.8
10725 5815 199 16739
(64.1) (34.7) (1.2) (100.0)
(100.0) (100.0) (100.0) (100.0)
*include Muslim, Buddhist, Sikh, etc.
3.2. Age at Cohabitation
According to Table 4 married women reported an early
sexual experience with first cohabitation below or around
15 years (8%).
However, 48% have reported having first sexual ex-
perience at 20 years of age. Differences have been ob-
Table 2. Distribution of scheduled tribes and scheduled
castes women by age and educ ation.
groups IlliterateClass I-VClass VI-IX Class X+
15 - 1928.9 16.5 38.4 16.2 370 (100.0)
20 - 2931.5 11.5 28.2 28.8 6080 (100.0)
30 - 3943.7 13.2 22.4 20.7 6802 (100.0)
40 - 4959.9 13.5 15.6 11.0 3487 (100.0)
Total42.3 12.7 23.4 21.5 16,739 (100.0)
Table 3. Distribution of women respondents by house type
and state.
Type of House
AssamManipur Nagaland
Pucca 8.6 2.2 8.2 7.0
Semi pucca 20.2 28.6 36.7 28.7
Kaccha 71.1 69.2 55.1 64.3
6187 3841 6711 16,739
Total (100.0)(100.0) (100.0) (100.0)
Table 4. Distribution of scheduled tribes and scheduled
castes women by age at cohabitation and religion.
Age at Cohabitation
(in years) Christian Hindu Others*
Up to 15 5.5 12.4 10.6 8.0
16 5.9 10.5 7.0 7.5
17 8.6 10.1 7.5 9.1
18 16.7 16.0 14.1 16.5
19 10.4 10.8 10.6 10.5
20 52.8 40.2 50.3 48.4
10725 5815 199 16739
(64.1) (34.7) (1.2) (100.0)Total
(100.0) (100.0) (100.0)(100.0)
*include Muslim, Buddhist, Sikh, etc.
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Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India
served among various religious groups in which Hindu
women have reported having early cohabitation com-
pared to Christian and other religious groups. These
differences may be due to early marriages among the
Hindus. It shows sexual experiences and encounter of sex
early in lives. It is therefore suggested that HIV/AIDS
campaign must be targeted to young girls and women
regardless of their religious, tribal or non-tribal back-
ground. Since literacy rate is high among these women, it
is suggested that educational institutions may be an
appropriate starting point for communication.
3.3. HIV/AIDS Awareness
“Have you heard of an illness called HIV/AIDS”? This
question was uniformly asked to all respondents. F igure
2 shows the association between awareness to HIV/AIDS
to selected background characteristics. On the whole
59% women had heard of HIV/AIDS in all three states.
Compared to rural areas the awareness is better in urban
areas by 24% points. Further the figure shows that the
women in the age group of 20 - 29 years had heard most
about HIV/AIDS (64%) and least informed were in 40 -
44 years age group (51%). The HIV/AIDS was no threat
and unheard by these women twenty years ago when they
were growing. It is not surprising that more urban
women in the age group of 20 - 29 years had heard of
HIV/AIDS (85%) than their rural counterpart (61%) due
to high electronic media exposure.
The awareness increases with increase in educational
level. There are sharp differences of HIV/AIDS aware-
ness between illiterate rural and literate urban women
and the same for the women studied up to standard I - V
in school. The rural illiterate women had heard least
about HIV/AIDS whereas urban literate women had
heard most about it. Improvement in educational oppor-
tunities for rural women may be the key to enhancing
any information level including HIV/AIDS.
Broadly “economic status” of the women has been
gauged with the help of their residential accommodation
classified as pucca, semi-pucca and kaccha. There seems
to be a positive association between degree of HIV/AIDS
information and economic status of the respondents.
Both rural and urban women living in pucca houses had
known the most about HIV/AIDS (75% and 85%) as
opposed to rural and urban living in kaccha houses (49%
and 73%). As regard religious background of the re-
spondent is concern it is found that Christians were better
informed about HIV/AIDS compared to Hindus and
other religious groups in both rural and urban areas.
Percentage share of women aware of HIV/AIDS is
highest for Nagaland followed by Manipur and Assam
(Figure 3). Education and religion might have been re-
Figure 2. Aware of HIV/AIDS by background characteris-
sponsible for such a differential level of HIV/AIDS in-
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Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India
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3.4. Sources of HIV/AIDS Information gans/pamphlets and posters seemed quite effective in
inaccessible states like Manipur (50%) and Nagaland
(36%) of women came to know about HIV/AIDS
through these means. Health workers including doctors
had minor role in providing information about HIV/
AIDS. Community meeting and interpersonal communi-
cation among friends, relatives including husband re-
mained another important source of information about
HIV/AIDS in these states. In Nagaland, where 57% and
54% respondents reported having heard of HIV/AIDS
through community meeting and inter-personal commu-
nication. The same for Manipur was 51% and 43% and
for Assam it was 34% and 51% respectively. Other than
radio, community meeting and inter-personal communi-
cation seems to be a dominant mode of sharing and ex-
changing information in inaccessible states like Nagaland
and Manipur.
The respondents were asked to identify sources of infor-
mation or persons from whom they had heard about HIV/
AIDS. For this purpose multiple information sources
were indicated. Table 5 shows that both radio and televi-
sion had provided maximum information to women in
Assam (about 60% each) and 60% radio and 12% televi-
sion in Manipur. In case of Nagaland, this figure is 56%
radio and 32% television. It seems that radio user remain
almost constant in the three states but the reach of televi-
sion decreases as one moves from geographically acces-
sible to inaccessible areas in northeastern region. Ex-
cept Manipur print media (news paper, magazines and
books) more or less gave an identical picture in providing
information, though ability of print media to reach wo-
men was much lower than that of electronic media. Slo-
It is suggested that healthcare workers must not be
utilized as prime movers and source of information of
HIV/AIDS in northeastern region. Also state specific
communication strategy should be designed to reach to
women in their early age.
Ma nipu r
3.5. Knowledge about Routes of Transmission of
By and large a similar pattern of routes of transmission
of HIV/AIDS was reported in all the age groups. Higher
is the education; better is the reporting of all the means of
transmission of HIV/AIDS. Over all Christian women
Figure 3. Percentage share of those who heard about HIV/
Table 5. Distribution of the respondents aware of HIV/AIDS by source of information.
Assam Manipur Nagaland
Sources of Information
Rural Urban Total Rural Urban Total Rural Urban Total
Radio 61.0 57.5 60.5 59.2 71.0 60.2 49.9 51.9 50.4 55.5
TV 55.0 88.3 60.1 9.8 38.8 12.1 24.3 45.4 29.5 32.1
News paper/Magazines 39.5 56.1 42.1 13.2 37.4 15.1 30.9 49.8 35.6 31.5
Slogans/Pamphlet/Posters 13.3 27.0 15.4 52.6 22.4 49.9 37.7 42.3 38.8 36.2
Doctors 6.0 8.2 6.3 14.4 16.8 14.6 13.2 18.5 14.5 12.6
Health workers 6.8 4.1 6.3 2.3 1.4 2.2 15.7 15.6 15.7 9.8
School teachers 5.0 2.0 4.5 15.6 15.9 15.6 11.5 51.2 21.3 15.8
Community meeting 36.6 17.2 33.6 52.5 31.8 50.9 76.4 56.7 71.5 56.8
Friends/Relatives husband 52.0 46.0 51.1 41.8 52.3 42.6 64.1 51.2 60.9 53.6
1999 367 2366 2490 214 2704 3630 1195 4825 9895
Total (100.0) (100.0) (100.0)(100.0)(100.0) (100.0)(100.0) (100.0) (100.0) (100.0)
*Percentages do not add up to 100 due to multiple responses.
Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India
reported better than Hindus for different routes of trans-
mission of HIV/AIDS (Table 6(a)). About 68% across
three states believe that HIV/AIDS are transmitted
through heterosexual sex. Pilot, et al. [10] in his study
mentioned that hetro-sexual act is the main source of
transmission of HIV/AIDS as it is estimated by them that
at least 80% of all new cases of HIV infection in Africa
are acquired heterosexually.
Further from the Table 6(a), it is evident that in con-
trast to Manipur and Nagaland a sizeable number of
women (40%) believe homosexual intercourse is also a
means of transmission of the deadly infection. In another
study conducted in southern India, it was highlighted that
worldwide, about 75% of all HIV infections occur
through sexual intercourse when one or other partner has
HIV and the risk of spreading HIV greatly increased
when other STDs are present [11]. Post in her article as
available to us from internet reports that women are at
greater risk of acquiring infection from an infected male
partner and about 2 - 5 times higher than that of males of
acquiring the infection from an infected female partner.
The use of common needle/blade or skin puncture was
second most common mode by which HIV/AIDS infec-
tion is transmitted. This was most reported by women
from Manipur. At this juncture it is to be mention that a
study conducted by Sarkar [12] among the injectable
drug user reports that in Manipur, HIV has spread with
deadly speed among them.
Table 6. (a) Distribution of the responde nts by routes of transmission and age , education and religion; (b) Distribution of the
respondents by knowledge of routes of transmission and state.
Age (in years) Education Religion
Routes of Transmission
15 - 19 20 - 2930 - 3940 - 44IlliterateI - VVI - IXX+ Christian HinduOthers
Male having sex with male (Homo sexual) 16.0 27.226.8 29.416.6 22.6 27.0 36.0 35.4 18.824.7
Female having sex with male (Hetero sexual) 69.5 65.268.2 59.856.2 60.5 67.7 79.6 61.1 73.569.4
Needles/blades/skin puncture 47.9 55.454.6 52.639.5 47.2 54.1 69.0 45.7 57.356.9
Mother to child 29.1 39.436.2 36.623.0 30.2 35.7 52.4 39.6 31.636.2
Blood transfusion 44.1 51.448.2 42.232.4 38.3 50.3 63.5 41.6 49.650.7
Others 0.5 1.5 1.6 1.8 1.1 1.8 2.0 1.8 1.1 2.6 1.7
Do not know 24.4 18.318.6 21.431.6 24.2 18.7 8.1 30.1 12.016.3
213 3890402817642471 119429793251 2219 1177559
Total (100.0) (100.0)(100.0) (100.0)(100.0)(100.0)(100.0)(100.0) (100.0) (100.0)(100.0)
Assam Manipur Nagaland
Routes of transmission
Rural UrbanTotalRuralUrbanTotalRural Urban Total
Grand Total
Male having sex with male (Homo sexual) 37.5 56.2 40.18.4 27.6 10.4 28.5 34.9 30.1 27.1
Female having sex with male (Hetero sexual) 58.4 80.4 61.876.1 88.3 77.0 67.5 61.5 66.0 68.0
Needles/blades/skin puncture 39.3 56.7 42.059.7 81.8 61.5 54.6 63.2 56.7 54.5
Mother to child 36.1 49.6 38.225.0 49.1 26.9 40.1 51.0 42.8 37.4
Blood transfusion 35.2 51.5 37.745.3 69.6 47.2 53.0 61.6 55.1 48.8
Others 1.3 1.1 1.2 0.8 2.3 0.9 1.7 3.4 2.2 1.6
Do not know 33.3 11.7 30.019.3 7.9 18.4 16.4 7.6 14.2 19.1
1999 367 23662490214 27043630 1195 4825 9895
Total (100.0) (100.0)(100.0)(100.0)(100.0)(100.0)(100.0) (100.0) (100.0)(100.0)
*Percentages do not add up to 100 due to multiple responses.
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Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India 373
The third important route for transmission of HIV/
AIDS as reported is due to blood transfusion (49%). Be-
lief that the infection is passed from mother to child was
notable in the states of Assam and Nagaland (38% and
43% respectively), but fairly low in Manipur (Table
6(b)). Shrotri et al. [13] in his study reports that north-
eastern SC/ST women were less aware of maternal to
child infection than that SC/ST women residing in the
western India.
The analysis shows inter-state and rural-urban differ-
ences in the knowledge thereby suggesting state specific
communication strategy with special emphasis on rural
areas to control HIV/AIDS spread in the region.
3.6. Preventive Measures of HIV/AIDS
Table 7 shows that by and large women were aware of
different methods of HIV/AIDS control by varying de-
grees in three states. Safe sex/condom use in each inter-
course seemed to be known to three-fourth of the women
as sure means of HIV/AIDS prevention. Inter-state and
rural urban variation were observed in the use of condom
or safe sex as preventive measure, lowest being in Assam
(66%) and highest in Nagaland (78%). To reveal the re-
ality that in India a large number of women are not lucky
to have husband who has a restrictive and positive out-
look towards safer sex with his wife. On the contrary
most of them believe that wife should share husbands
sorrow more than joys may be it is biologically or so-
cially destructive to her. Growing number of Indian
women who have had sex only with their husbands are
now being infected with HIV. A study conducted in the
Pune district of Maharashtra state in Western India found
that a good number of married women with STDs and
none of whom reported sexual contacts outside their
marriages were HIV positive [14]. Bhattacharya [15] in
his study also stressed the use of condom among the het-
erosexual married couples in India towards prevention of
HIV/AIDS infection.
About 49% women knew that HIV/AIDS infection
could be prevented by transfusion of tested blood. To be
mentioned here that commercial blood donors are an
integral part of Indian blood supply network and these
donors are generally poor and tend to engage in high risk
sex and intravenous drugs more than the general popula-
tion. In a study conducted in 1992, 86% of a group of
commercial blood donors screened in Mumbai erstwhile
Bombay were found to be HIV infected [16].
The use of sterilized needles and syringes could pre-
vent infection is known to 52% women. However, only
28% knew that HIV/AIDS could be prevented by avoid-
ing pregnancy among HIV/AIDS infected persons. About
22% of women did not know any preventive measures
across three states. Both inter-state and rural-urban dif-
ferences were observed in which a sizeable proportion of
women in Assam (33%) were not aware of any preven-
tive measures against HIV/AIDS. It seems communica-
tion focus should be targeted towards actual preventive
measures especially use of condom.
3.7. Misconception about Mode of HIV/AIDS
Little more than one-third of respondents had miscon-
ceptions as to how HIV/AIDS are transmitted among
humans, highest being 42% in Nagaland (Table 8(a)).
“Mosquito, flea or bed bug bites” was considered as
one of the modes by which HIV/AIDS could be trans-
mitted (25%) followed by modes like “kissing” (21%)
and “sharing kitchen utensils and stepping on urine/stool
Table 7. Distribution of the respondents aware of preventive measure against HIV/AIDS by residence and state.
Assam Manipur Nagaland
Preventive measure
Rural Urban TotalRuralUrbanTotal Rural Urban Total
Grand Total
Safe sex/Use of condom in each intercourse 62.3 84.7 65.8 75.1 90.6 76.4 74.9 85.9 77.6 74.5
Check blood prior to transfusion 38.2 56.1 41.0 45.7 70.1 47.7 51.9 62.4 54.5 49.4
Sterilize needles & syringes for injection 33.1 48.5 35.5 57.6 78.0 59.2 54.0 63.7 56.4 52.2
Avoid pregnancy when having AIDS 24.1 34.1 25.7 19.8 38.8 21.3 33.2 31.2 32.7 27.9
Others 1.2 0.5 1.1 0.7 1.9 0.8 1.6 2.4 1.8 1.3
Do not know 36.4 13.9 32.9 20.7 7.5 19.7 19.5 9.0 16.9 21.5
1999 367 2366 2490214 2704 3630 1195 4825 9895
Total (100.0) (100.0)(100.0)(100.0)(100.0)(100.0)(100.0) (100.0) (100.0)(100.0)
*Percentages do not add up to 100 due to multiple responses.
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Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India
Table 8. (a) Distribution of the respondents having misconceptions about routes of transmission of HIV/AIDS by residence
and state; (b) Distribution of the respondent s having misconceptions about routes of transmission of HIV/AIDS by residence
and state.
Assam Meghalaya Nagaland
Rural Urban Total Rural UrbanTotal Rural Urban Total
Having misconception 26.1 25.9 26.0 34.3 33.6 34.2 40.9 46.4 42.3 36.2
No misconception 73.9 74.1 74.0 65.7 66.4 65.8 59.1 53.6 57.7 63.8
1999 367 2366 2490 214 2704 3630 1195 4825 9895
Total (100.0) (100.0) (100.0)(100.0)(100.0)(100.0)(100.0)(100.0) (100.0) (100.0)
Assam Meghalaya Nagaland
Rural Urban Total Rural Urban Total Rural Urban Total
Shaking hands 5.0 3.0 4.6 5.3 4.7 5.3 12.3 14.0 12.7 8.7
Hugging 9.0 7.4 8.7 6.3 7.9 6.5 15.4 14.6 15.2 11.3
Kissing 19.3 16.9 18.9 13.8 11.2 13.6 26.4 25.7 26.3 21.1
Sharing cloths 9.2 9.5 9.3 9.1 8.9 9.1 23.1 22.8 23.0 16.0
Sharing kitchen utensils 9.8 9.2 9.7 10.5 8.4 10.3 26.1 26.4 26.2 17.9
Stepping on urine/stool 6.9 7.9 7.1 11.8 10.3 11.7 26.3 26.8 26.4 17.8
Mosquito, flea or bedbug bites 9.9 9.8 9.9 29.7 29.0 29.7 28.6 30.4 29.0 24.6
1999 367 2366 2490 214 2704 3630 1195 4825 9895
Total (100.0) (100.0) (100.0)(100.0)(100.0) (100.0) (100.0)(100.0) (100.0) (100.0)
*Percentages do not add up to 100 due to multiple responses.
of HIV patient” (18% each) (Table 8(b)). In the same
order even “sharing cloths” (16%) and hugging (11%)
believe to infect a person. It seems all known modes of
transmissions related to other diseases were thought to be
sources of HIV/AIDS infection though inter-state and
rural-urban differences were observed. One of the sur-
prising finding is that these misconceptions were higher
among urban women than rural women in Nagaland,
where as in the other two states it was almost similar in
the two localities. In order to combat misconceptions,
specific communication approach would be essential.
3.8. Awareness to HIV/AIDS and Condom Use:
A Multivariate Analysis
Two separate multivariate logistic regression models are
computed and results are presented in Table 9. Aware-
ness to HIV/AIDS and ever use of condom are taken as
dependent variables in the two models. Further aware-
ness to HIV/AIDS is also taken as predictor in model-II.
It is found that awareness to HIV/AIDS increases sig-
nificantly with the increase in respondent’s education. A
similar pattern is observed in case of use of condom in
model-II, but the relationship is not found significant.
Husband’s educational background is also found to be
positively and significantly related to awareness to HIV/
AIDS and use of condoms. House type is also found to
be positively and significantly associated with awareness
to HIV/AIDS. Further the results shows that women liv-
ing in kaccha houses had lower awareness compared to
those living in pucca houses. However, no definite trend
could be established for the same variable in case of use
of condom. It is to be noted here that compared to Hin-
dus, Christians were better aware of HIV/AIDS and the
odds increases significantly. However, the use of condom
was significantly lower among Christians compared to
Hindus and other religious groups. Though Christians
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Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India 375
Table 9. Results of logistic regression show ing the impact of
background variables on respondent awareness on HIV/
AIDS and condom use.
Exponential β for odds
Background variables Heard about of
HIV/AIDS (Model-I) Ever use of condom
Age of the respondents
15 - 19R 1.000 1.000
20 - 29 1.114 1.376
30 - 39 1.200 1.828
40 - 49 0.988 1.281
Respondents education
IlliterateR 1.000 1.000
Class I - V 1.944*** 0.854
Class VI - IX 3.721*** 1.251
Class X+ 8.087*** 1.190
Husband’s education
IlliterateR 1.000 1.000
Class I - V 1.380*** 1.336
Class VI - IX 1.965*** 2.345***
Class X+ 2.847*** 3.661***
Type of house
PucchaR 1.000 1.000
Semi-puccha 0.899 1.189
Kaccha 0.619*** 0.809
HinduR 1.000 1.000
Others 2.758*** 0.342**
Christians 4.260*** 0.203***
Type of residence
RuralR 1.000 1.000
Urban 1.397*** 1.124
Age at first cohabitation
Up to 17 yearsR 1.000 1.000
18 years+ 1.009 1.450***
Intention to use
condom in future
Intend to useR 1.000 1.000
No intention 0.065** 0.173***
Awareness to HIV/AIDS
AwareR 1.000
Not aware 0.089***
***P < 0.001, **P < 0.01, R-refers to reference category.
were better aware of HIV/AIDS than others but they
need special motivation towards the use of condom. Ur-
ban women were significantly better aware of HIV/AIDS
and they were also found to have use condoms more than
their rural counterpart, the results are not significant in
model-II. The legal age at marriage in India for women is
18 years. Due to lower age at marriage in India co-habi-
tation usually takes place at a very tender age. It is found
that those who co-habit for the first time at the age of 18
years or above were better aware of HIV/AIDS. Also
they are better user of condoms compared to those who
first cohabit below 18 years. Thus communication strat-
egy must stress to raise the age at marriage. The results
also indicates that those who do not intend to use con-
dom in future were significantly lesser aware of HIV/
AIDS compared to those who intend to use condom in
future. Further it is also seen that intention for condom
use in future has a significant and positive linkage with
ever use of condom. Further those who were not aware of
HIV/AIDS were significantly lesser users of condoms.
This positive relationship between AIDS knowledge and
condom use was also found among African women [17].
Need of the hour is to motivate people and promote con-
dom use as a safeguard against the dreaded infection.
4. Conclusions and Suggestions
The study reveals that about 59% women had heard of
HIV/AIDS in all the three states. The age share of those
who heard about HIV/AIDS is the highest among Na-
galand (49%) followed by Manipur (27%) and Assam
(24%). Thus communication strategies should pay more
attention to the later two states. Radio appears to be more
popular than television. Electronic media particularly
television reach decreases as one moves from geo-
graphically accessible areas to inaccessible areas in
northeastern region. Except for Manipur, the print media
more or less gave an identical picture in providing in-
formation. Slogans/pamphlets and posters seemed quite
effective in accessible areas. About 68% believe that
HIV/AIDS are transmitted through heterosexual act.
However, there are inter-state differences in the knowl-
edge suggesting state specific communication strategy.
“Safe sex/use of condom to prevent HIV/AIDS” seemed
to be known to 75% women as a sure means of HIV/
AIDS prevention. Almost one third of respondents had
misconception as to how HIV/AIDS is transmitted
among human beings. So it is urgently felt to develop
intra-region specific communication approach, female
focused communication and emphasis on inter-personal
communication. Furthermore, the multivariate analysis sug-
gests that respondents’ education, their husbands’ educa-
tional background and their economic condition are sig-
nificantly and positively associated towards awareness to
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Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes
and Scheduled Castes Women in Three Northeastern States of India
HIV/AIDS. The multivariate model also suggests that
husbands’ education of respondents plays a pivotal role
in determining the use of condom—a strong preventive
measure against HIV/AIDS and thus it demands to in-
crease men’s participation in reproductive health matters.
The analysis also shows that though Christians are better
aware of HIV/AIDS, the use of condom among them is
lower than Hindus.
Manipur and Nagaland have predominantly Christian
population, whereas Assam has Hindu population. A
comparison of the responses of Christian and Hindu re-
spondents has been made for evolving broad communi-
cation strategy in northeastern region of India. The sug-
gested communication strategies are mentioned below.
4.1. Need for Region Specific Communication
Inter-state and rural-urban differences were observed
about HIV/AIDS awareness, prevention methods, media
contribution and related misconceptions about HIV/
AIDS among three states. Hence, communication ap-
proach must take these findings and findings of similar
surveys in other northeastern states into consideration
while designing any communication strategy. Education
seems to be the single most important determinant in
creating awareness of HIV/AIDS. Communication of
HIV/AIDS message should aim at reducing the existing
knowledge gap and bring about desired behavioural
changes among the persons considered in “high risk”
group with special reference to female population of
Scheduled caste and Scheduled tribes in northeastern
region. Two specific communication approaches have
been suggested to develop state and community specific
communication strategy.
4.2. Female Focused Communication
Keeping in view that women by and large in northeast-
ern region play a prominent role in domestic and commu-
nity activities, a “female focused” communication will
have positive effects in controlling HIV/AIDS in the re-
gion. The women should be “educated” to remove the
misconception, and to persuade their men folks to adopt
methods of safe sex. The “safe sex” concept must be in-
corporated in the family planning programme and media
message must highlight concept of safe sex. Since
women encounter sexual experiences early in their lives,
existing means of communication including educational
institutions must form a part of an “advocacy group” to
promote safe sex targeted to young and adolescent fe-
males women who should be encouraged to persuade
their men folks to use condom for safe sex and sex denial
to men without condom use should be advocated. A
study suggested the promotion of condom use particu-
larly in the context of casual sexual relations to reduce
the potential for the spread of STD/HIV in Bangladeshi
population [18]. At the same time, communication should
also stress to raise the age at marriage in the region.
4.3. Emphasis on Interpersonal Communication
In all three states’ interpersonal communication, husbands
and other relatives seem to provide a great deal of
information to women. Due to limited reach of mass
media in inaccessible areas, interpersonal communication
keeps a prime mode of sharing and exchanging views of
ideas. Also community meetings are found to be
effective in these areas. Hence, it is suggested that apart
from electronic and print media, interpersonal communi-
cation, community meetings and use of posters, hoarding
and other existing locally popular means must form an
integral part of communication strategy. Efforts should
be made to utilize health workers including doctors in
creating awareness of HIV/AIDS who are currently least
involved in promoting health care.
5. Acknowledgements
The authors sincerely acknowledge the support extended
by Dr. Neeru Singh, Director, Regional Medical Re-
search Centre for Tribals (ICMR), Jabalpur and Indian
Council of Medical Research, New Delhi, India for pro-
viding the facilities. Further the authors also place on
record and thank Ministry of Health and Family Welfare,
Government of India and International Institute for Popu-
lation Sciences, Mumbai, India for allowing using RCH
data set for the study.
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List of Abbreviations
Abbreviation/Symbol Meaning:
HIV: Human immunodeficiency syndrome
AIDS: Acquired immune deficiency syndrome
%: Percent