Socio-demographic Characteristics of the Study Participants
1,000 male participants were included in the final study. Table 1 summarizes the socio-demographic characteristics of all participants. The mean age was 64.7 ± 8.1 (range 50–94 years), and the median age was 64 years (Inter Quartile Range [IQR]: 59,70). Most of the participants were aged 60–69 years (43.5%, n = 435), with 42 (4.2%) people aged 80 years and over. The majority of the participants (82.2%, n = 822) were married and 76.8% (n = 768) were rural residents. More than four-fifths of the participants (n = 872, 87.2%) had at most a junior high school level of education (Table 1).
Table 1
Socio-demographic Characteristics of Males aged 50 years and older from Wuxi, Jiangsu Province, Eastern China
Demographic variables
|
Participants (N)
|
Proportion (%)
|
Age
|
|
|
50–59
|
293
|
29.3
|
60–69
|
435
|
43.5
|
70–79
|
230
|
23.0
|
80 and older
|
42
|
4.2
|
Marital status
|
|
|
Unmarried
|
14
|
1.4
|
Married
|
822
|
82.2
|
Cohabitation
|
119
|
11.9
|
Divorced or widowed
|
45
|
4.5
|
Place of residence
|
|
|
Towns
|
232
|
23.2
|
Rural
|
768
|
76.8
|
Education
|
|
|
Illiterate or primary school
|
435
|
43.5
|
Junior high school
|
437
|
43.7
|
High school or higher
|
128
|
12.8
|
HIV/AIDS-Related knowledge
There were eight questions assessing HIV/AIDS-related knowledge, with scores ranging from zero to eight points. 190 (19%) people answered all eight questions correctly, while 217 (21.7%) did not answer a single question correctly. Most participants knew that it was possible to be HIV infected via an HIV-positive blood transfusion (n = 639, 63.9%) and from sharing syringes with HIV infected people (n = 636, 63.6%), while fewer (n = 407, 40.7%) knew that “mosquito bites won’t spread AIDS” (Table 2).
Table 2
Answers to HIV*/AIDS+-related knowledge of Males aged 50 years and older from Wuxi, Jiangsu Province, Eastern China
8 questions about HIV/AIDS related knowledge
|
Correct
n (%)
|
Incorrect n (%)
|
Unknown
n (%)
|
Is it possible to get AIDS with the input of blood or blood products contaminated by HIV virus?
|
639 (63.9)
|
56 (5.6)
|
305 30.5)
|
Is it possible to get AIDS if sharing syringes with HIV infected people?
|
636 (63.6)
|
43 (4.3)
|
321 (32.1)
|
Can someone infected with HIV look like a healthy person?
|
594 (59.4)
|
26 (2.6)
|
380 (38.0)
|
Can you get HIV by eating with an infected person or a patient?
|
572 (57.2)
|
86 (8.6)
|
342 (34.2)
|
Is it possible for a baby born with HIV by a HIV-positive woman?
|
557 (55.7)
|
64 (6.4)
|
379 (37.9)
|
Can people reduce the risk of HIV infection if they use a condom during sex?
|
567 (56.7)
|
61 (6.1)
|
372 (37.2)
|
Can people reduce the risk of HIV infection if they sex with only one partner?
|
531 (53.1)
|
78 (7.8)
|
391 (39.1)
|
Can people get AIDS from mosquito or other insect bites?
|
407 (40.7)
|
184 (18.4)
|
409 (40.9)
|
*HIV: Human immunodeficiency virus; +AIDS: Acquired immune deficiency syndrome. |
Less than half (48.9%) of all participants were considered to be aware of HIV/AIDS (range 40.7%-63.9%). The awareness rate decreased with increasing age (χ2 = 23.175, P < 0.05), which was 57.3% in the 50–59 age group and 28.6% in those aged over 80 years old. Less education was also negatively correlated with HIV awareness (χ2 = 52.054, P < 0.05) (Table 3).
Table 3
Awareness of HIV*/AIDS+-related knowledge of Males aged 50 years and older from Wuxi, Jiangsu Province, Eastern China
Demographic variables
|
Awareness rate (%)
|
Opposite rate (%)
|
OR
|
χ2
|
P
|
Age
|
|
|
1.07
1.03
1.19
1.00
|
|
|
50-59
|
57.3
|
42.7
|
23.175
|
<0.001*
|
60-69
|
50.1
|
49.9
|
70-79
|
39.6
|
60.4
|
80 and older
|
28.6
|
71.4
|
Place of residence
|
|
|
|
|
Towns
|
46.6
|
53.4
|
0.667
|
0.414
|
Rural
|
49.6
|
50.4
|
Education
|
|
|
|
|
Illiterate or primary school
|
37.2
|
62.8
|
52.054
|
<0.001*
|
Junior high school
|
54.2
|
45.8
|
High school or higher
|
70.3
|
29.7
|
Marital status
|
|
|
|
|
Unmarried
|
50.0
|
50.0
|
|
0.200
|
Married
|
48.1
|
51.9
|
|
0.291
|
Cohabitation
|
55.5
|
44.5
|
|
0.779
|
Divorced or widowed
|
46.7
|
53.3
|
|
0.097
|
Total
|
48.9
|
51.1
|
|
|
*P<0.05 |
HIV/AIDS-Related Attitudes
Table 4 highlights the generally low HIV and STD-related attitudes of participants in the study. Nearly two-thirds of the participants (n = 694, 69.4%) believed they would perceive a low risk of acquiring HIV, but only a small fraction (n = 80, 8.0%) said they would pay attention to AIDS prevention messaging and even fewer (n = 20, 2.0%), reported they were willing to work with an infected person. Less than 10% (n = 96, 9.6%) of participants knew where to get tested for HIV, only one-fifth of participants had ever been tested (n = 21, 2.1%), and 3% (n = 32) had ever consulted a doctor or expert on AIDS/STDs (Table SⅠ).
Table 4
Relationship between self-reported risk behaviors and HIV and STD test results of Males aged 50 years and older from Wuxi, Jiangsu Province, Eastern China
Self-reported high-risk behavior
|
Diagnostic Test
|
Total
|
Positive
|
Negative
|
Yes
|
0(A)
|
13(B)
|
13(R1)
|
No or Refuse
|
21(C)
|
966(D)
|
987(R2)
|
Total
|
21(C1)
|
979(C2)
|
1000(N)
|
AIDS/STDs-Related Behaviors
Only a handful of study participants mentioned engaging in high-risk behaviors. Eight participants (0.8%) reported having previously had sexual intercourse with Female Sex Workers (FSWs), two participants (0.2%) reporting have anal sex with a male partner, four (0.4%) had previously been diagnosed with an STD, and only one (0.1%) reported ever having injected drugs (Table SⅡ). Because the drug user also had sex with FSWs and had been diagnosed with STDs, a total of 13 people self-reported various HIV/AIDS-related risky behaviors among the participants.
HIV and Syphilis Testing
Based on the results of the TRUST and ELISA tests, 20 (2.0%) participants were currently infected with syphilis, while 25 (2.5%) were ELISA positive only, indicating that they had previously been infected with syphilis. More individuals aged 70 years and older (n = 8, 3.5%), residing in towns (n = 22, 2.2%) were currently infected with syphilis. There was no significant difference in the positive rate between participants of varying educational levels. Additionally, only 1 individual (0.1%) tested positive for HIV.
13 participants whom reported risky sexually behaviors (Table 4) were all tested negative for HIV and STDs. The relationship between the self-reported risk behaviors and the results of the diagnostic tests are highlighted in Table 6. The true positive rate of self-reported was only 2.3% (A + 0.5/A + C + 1)*100%, true negative rate of self-reported was 98.6% (D + 0.5/B + D + 1)*100%, missing report rate (false negative rate) was 97.7% (C + 0.5/A + C + 1) *100% (add 0.5 for each cell in Table 6 for the cell A is 0).
Risk Factors of HIV/STDs Infections
The results of the matched case-control study can be found in Table SⅢ. The case group was composed of 21 individuals, consisting of the twenty participants currently infected with syphilis and one whom tested HIV positive. The control group was composed of 42 individuals, randomly selected from the remaining participant, and matched on age. AIDS related attitudes were associated with HIV or syphilis infection (χ2 = 8.726, P = 0.013), while demographic characteristics, knowledge and other factors had no relationship with risky behaviors (Table SⅢ). The multivariate logistic regression analysis indicated that scores of AIDS health knowledge was the only significant prognostic factor for the HIV or syphilis infection (HR = 0.754 (0.569–0.999), P = 0.049).