Large population-based studies that integrate HIV knowledge surveys serve as crucial tools for gaining valuable insights within communities. These surveys provide a thorough understanding of the breadth and depth of knowledge gaps, enabling the identification of vulnerable groups associated with inadequate HIV knowledge. This identification, in turn, may facilitate the implementation of targeted interventions aimed at addressing these specific factors.
Our recent study highlighted a significant concern regarding HIV knowledge within the Malaysian population. Findings from the study revealed that the prevalence of inadequate HIV knowledge was 77.4%. This figure surpasses the prevalence rates observed in various countries worldwide, such as Bangladesh (38.0%) (19), Indonesia (45.0%) (20), Rwanda (46.4%) (10), Pakistan (64.3%) (21), Bolivia (67.0%) (22), and India (74.2%) (23). Such disparities underscore a considerable gap in HIV awareness among Malaysians. It is noteworthy that the discrepancies in prevalence across various studies may be attributable to the use of different tools, varied sample ages, and varying backgrounds of the people studied. Our study also demonstrated a higher rate than did an online local survey, which reported that 61.0% of the general population had insufficient awareness of HIV (8). Furthermore, our findings aligned with a study conducted among secondary school students in Malaysia, where only one in five respondents could accurately identify both methods of preventing sexual transmission of HIV and dispelling common misconceptions about HIV transmission (8), while the National Health and Morbidity Survey 2022: Adolescent Health Survey reported a very concerning result in which the prevalence of inadequate HIV knowledge among school-going adolescents was 98.7% (9) Similarly, a local study focusing on university students found that 59.9% of participants lacked sufficient knowledge about HIV (24). These findings underscore the critical need for enhanced HIV education and awareness programmes within the population.
In the present study, the majority of respondents exhibited favourable responses to the five inquiries addressing common misconceptions and transmission of HIV. Notably, approximately 30% of participants harboured the erroneous belief that engaging solely in sexual activity with a single uninfected partner while consistently using condoms could mitigate the risk of HIV transmission. This discovery mirrors findings from research conducted in Ethiopia among women of reproductive age, where a similar misconception regarding the efficacy of monogamy and condom usage in preventing HIV transmission prevailed (25). Additionally, our results also showed that the participants had the lowest percentage of correct responses to the question about whether HIV can be contracted by sharing food with an infected individual (58.9%). These findings parallel those of a study conducted among local university students (26) and another study in Bangladesh (27), which reported nearly identical proportions of accurate responses to the same question. The findings of this study underscore the necessity for awareness-raising campaigns and the imperative to enhance overall HIV knowledge. This is crucial, as accurate understanding is paramount in dispelling various misconceptions surrounding HIV.
The results of the multiple logistic regression analysis revealed a greater likelihood of inadequate HIV knowledge among individuals residing in rural areas. This finding aligns with similar studies conducted in India (12) and Ethiopia (28), which also demonstrated that rural residents exhibited significantly lower levels of HIV knowledge. Conversely, a study conducted in Karnataka, India, found no notable disparity in knowledge scores between urban and rural respondents (29). This could be attributed to an overall increase in HIV awareness facilitated by government initiatives, nongovernmental organizations, and community-based programs, which may have been less prevalent in rural regions. Factors such as poverty, limited healthcare resources, and restricted access to information likely contribute to this knowledge gap in rural areas.
Moreover, our study revealed that non-Malaysian citizens exhibited a strong correlation with inadequate HIV knowledge. This discovery aligns with previous studies by Najimudeen et al. (30), which underscored the limited awareness of HIV among migrant workers, especially those originating from Indonesia, Nepal, and Bangladesh. A lack of awareness regarding HIV may result in a deficiency of understanding, potentially leading to increased involvement in risky sexual behaviours and subsequently contributing to a surge in HIV cases (31). Efforts and awareness programs should aim to bridge the gap in HIV knowledge among nonnative communities.
Our findings also revealed that age was not associated with a lack of HIV knowledge, despite the prevalence of this knowledge gap being greater among both younger and older segments of the population. Our results echo those of a previous study (32), which revealed no significant disparity in HIV knowledge between different age groups. Additionally, research by Kembo J et al. (33) demonstrated no notable variance in HIV knowledge levels between African American undergraduates aged 18–24 and those aged 25 and older. However, these findings contrast with earlier studies suggesting a positive association between age and HIV knowledge (34, 35). Traditionally, age has been presumed to correlate with increased exposure to essential information for daily life, leading to the belief that older individuals possess greater knowledge of HIV due to prolonged exposure to educational initiatives. With many interventions targeting young adults, recent reports indicate that adults aged 50 and above are experiencing a significant increase in new HIV diagnoses (36). This phenomenon may be attributed to older individuals being less likely to perceive themselves as at risk of contracting the virus, a sentiment consistent with both public and medical perspectives (37). Ageist attitudes among healthcare professionals, influenced by the misconception that older persons are not engaged in high-risk behaviours, further compound this issue, with many assuming older individuals to be sexually inactive and therefore immune to infection (38). In our study, we did not find a significant association between knowledge level and gender. These results contrast with studies conducted in South Africa (7) and locally in Melaka (39), which indicated that females were more likely to have inadequate knowledge about HIV. Potential explanations for this difference could include variations in socioreligious beliefs, ethnic backgrounds, and family dynamics.
Our study findings highlight the significant role of education in predicting HIV knowledge among the Malaysian population, aligning with similar trends observed globally (14, 40, 41). For instance, research conducted among the general population in Ecuador revealed a strong association between lower educational attainment and inadequate understanding of HIV. This underscores the critical importance of integrating HIV education and awareness initiatives into early education curricula to combat misinformation, encourage regular testing, and promote safe practices (42). Furthermore, our research sheds light on the heightened risk of inadequate HIV knowledge among certain occupational groups, including private employees, unpaid workers, homemakers, and caregivers. Individuals in these roles were found to be 1.5 times more likely to lack sufficient awareness about HIV (6). Differences in access to education and resources might explain why certain job groups have less exposure to HIV. Private employees might lack workplace health programs, while unpaid workers, homemakers, and caregivers may face limited access to education and healthcare, hindering HIV awareness (43).
Similar to any scientific study, the current research possesses both strengths and limitations that warrant careful consideration. One notable strength lies in its distinction as the first national dataset on HIV knowledge among the general population, offering comprehensive insight into the subject matter. Additionally, the study's large and ethnically diverse sample size further enhances its robustness, enabling the detection of meaningful relationships and associations within the data and thereby increasing the reliability of the findings. However, it is essential to acknowledge certain limitations within this study. First, the study design is noteworthy, specifically its cross-sectional nature. Although cross-sectional studies are valuable for identifying associations and trends, they lack the ability to establish causality because they collect data from participants at a single point in time. Second, the survey was conducted during the peak of the COVID-19 pandemic in 2020, necessitating the use of computer-assisted telephone interviews (CATI). Despite the use of CATI, interviewers were diligently trained to adhere to the study protocol, minimizing potential information bias. Last, it is crucial to recognize that the survey focused on respondents from the general population and did not specifically target key populations, which have historically been the primary drivers of the HIV epidemic in Malaysia, which signifies a major limitation.