Assessing knowledge, attitude, behavior, and practices related to Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome in a United States-based refugee population

Human Immunodeficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be major global health priorities. Although forced displacement is believed to fuel HIV/AIDS epidemic in countries affected by conflict, factors associated with forced displacement and HIV risk in conflict-affected populations are not well understood. The aims of this study were therefore (1) to describe factors that influence risk for HIV infection in a Utah-based Burundi refugee population and (2) explore relationship between Knowledge, Attitudes, and Behavior/Practices (KABP) in order design targeted HIV/AIDS prevention interventions for the population. We conducted a systematic review of studies on HIV/AIDS risk and protective factors and interventions that target HIV risk factors. Although the review found a plethora of data collection tools, there was marked shortage of culturally appropriate instruments with demonstrated reliability or validity. We therefore designed a valid, reliable, culturally appropriate questionnaire for use in assessing HIV/AIDS knowledge, attitudes, and behavior/practices. The questionnaire was administered in a cross-sectional study to a random sample (with replacement) of 215 Burundi refugees (n = 76 and age ≥ 12). The main outcome measure was behavior/practices. Predictor variables were: (1) knowledge; (2) Attitude; (3) self-efficacy. Univariate, bivariate, and multivariate analyses were performed. Regression models were developed to highlight significant predictors of HIV infection in the population. Results were controlled for known confounders. Questionnaire reliability was satisfactory (Cronbach's Alpha ≥ 0.70). A 97.36% response rate was achieved. Significant predictors of protective HIV/AIDS behavior/practices were self-efficacy (b = 0.248, p = 0.027 ) and HIV/AIDS-knowledge (b = 0.454, p < 0.001). Attitude towards HIV/AIDS (b = 0.5071, p < 0.001) was a significant predictor of HIV/AIDS knowledge. Behavior/ practices were strongly associated with knowledge, attitudes, self-efficacy, gender, and household size. Overall, men were more knowledgeable than women and had higher self-efficacy. Women had more positive attitudes and scored higher behavior/practices. These findings create foundational HIV/AIDS KABP as a basis for designing targeted, culturally-tailored HIV/AIDS interventions strategies for the population.