Objectives: To evaluate the impact of a community-wide intervention to increase HIV/AIDS-related knowledge, change attitudes and increase safer-sex practices in Managua, Nicaragua.
Design and settings: Household-based health education intervention trial comprising a knowledge, attitudes and practices (KAP) survey at baseline, a health education intervention and a follow-up KAP survey. Four neighbourhoods were included, two received the intervention, and the other two served as controls. Randomly selected residents aged 15-45 years were interviewed at baseline (n = 2160) and follow-up (n = 2271) using an identical questionnaire. The intervention consisted of a health education campaign that emphasized HIV transmission and condom use. OUTCOME AND ANALYSIS: Knowledge levels regarding transmission and prevention of HIV infection, self-reported use of condoms, levels of worries about HIV/AIDS and perceptions of personal risk of HIV infection. Comparisons between baseline and follow-up employed chi 2 tests with continuity correction. The influence of the intervention was examined in multivariate logistic models including an appropriate interaction term.
Results: Intervention and control samples were comparable with regard to sex, age, and age at first intercourse. Significantly less intervention residents had formal education (P < 0.001). At baseline, outcome variables were generally similar in control and intervention samples. Condom use increased from 9 to 16% (P = 0.003) among intervention women, but only from 9 to 11% (P = 0.5) in control women (test for interaction, P = 0.08). Among men, increases were from 31 to 41% (P < 0.001) and from 30 to 37% (P = 0.06), respectively (test for interaction, P = 0.3). Levels of worries about HIV/AIDS decreased in all groups, but perception of individual risk increased only among intervention women (test for interaction, P = 0.02).
Conclusions: This household-targeted health education intervention appears to have had some effect; however, sustained efforts are needed further to improve levels of knowledge and to increase condom use in Managua.