The impact of social organizations on HIV/AIDS prevention knowledge among migrants in Hefei, China

The economy in China has developed rapidly over the past several years, and as a result there is an increase in the number of migrants as sources of social capital. Large-scale population migration has unique economic, social and demographic impacts, which may influence the risk of HIV transmission [1]. In China, there were an estimated 780,000 people living with HIV/AIDS (PLWHAs), and migrants accounted for 21.0% of PLWHAs [2]. Many factors including limiting familial and social network support, forcing migrants into physically demanding jobs and poor housing and living conditions limit migrants’ access to health care and health information, which put migrants at higher risk of HIV infection [3]. Migrants are an important vector for the spread of HIV/AIDS. Participation in social organizations, a type of social capital, may provide an important channel to deliver information on safe sex practices and influence beliefs and attitudes towards Sexually Transmitted Infections (STI) prevention, including HIV/AIDS. Leveraging social capital to improve HIV/AIDS prevention may be an important component to address this public health problem of high incidence and prevalence of HIV/AIDS in migrants [4].

Social capital is defined as the power, benefit, value emanating from any social interaction among individuals, groups, institution, communities or networks. It is the intrinsic and extrinsic benefit that members gain for belonging to a group or network. A type of social capital includes the number and types of social organizations. In China, social organizations include governmental organization like various political parties and non-governmental organization include alumni association and cultural & sports clubs. According to 2013 statistics from China, the number of social organizations reached 289,026, which is a 51.2% increase compared with 10 years ago [5]. Increases in social organization participation has played an important role in HIV/AIDS prevention and control and has gradually gained popularity in recent years [6, 7]. For instance, Bhattacharjee et al. investigated the role of membership in peer groups and found that community mobilization and peer group formation reduced HIV-related risk and vulnerability among female sex workers [8]. Campbell et al. explored pathways between community participation and HIV prevention, treatment and impact mitigation in Zimbabwe and found that community group membership is often associated with decreased HIV incedence, improved access to some services particularly amongst women [9]. FSWs who are exposed to social organizations are also at a substantially lower risk of STIs than those who are unexposed [10].

HIV/AIDS knowledge and attitudes towards HIV/AIDS and high-risk behaviors are the measures of the HIV/AIDS prevention effect. The key question is if understanding whether the improvement of knowledge can change migrants’ attitudes towards HIV/AIDS can reduce HIV-related high-risk behaviors. Our previous study found that HIV/STI knowledge is related to attitude and practice for market vendors [11]. Malcolmet et al.’ research showed knowledge alone is not sufficient to eliminate stigmatizing attitudes and behaviors [12, 13]. Lim et al.’s findings suggest that understanding HIV more broadly may be associated with lower HIV-related risk behavior and more comprehensive HIV knowledge may reduce HIV-related high-risk behavior [14].

In this paper, we aimed to explore the role of different types of social organizations on the prevention of HIV/AIDS among migrants. The difference on HIV/AIDS knowledge levels between participants and non-participants for each organization were obtained. The impact of HIV/AIDS knowledge levels on attitudes towards HIV/AIDS and risk behavior was also analyzed for organizations with significant differences between two groups.

Our study provides an initial exploration of correlations between membership in social organizations and migrants’ HIV/AIDS knowledge, attitudes and HIV-related high-risk behavior. With further development, our findings can be used to develop evidence-based policy to improve programs for HIV/AIDS prevention and control for migrant populations in China.

As can be seen, a relatively low proportion of migrants participated in social organizations. This phenomenon may due to the essence of migrants. Compared with the city’s permanent population, the income of migrants is lower. They have to spend more time on work. Therefore, most migrants have no spare time to join the social organizations.

According to the results, migrants who are members of political parties or alumni associations have more HIV/AIDS knowledge than those who do not participate in any social organizations. Social organizations have promoted the advertisement of HIV/AIDS knowledge. In recent years, the government has paid more attention to social organizations so that HIV/AIDS-related knowledge can be spread more extensively among migrants, highlighting the need to take advantage of social organizations to carry out various training courses, which include HIV/AIDS prevention and knowledge. However, misconceptions about the routes of transmission are common. According to the answers by respondents, there are some false beliefs that HIV/AIDS can be transmitted by mosquito bites, a belief that has also been observed in previous studies [16]. To resolve this problem, social organizations should educate migrants on the routes of HIV/AIDS transmission and common fallacies about the virus.

The results of multiple logistic regression analysis demonstrate that HIV/AIDS knowledge is an important factor that influences political party members’ behaviors and attitudes towards HIV/AIDS. High knowledge levels may have positive effects on people’s behaviors. Research has shown that health education of HIV/AIDS can improve peoples’ understanding of HIV/AIDS, thus it could decrease high-risk behaviors [17, 18]. The impact of high knowledge level on HIV/AIDS-related behavior is not significant for migrants who participated in alumni associations. Different roles played by different social organizations may explain this phenomenon. Alumni associations or NGOs may have insufficient capacities, be deficient in resources, and not systematic enough compared with political parties to effectively reduce HIV/AIDS-related behavior [19, 20]. On the other hand, mobility of migrants causes difficulties for HIV/AIDS-related education and intervention services. Most of the migrants are from suburbs, and those who have lower HIV/AIDS-related knowledge than long-term residents are more likely to be engaged in high-risk behaviors [21]. Our previous research has shown that migrants are more likely to have high risk HIV-related sexual behavior than non-migrants [22]. Fang et al. mentioned that even if HIV/AIDS universal education improved knowledge levels that it will be hard to change their attitudes toward HIV/AIDS [23‐25]. Most migrants have positive behaviors towards drug abuse regardless of social organization participation. In China, it is well known that taking drugs is harmful, requiring lots of money and with serious legal punishment, which makes people consciously regulate their own behaviors. On the one hand, humanistic care could be developed through community support and psychological care for migrants such as organizing some healthy, informative, interesting entertainment activities. With a rich amateur life, prostitution and drug abuse are obviously reduced while loneliness and dissatisfaction are also reduced and confidence is established in life. On the other hand, multi-channel peer education and behavioral interventions could be carried out by social organizations. Health publicity and bulletin boards could be made and free condoms could be distributed in high HIV/AIDS epidemic areas. Social organizations with abundant resources could make in-depth publicity and face to face education for high-risk HIV populations.

There are still substantial intolerant attitudes towards HIV positive and HIV/AIDS patients. Interestingly, although migrants who participate in either political parties or alumni associations had higher-levels of HIV/AIDS knowledge and are willing to obtain more HIV-related knowledge. However, they also had more negative attitudes toward HIV/AIDS than migrants with low-levels of HIV/AIDS knowledge, especially in the aspect of accepting HIV/AIDS patients. Other studies suggest that improving HIV/AIDS knowledge is not enough for to change attitudes. Yu et al.’s study which collected articles published between 1996 and 2006 concerning the effect of HIV/AIDS education intervention in migrants shows that health education for preventing HIV/AIDS is effective in changing attitudes in migrants [26]. However, Chen et al.’s study which is based on a sample of nurses in a single hospital in Jiamusi City, Heilongjiang, China, suggests the opposite conclusion. In their study, nurses who have a better understanding of HIV/AIDS prevention are more likely to have negative attitudes toward HIV/AIDS [27]. But study by Anahita Tavoosi also shows although the knowledge level seems to be moderately high, misconceptions about the routes of transmission are common among Iranian students [28]. So if we only disseminate preventive knowledge and promote a positive attitude, the results are likely to be unsatisfactory. The main reason for negative attitudes is that most of migrants have less education which affects their understanding and acceptance of HIV/AIDS knowledge. Better understanding of HIV/AIDS knowledge actually increased people’s panic. They fear for their personal safety, their family members’ health and others’ attitudes towards them so that they want to stay away from this sensitive issue [27]. We also found that the majority of migrants are not willing to accept the HIV voluntary counseling testing (VCT). Two main factors led to this phenomenon. First, migrants cannot fully understand VCT. Second, social discrimination and stigma make people fear to seek and accept testing. Worrying about exposing their privacy is also a reason. This result shows that it is important for migrants to eliminate the misunderstanding so as to change their attitudes. Social organizations also should be more comprehensive when disseminating HIV/AIDS knowledge, not only to enhance the awareness of HIV/AIDS, but also to deepen the understanding of transmission and non-transmission routes to decrease panic and discrimination against HIV/AIDS. Social organizations can also take measures, including cooperating with local health sector, setting up VCT consulting point convenient to migrants, training VCT services consultant to improve the quality of their service, persisting in the principle of protecting consultants’ privacy and perfecting care service after counseling and testing, to change migrants’ attitude toward VCT and increase utilization of VCT in migrants. For migrants who have been infected with HIV/AIDS, it is applicable and effective for social organizations to take their advantages, which included training peer educators, developing civil relief, helping migrants infected with HIV/AIDS to engage in production to support themselves and providing psychological counseling for them, their participation can make services more professional, comprehensive and sustainable.

Here we observe a significant association between Agricultural workers and positive behavior (P < 0.05), but a wide range for 95% confidence interval. This phenomenon may due to the small sample size. Migrant who had higher incomes tended to exhibit more positive behaviors. People with higher incomes may have more educated social circles, which allows them receive more informative knowledge of HIV/AIDS [29‐31].

Limitations of this study include the use of data from a cross-sectional survey, where causality cannot be ascertained. In addition, our sample size is not big enough due to limited funding. Finally, the results may not be generalized to all Chinese migrants. Our data is collected in Anhui province, which has a relatively low HIV/AIDS prevalence for China, and thus may not reflect the situation in other provinces due to regional differences in the epidemic characteristics of HIV/AIDS, prevention and control measures, funding, and policy environment.

Overall, community groups appear to raise awareness of HIV/AIDS-related knowledge. Therefore, increasing the percentage of migrants who are members of community groups could help increase HIV/AIDS knowledge. Although the knowledge is transferred into positive behavior, the two groups show different abilities. Due to excellent organization capacity, scale and the advantages in resources, the party organization could transfer knowledge into positive behavior better than alumni association as a government agency. It also indicates that organizations that target migrants specifically could have a much larger impact in HIV/AIDS knowledge on this relatively clandestine and high-risk population. As HIV/AIDS knowledge publicity is not comprehensive, migrants with high knowledge on HIV/AIDS would have more negative attitudes towards HIV/AIDS than that with low-levels of HIV/AIDS knowledge. Although the current situation there is not complete, social organizations still play an important positive role on HIV/AIDS prevention for migrants. They present great potential in curbing the spread of HIV/AIDS. With the completing of organizational mechanism, social organizations will make a greater contribution to HIV/AIDS prevention for migrants in the future.