Fostering accurate HIV/AIDS knowledge among unmarried youths in Cameroon: Do family environment and peers matter?

BACKGROUND: The last three decades have seen a series of HIV interventions in sub-Saharan Africa. However, youths still have a mixture of correct and incorrect HIV/AIDS knowledge of transmission routes and prevention strategies. Previous studies have identified parents and peers as the most important socializing agents for youths. This paper assesses the relationships between family structure, family/peer communication about sexuality and accurate knowledge of transmission routes and prevention strategies. METHODS: Data were drawn from the Cameroon Family Life and Health Survey (CFHS) conducted in 2002. The CFHS collected information on a representative sample of 4 950 people aged 10 years and over nested within 1 765 selected households from the 75 localities forming the administrative prefecture of Bandjoun, using detailed questionnaires about family, HIV/AIDS/STDs knowledge, sexual behaviors, contraception, health, media exposure, household assets and neighborhood characteristics. The survey cooperation rates were high (97%). For the purpose of this study, a sub-sample of 2 028 unmarried youths aged 12 - 29 years was utilized. RESULTS: Overall, 42% of respondents reported accurate knowledge of documented HIV transmission routes whereas 21% of them had inaccurate knowledge such as AIDS can be transmitted through mosquito bites or casual contact with an infected person. Only 9% of respondents were knowledgeable about all HIV prevention strategies. Multivariate analyses showed that family structure, communication with parents/guardians and peers about sexual topics were significantly associated with accurate HIV knowledge. Additionally, age, education, sexual experience and migration had significant effects on accurate knowledge. Finally, living in poor households and disadvantaged neighborhoods significantly increased inaccurate knowledge of HIV transmission modes and prevention strategies. CONCLUSIONS: This paper evidenced the limited effects of HIV interventions/programmes in sub-Saharan Africa. Indeed, few respondents reported accurate knowledge about HIV transmission routes and prevention strategies. Findings showed that the role of family environment as source of accurate HIV knowledge transmission routes and prevention strategies is of paramount significance; however, families have been poorly integrated in the design and implementation of the first generation of HIV interventions. There is an urgent need that policymakers work together with families to improve the efficiency of these interventions. Peer influences is likely controversial because of the double positive effect of peer-to-peer communication on both accurate and inaccurate knowledge of HIV transmission routes.