human immunodeficiency virus ( hiv ) infection is one of the most serious public health problems worldwide particularly among developing nations of africa and south - east asia . the estimated number of persons living with hiv / acquired immuno deficiency syndrome ( aids ) in india was 20.89 lakhs , with an estimated adult prevalence of 0.27% in 2011 . although the disease prevalence is low , india still houses the third largest hiv - infected population in the world after south africa and nigeria . since specific behavior patterns are associated with high risk of transmission of infection , it is imperative that persons living with hiv / aids have adequate knowledge of different modes of its transmission and overall impact of the disease on personal and social health of an individual . adequate knowledge and accurate information about hiv infection and its ultimate outcome are also important both for the general population and hiv - infected persons in particular for bringing a behavioral change and preventing the transmission of infection . this will not only reduce the risk of hiv transmission to the uninfected but also prevent other secondary infections and coinfections such as hepatitis b and tuberculosis as well . identification of correlates of poor knowledge , casual attitude , and wrong perceptions among affected persons will also help in planning interventions to reduce hiv transmission . hiv - related knowledge among uninfected persons and at - risk groups ( antenatal women , drivers , and commercial sex workers ) or certain population cohorts ( students , youth , slum dwellers , and general population ) delineating a positive correlation between knowledge of hiv and risk reduction behavior has been well studied . however , there is a paucity of literature on the level of knowledge , attitude , and perceptions of persons living with hiv / aids per se as they are rarely included in such studies despite being a primary source of infection for the susceptible population . this study assesses the knowledge , attitude , and perceptions of persons living with hiv / aids in himachal pradesh , a small hill state of northern india . all hiv / aids - affected patients attending outpatient / inpatient dermatology clinic during october 2013 to september 2014 were enrolled for this questionnaire - based , cross - sectional , descriptive study . children aged < 14 years and severely ill patients were excluded from the study owing to their inability to comprehend or respond to the questionnaire . after informed written consent and assuring confidentiality , they were asked to answer a predesigned , structured questionnaire in their native language . the questionnaire had two parts with the first section for their sociodemographic details and the second section comprised questions aimed at assessing their knowledge , attitude , and perception for the disease [ tables 1 and 2 ] . baseline characteristics of patients studied results of questionnaire on human immunodeficiency virus / acquired immuno deficiency syndrome knowledge , attitude , and perception these 150 patients comprised 93 ( 62% ) men and 57 ( 38% ) women , aged between 14 and 78 ( mean 37.13 ) years . their baseline demographic features are shown in table 1 . the majority , 112 ( 74.7% ) patients were of 2050 years age group and 118 ( 78.7% ) patients were ruralites . the most , 116 ( 77% ) respondents were either illiterate , under matric , or school dropouts . the majority , 69 ( 74.2% ) patients were drivers , staying - alone laborers , and self - employed among males whereas 51 ( 89.5% ) women were homemakers . heterosexual contact was the most common mode of disease acquisition in 138 ( 92% ) patients . while 2 ( 1.3% ) patients implicated past blood transfusion and vertical transmission observed in 4 ( 2.7% ) patients , none of the patients had acquired the disease from homosexual or intravenous injection route . analysis of the questionnaire [ table 2 ] revealed that 129 ( 86% ) patients had heard about hiv / aids , and 66 ( 44% ) patients were aware that it weakens the immune system . although only 32 ( 21.3% ) patients knew that it is due to a virus , 124 ( 82.7% ) knew that disease could be transmitted by unprotected sexual intercourse . among other causes , 106 ( 70.7% ) patients considered transmission from transfusion of infected blood and 98 ( 65.3% ) patients considered infected needles , and syringes are the cause . only 58 ( 38.7% ) and 34 ( 22.7% ) respondents , respectively , were aware of transmission from an infected mother to her unborn child or that from breastfeeding . on the other hand , 46 ( 30.7% ) patients believed insect / mosquito bites , 40 ( 26.7% ) patients considered sharing of personal items ( towels , utensils ) , and 56 ( 3.3% ) patients thought infected razors / blades are its other transmission routes . nearly , 131 ( 87.3% ) patients also considered public toilets , coughing / sneezing , hugging / kissing , shaking hands , and living together as other modes of disease transmission . the majority , 106 ( 70.7% ) respondents were aware of prevention of hiv / aids from use of condoms but only 24 ( 16% ) favored complete abstinence as a preventive measure . surprisingly , 43 ( 28.7% ) patients and 28 ( 18.7% ) patients , respectively , also believed that avoiding physical contact and separating personal items would prevent disease transmission . avoidance of smoking , alcohol , and drugs was also considered useful in preventing disease transmission by 51 ( 34% ) patients . sixty - one ( 40.7% ) patients knew that the disease is incurable at present whereas 47 ( 31.3% ) patients considered it curable with early treatment . while 87 ( 58% ) patients were comfortable in sharing their disease status with family , friends , and colleagues , 104 ( 69.3% ) patients were not comfortable with sharing such information with them fearing stigmatization . the most patients were not hesitant to take care of their family and social interactions as before . television and radio were the major source of information for 135 ( 90% ) patients followed by health personnel for 97 ( 64.7% ) patients , respectively [ table 1 ] . twenty - one ( 14% ) patients had no source of information regarding the disease , a significant number of patients were also in the group of  do n't know / no response  respondents . despite an impressive 57% decline in annual new hiv infections in adults from 2.74 lakhs in 2000 to 1.2 lakhs in 2011 , india still house a large number of hiv - infected people with andhra pradesh , maharashtra , tamil nadu , and the northeast states topping the list . himachal pradesh with approximately 70- lakh population has an estimated 8000 ( approximately ) people living with hiv / aids ( adult prevalence 0.17% ) . although the antiretroviral therapy ( art ) significantly slows down the disease progression , a definitive cure of hiv remains elusive despite significant advances made in hiv therapeutics during the last few decades . apart from high - risk behaviors and practices , poverty , poor availability of health facilities , low education , and ignorance for various aspects of hiv / aids increases the vulnerability of population to the disease . sudha et al . noted nearly 80% and 75% of general population interviewed were aware of hiv / aids and its transmission from unprotected sexual contact , respectively . factors such as low education and rural background have been associated with low hiv / aids - related knowledge and increased high - risk behavior in another study . goswami et al . also observed that 22% of illiterate pregnant women had heard of hiv / aids as compared to 99% of literate women . only 32% of general population interviewed in another study was aware of its cause being a virus . nearly 54% of 400 adolescent girls from slum area were unaware of the modes of disease transmission . kalasagar et al . observed that 45% of males and 62% females considered sexual contact , contaminated air or water , mosquito bite , and fomites as modes of disease spread . although 8286% respondents had heard of the disease and were aware of sexual mode of its transmission , the rural background , low education , high - risk occupations ( drivers , stay - alone laborers , and defense personnel ) , and general ignorance were the common sociodemographic features in our studied population . our 21.3% respondents knew that a virus causes this disease , and 44% had the knowledge that it weakens the immune system . most of the respondents in our study were also aware that blood transfusion ( 70.7% ) , infected needles / syringes ( 65.3% ) , or infected razors / blades ( 3.3% ) could transmit the disease . surprisingly , a sizeable minority also held a view of disease transmission from living together or sharing personal items ( 26.7% ) , insect / mosquito bites ( 30% ) , coughing and sneezing ( 27% ) , or other modes such as public toilets , hugging , and shaking hands . such misconceptions and lack of awareness about disease transmission in our study population this is also evident from the fact the newspapers / books were not the major source of information for them . the use of condom for safe sexual practices and disease transmission is highly important and its preventive role remains undeniable . in addition , it helps the hiv - affected persons to lead a socially normal life once the misconception of being a source of infection to the family no longer exists . however , awareness for preventive importance of condoms was noted in only 47% of hiv - infected patients interviewed by taraphdar et al . whereas 56% males and 71% females in another study held a view that hiv is curable by western or traditional indian medicine . more than 70% of our patients knew the importance of condom use but only 40% of the respondents were aware of the incurable nature of the disease and 31% thought that early initiation of appropriate treatment is curative . this suggests level of their better awareness reflecting positively on information , education , and communication ( iec ) activities in the state . it is also evident from our observations that health personnel remain significant source of information for 97 ( 64.7% ) patients . nevertheless , a sizeable number of patients were also of the view that keeping personal belongings separate , avoidance of physical contact , and avoidance of smoking and alcohol are also preventive . the problem of social stigma and discrimination of hiv / aids patients within the family or at workplace can be gauged from the fact that 48% males and 60% women slum dwellers in chennai preferred outcasting them from the community . this can lead to hiv - affected persons to live in isolation and causing great psychosocial distress . although 58% respondents in our study were comfortable in discussing their disease with family and willing to take care of them or attend social gatherings , 69% of the respondents were reluctant to disclose their disease status particularly to friends / colleagues fearing discrimination at workplace / society . mass media ( television , radio ) remains the most common sources of information for our 135 ( 90% ) patients and in previous studies as well . this highlights the pivotal role that mass media can play in generating awareness for various aspects of disease among general population and the patients alike or in eliminating its stigma . it is obvious that art alone will not be enough to contain hiv epidemic or achieving the global target of it needs to be supplemented with adequate information , education , and counseling of the hiv - affected population . they must be encouraged to adopt safe sexual practices and behaviors to prevent further transmission of the disease among the susceptible uninfected population . since modification of behavioral practices among hiv - affected patients is important in decreasing hiv disease transmission , it becomes imperative that persons living with hiv must be aware of the disease and its various epidemiological aspects indicating increasing need to scale up iec activities . while improvement in individual economic status and education and health services remains highly desirable , mass media can play a pivotal role in creating awareness among masses . small number of respondents and lack of follow - up assessment for postcounseling behavior change and awareness levels are some of the limitations . small number of respondents and lack of follow - up assessment for postcounseling behavior change and awareness levels are some of the limitations .
background : although modification of behavioral practices among human immunodeficiency virus ( hiv)-affected patients is important in decreasing hiv disease transmission , the knowledge , attitude , and perception studies about hiv infection rarely include persons living with hiv / acquired immuno deficiency syndrome ( aids).aims : to assess knowledge , attitude , and perceptions of persons living with hiv / aids for the disease and other epidemiological aspects.materials and methods : one - hundred and fifty consecutive persons living with hiv / aids were enrolled for this questionnaire - based cross - sectional , descriptive study.results:these 150 patients comprised 93 men and 57 women , aged between 14 and 78 ( mean 37.13 ) years . the majority , 112 ( 74.67% ) patients were between 20 and 50 years of age and 116 ( 77.3% ) patients were either illiterate or high - school dropouts . 
 drivers , laborers , and self - employed comprised 69 ( 74.2% ) patients among affected males . only 129 ( 86% ) 
 respondents had heard about hiv / aids and knew about its heterosexual transmission . 
 ninety - eight ( 65.3% ) respondents were aware of disease transmission from infected blood or needle pricks . 
 interestingly , 106 ( 70.7% ) respondents were aware of the importance of using condom in preventing disease transmission . 
 television / radio was the most common sources of information for 135 ( 90% ) patients . 
 nearly , 69% respondents disfavored disclosing their disease to friends / colleagues fearing stigmatization.conclusions:information , education , and communication activities are imperative to educate persons living with hiv / aids about life - long nature of the disease , modes of its transmission , and significance of preventive measures to bridge the gaps in their knowledge . 
 while improvement in individual economic status , education , and health services remains highly desirable , mass media can play a pivotal role in creating awareness among masses .