The HIV/AIDS epidemic in Malaysia has emerged as an important health problem since the first HIV case was detected in 1986.[4] Since then, according to the Malaysian AIDS Council Resource Center, the cumulative number of HIV infections up to June 2007 amounted to a total of 78,784.[5] Particularly alarming is the fact that the HIV infection rate and AIDS cases are showing a rapid increase among young people. In young people aged less than 30 years, there were 20,330 HIV infections and 1818 AIDS cases recorded in 2002. In 2005, the number increased to 26,810 and 2546, respectively. Up to June 2007, a total of 29,269 HIV infections and 2974 AIDS cases were reported in Malaysians below the age of 30 years.[5]

Malaysia is a moderate Islamic country with the majority of Muslim Malays and other ethnicities (Chinese and Indian) living together with the freedom to practice their religion and observe other cultural practices. Like many Islamic societies, issues dealing with sex and sexually transmitted infections (STIs) are seen as taboo and sensitive, and therefore are not discussed openly.[6-8] Despite the domination of conservative and traditional values in Malaysia, adolescents date and many engage in unsafe sexual intercourse.[9] The incidence of adolescents engaging in sexual intercourse also increases with age.[10,11] What is more alarming is that most sexual encounters are unsafe, with no protection against STI and unwanted pregnancy.[12] There is no doubt that young people are at greater risk of acquiring STIs, particularly HIV/AIDS, than other age groups.

With no specific cure for HIV/AIDS, preventive measures based on information and education programs remain crucial for tackling HIV/AIDS and its associated problems.[13] Thus, communication and intervention strategies play important roles in educating the public, especially the young adult, on the prevention and control of HIV/AIDS. Previous studies on HIV/AIDS issues were done based on purposive sampling of populations such as drug users, healthcare workers, and adolescents[14-16] and results cannot be generalized to the population as a whole. Few published studies are available on the knowledge, attitudes, and beliefs about HIV/AIDS among the general population in Malaysia.

The data in this study revealed a significant gender difference in general HIV/AIDS knowledge, with females being more knowledgeable than males. Gender differences in AIDS knowledge have been found in other studies[21,22];however, a study among college students in China, found males to be more knowledgeable than females.[23] General HIV/AIDS knowledge also appeared to vary with other demographic characteristics, with the highest knowledge among the Malays, those from urban areas, and the older age group. This finding is consistent with studies in other countries[23,24] and may reflect differences in the level of HIV/AIDS education. Educational efforts need to be targeted at those who are most misinformed to meet the needs of different populations: (1) particular age groups, (2) those in different geographical locations, and (3) different ethnic groups.

Despite the fact that anonymous HIV testing has been made available to the public, many have not heard of it. People are more likely to be voluntarily tested for HIV if the testing is anonymous; for example, a study reported an increase in the demand for HIV testing once the option of anonymous testing was provided,[25] and this may even contribute to early HIV medical care.[26] Hence, the availability of anonymous HIV testing needs to be emphasized in the information and education programs directed at people who are seeking testing.

Consistent with findings in the other Asian countries[23,27] and the United States,[28,29] the majority of young people appeared to rely on the public media (television, newspapers, and radio) as their primary source of HIV/AIDS information. Our findings suggest that future education campaigns on HIV/AIDS would best be conducted via mass media (specifically television, newspapers, and radio). There is overwhelming evidence for the effectiveness of mass media in raising awareness and increasing knowledge in developing countries.[30] The findings of this study are also consistent with other studies[31] that found that relatively high percentages of young people did not receive information from family members and medical professionals. Since the majority of respondents identified mass media as their main source of information, it may be one of the most effective channels for the delivery of HIV/AIDS-related information and education efforts.

Although it has been reported that the Ministry of Health's PROSTAR program (Healthy Living without AIDS for Youth) significantly increased the level of awareness among the club members,[32] our survey indicated the majority of young people were not members of PROSTAR and many had never heard of it. PROSTAR should attempt to reach more young people, especially from rural or hard-to-reach groups to create a future generation of well-informed youth in relation to HIV/AIDS.

It was observed in this study that although the large majority of the study population had correct knowledge of the most common modes of transmission, such as sharing injecting needles and sexual transmission, misconceptions were still held regarding nonsexual routes of transmission. Belief that HIV could be transmitted by mosquito bites, sharing meals, casual contact, and using public swimming pools and toilets still appeared prevalent. Mirroring a local study[33] conducted in 1991, this study showed that the majority of the adolescents interviewed were aware that HIV transmission resulted primarily from high-risk behaviors, such as having unprotected sex and sharing needles. For these reasons, efforts should be made to provide accurate information and address misconceptions about HIV transmission. The erroneous belief that mosquitoes are vectors for HIV is a quite common misconception, as has been shown in many other studies.[34-38] The proportion of respondents that were aware that HIV/AIDS is not transmitted by mosquito bites in our study (47.0%) was similar to the results from studies conducted among Asian-Indian adolescents (48.0%)[35] and Turkish adolescents (40.3%).[36] Casual contact and sharing meals were also more likely to be cited as a way to transmit HIV by those who had less awareness of the disease, and by those who held more stigmatizing views toward those living with HIV/AIDS. Many were also unaware that HIV transmission could occur from getting a tattoo or through body piercing.

In general, knowledge about HIV prevention was high among the respondents. Nevertheless, a significant number of respondents had misconceptions about HIV prevention methods, in particular the beliefs that washing the genital area with soap after sexual intercourse and avoiding touching people living with HIV could prevent infection. The knowledge of HIV/AIDS prevention in this study appeared slightly higher among the rural respondents than among urban respondents. Our findings differ from those of other studies that found the highest knowledge levels among students from urban areas and the lowest levels among those from rural areas.[23,24] Nevertheless, this may reflect differences in the level of HIV/AIDS education or information access in different regions; HIV/AIDS education should therefore target the underserved regions.

Although the knowledge of HIV prevention methods is good, it is important to know whether the young people are equipped with the necessary life skills to reduce their vulnerability to HIV infection, such as the ability to negotiate condom use. Elsewhere, many young people do not have the basic knowledge and skills to prevent themselves from becoming infected with HIV.[39] Having access to HIV/AIDS information is not sufficient; young people, especially adolescents, need to be guided and taught to incorporate this knowledge into daily life.[40]

Caroline Chin KL, BSc, has disclosedno relevant financial relationships.

W.Y. Low PhD, AFBPsS, Cpsychol, has disclosedno relevant financial relationships.