title: Assessing knowledge, attitudes, and behaviors related to HIV and AIDS in Nicaragua: a community-level perspective.
abstract: BACKGROUND
  Nicaragua's HIV epidemic is concentrated among men who have sex with men. Nevertheless, the increasing number of HIV cases among heterosexuals, high levels of poverty and migration rates, and incomplete epidemiological data suggest the need to improve the understanding of the epidemic.
  
  
  OBJECTIVE
  To examine the prevalence of HIV-related knowledge, attitudes, and sexual risk-taking behaviors, and their predictors among the adult population.
  
  
  METHODS
  A community-based cross-sectional survey was conducted in 2009 among 520 participants ages 15-49 from an ongoing Health and Demographic Surveillance System in Nicaragua. Bivariate analysis and adjusted prevalence ratios were use to examine factors associated with HIV-related knowledge, attitudes, and sexual behavior.
  
  
  RESULTS
  Contributing factors for risk-taking behaviors included cognitive, psychosocial, and emotional elements. Insufficient knowledge affecting the accurate assessment of HIV risk were low educational level, poverty, and rural origin, especially among females. Recognizing risk was not sufficient to promote safer sex: 90% of the females and 70% of the males who reported being sexually active in the past year did not use condoms during their last sexual encounter. Inconsistent condom use among men was associated with older age, long-term relationships, and lack of awareness about acquiring HIV infection.
  
  
  CONCLUSIONS
  Interventions to reduce social-structural contextual factors in Nicaragua are needed so that individuals may adopt and maintain HIV risk reduction strategies. Increased gender-specific HIV education and skills-building programs need to be implemented. Sensitive mass media messages may also increase the knowledge of HIV and AIDS, and serve to encourage protective attitudes and behaviors.
authors: Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Sweden. william.ugarte@kbh.uu.se
authors: William J
authors: WJ
authors: Ugarte
authors: Ulf
authors: U
authors: Högberg
authors: Eliette
authors: E
authors: Valladares
authors: Birgitta
authors: B
authors: Essén
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003075:Coitus; D003430:Cross-Sectional Studies; D058872:Epidemics; D005260:Female; D006678:HIV; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009527:Nicaragua / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D055815:Young Adult