H I V and A I D S

Human Immunodeficiency Virus (HIV) is a virus that causes Acquired Immune Deficiency Syndrome (AIDS) and weakens the immune system, making the body susceptible to and unable to recover from other opportunistic diseases that lead to death through these secondary infections. The predominant mode of HIV transmission is through heterosexual sexual contact, followed in magnitude by perinatal transmission, where the mother passes the virus to the child during pregnancy, delivery or breastfeeding. Other modes of transmission are through homosexual sexual contact, infected blood and unsafe injections. Knowledge of HIV/AIDS is almost universal among the adult Marshallese population (95.8% of women and 96.6% of men). However, while general knowledge of HIV/AIDS is quite high, more comprehensive knowledge of HIV/AIDS is much lower (at only 33 percent), and in spite of the general knowledge, the number of those having high risk sex (i.e., having sex with a person who is neither a spouse nor cohabiting partner) and not using a condom remains very high.
Knowledge of HIV/AIDS prevention methods
89.7% 73.1% 85.7% 91.8% 67% 86.7% 85.4% 89%

Attitudes

Most women and men expressed positive attitudes and opinions with regard to family members living with HIV or AIDS: 74 percent of women and 72 percent of men report that they would not keep a secret that a family member has AIDS, while over half (56%) of the women and two in three men (66%) are willing to care for an HIV infected family member.

In contrast, only 28 percent of women and 21 percent of men reported that they would buy vegetables from a shopkeeper who has HIV or AIDS. Overall, a very low percentage of women and men (4 % and 7%) expressed positive attitudes toward people living with HIV/AIDS on all four indicators.

Attitudes toward negotiating safer sex

Almost all men (95%) aged 1549 years agree that a woman is justified in refusing to have sexual intercourse with her husband if she knows he has a sexually transmitted disease. The same proportion agreed that she is justified in asking him to wear a condom.

Approximately a third of young women and men (35% and 28%, respectively) aged 1524 at the time of the RMI 2007 DHS reported that they were abstaining from sex.

HIV and AIDS prevention and young people

Using condoms

Limiting sexual intercourse to one uninfected partner

Using condoms and Abstaining from limiting sexual sexual intercourse intercourse to one uninfected partner
Men

Women

Four percent of women aged 1519 have had higher-risk sex with a partner who is 10 or more years older in the past 12 months.
Condom use is not very high among Marshallese young people despite good knowledge of where to get them from, free access and knowledge that using condoms can reduce the risk of contracting HIV or other sexually transmitted infections.
HIV/AIDS knowledge and sexual behavior among young men and women (1524 years old) Women Men

Comprehensive knowledge of HIV/AIDS

72.3% 67.4% 79.8% 80.9% 61.4% 65.2% 43.7% 47.8% 33% 45.1%

A healthy-looking person can have the AIDS virus

A person cannot AIDS cannot be Healthy-looking Percentage with a become infected transmitted by person can have comprehensive the AIDS virus & knowledge about by sharing food supernatural AIDS reject the two with a person who means most common has AIDS local misconceptions

Comprehensive knowledge of AIDS Knowledge of condom source Percentage having high risk sex in the past 12 months Use of condoms during last sexual intercourse Use of condoms during high risk sex Condom used during first sex

26.6% 82.3% 38.7% 8.8% 8.9% 9.9%

39.4% 90.8% 71.8% 22.6% 21.7% 16.2%

Women

Men

While most Marshallese were aware that HIV can be transmitted via breastfeeding and during pregnancy (81.5% of all women and 77.5 % of all men), only 11.5 percent of all men and 17.5 percent of women were aware of the potential benefits of anti-retroviral medication during pregnancy for HIV positive mothers.

Mother to child transmission

Republic of the Marshall Islands 2007 Demographic and Health Survey Facts and Figures at Your Fingertips

Having sex under the influence of alcohol is more common in urban areas. For young women in urban and rural areas it is quite low (2.6% and 1.5%, respectively), while for young urban and rural men the difference is quite pronounced (23.8% and 6.7%, respectively).
Seven percent of women and 20 percent of men aged 1524 reported that they or their partner were drunk the last time they had sex with any partner in the last 12 months.

Alcohol use and sexual intercourse

HIV counselling and testing during pregnancy

The results showed that 41 percent of women received HIV counselling during prenatal care, 48 percent were offered a test, and 40 percent were tested for HIV during prenatal care. Overall, 24 percent of women were counselled, offered an HIV test and received an HIV test, and almost three in four who had been tested received post-test counselling.

The results show that overall less than one percent of men aged 1549 paid for sex in the 12 months prior to the survey. About 60 percent of young women and 73 percent of young men had sex before they turned 18. Ten percent of young women and 16 percent of young men aged 1524 used a condom during their first sexual intercourse.

Payment for sex

Women in rural areas and women with no or primary level education are least likely to receive these services. This is not surprising for women residing in rural areas, as HIV tests are not available in the outer islands health centers. Women aged 1524 are slightly more likely (27%) than men of the same age (19%) to have been tested for HIV in the 12 months preceding the survey.

Recent HIV tests among youth

Age at first sexual intercourse (1524-year-olds)

Sexually transmitted infections prevalence and symptoms

Premarital sex and condom use

Nearly half of young women and 67 percent of young men reported having sexual intercourse in the past 12 months. From this cohort, 8 percent of young women and 20 percent of young men used a condom during last sexual intercourse.

STIs are closely associated with HIV because they increase the likelihood of contracting HIV and share similar risk factors.

High risk sex among youth

Over one third (39%) of young women and almost three in four (72%) young men aged 1524 who had sexual intercourse in the past 12 months had high risk sexual intercourse.
Of those who had high risk sexual intercourse in the last 12 months, less than 1 in 10 young women (9%) and almost one in four (22%) young men reported using a condom at their last high risk sex.

Ten percent of women and 3 percent of men reported they had an STI or symptoms of an STI in the 12 months preceding the survey. Of those reporting having an STI or symptoms, 46 percent of women and 85 percent of men sought treatment from a clinic/hospital/private doctor or other health professional.
Policy note:

The survey found that men had 3 times more sexual partners in their lives compared to women (12 compared to 4 partners). Rural women and men (5.5 and 14.7 partners, respectively) are more likely to have more sexual partners compared to urban women and men (3.7 and 10, respectively).

Multiple sexual partners and high risk sex

As referred to earlier regarding fertility and family planning, there appears to be a substantial disconnect between knowledge and practice: while the reported knowledge about HIV/AIDS transmission is almost universal amongst men (96.6%) and women (96.8%), the prevalence of unprotected sex remains very high. This is most pronounced amongst women, with nearly twice as many women not using condoms during last sex, during high risk sex, or during first sex. Considering that the vast majority of Marshallese young men (73%) and young women (60%) have had sex before they turned 18, and only 10 percent and 16 percent of 1524 year old men and women, respectively, reported using a condom during their first sexual intercourse, this should be of considerable public health concern. It appears from these figures that awareness of HIV/AIDS is quite high while comprehensive knowledge and corresponding behavior are still very low, despite many years of sexual and reproductive health education. It appears that different strategies and a greater focus on behavior change are urgently needed.

HIV testing

The results showed that most Marshallese know where to get an HIV test, however, only a little over one in three ever had one done (39% of women and 37% of men). In the last 12 months, 22 percent of women and 21 percent of men were tested for HIV. Of those tested, 67 percent of women and 56 percent of men received counselling with the test.

* For more detailed information on HIV/AIDS related knowledge, attitudes and behaviors see chapter 12 in the full RMI 2007 DHS survey report.

Republic of the Marshall Islands 2007 Demographic and Health Survey Facts and Figures at Your Fingertips