OJPM  Vol.3 No.1 , February 2013
Knowledge, attitudes, and beliefs about HIV/AIDS of Sudanese and Bantu Somali immigrant women living in Omaha, Nebraska
A needs assessment of the knowledge, attitudes, practices, and beliefs about HIV/AIDS prevention was conducted among 100 Sudanese and Bantu Somali women immigrants aged 19 years and older, recruited through a community organization between April and July 2006. Information was collected by interview using interpreters to administer a 60-item test and a 116-item questionnaire that had been translated into Nuer and Arabic. Women in this study had low levels of education, poor knowledge about HIV transmission and prevention and safer sex practices, and poor attitudes to HIV/AIDS. They believe that HIV/AIDS is a punishment from God, HIV-positive people should be separated from society, carrying a condom indicates having loose morals, women should not experience sexual pleasure, and men should decide when and how to have sexual intercourse. Education, gender, and cultural beliefs are critical in the spread of HIV. Efforts to educate immigrant and displaced populations, particularly women, are essential.

Cite this paper
Feresu, S. and Smith, L. (2013) Knowledge, attitudes, and beliefs about HIV/AIDS of Sudanese and Bantu Somali immigrant women living in Omaha, Nebraska. Open Journal of Preventive Medicine, 3, 84-98. doi: 10.4236/ojpm.2013.31011.
[1]   UNAIDS (2000) Joint United Nations programme on HIV/AIDS. Migrant populations and HIV/AIDS. The development and implementation of programmes: Theory methodology and practice. Geneva. http://data.unaids.org/publications/IRC-pub01/jc397-migrantpop_en.pdf

[2]   UNAIDS (2001) Joint United Nations programme on HIV/AIDS. Population mobility and AIDS. UNAIDS technical update. http://data.unaids.org/Publications/IRC-pub02/JC513-PopMob-TU_en.pdf

[3]   Rosenthal, L., Scott, D.P., Kelleta, Z., Zikarge, A., Momoh, M., Lahai-Momoh, R.M.W. and Baker, A. (2003) Assessing the HIV/AIDS health services needs of African immigrants to Houston. AIDS Education and Prevention, 15, 570-580. doi:10.1521/aeap.15.7.570.24047

[4]   UNAIDS (2004) Joint United Nations Programme on HIV/AIDS. Migrants’ right to health. Unaids/Iom Statement on HIV/AIDS-related travel restrictions. UNAIDS technical update. http://www.iom.int/jahia/webdav/site/myjahiasite/shared/shared/mainsite/activities/health/UNAIDS_IOM_statement_travel_restrictions.pdf

[5]   UNAIDS (2004) Report on the global HIV/AID epidemic: 4th global report. http://data.unaids.org/Global-Reports/Bangkok-2004/unaidsbangkokpress/gar2004html/gar2004_00_en.htm http://www.un.org.np/sites/default/files/report/tid_107/Global_Report_2004.pdf

[6]   UNAIDS/WHO (2004) AIDS epidemic update. http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2004/2004_epiupdate_en.pdf

[7]   UNIADS (2005) AIDS epidemic update. http://data.unaids.org/Publications/IRC-pub06/epi_update2005_en.pdf

[8]   UNAIDS (2006) REPORT on the global aids epidemic global report chapter 2: Overview of the global AIDS epidemic. http://data.unaids.org/pub/GlobalReport/2006/2006_gr_ch02_en.pdf

[9]   UNAIDS/WHO. AIDS (2006) Epidemic update. http://data.unaids.org/pub/EpiReport/2006/2006_EpiUpdate_en.pdf

[10]   UNAIDS/WHO (2006) Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections. http://www.who.int/globalatlas/predefinedReports/EFS2006/EFS_PDFs/EFS2006_SD.pdf

[11]   UNAIDS/WHO. AIDS (2007) Epidemic update. http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf

[12]   Segal, U.A. and Mayadas, N.S. (2005) Assessment of issues facing immigrant and refugee families. Child Welfare, 84, 563-583.

[13]   Nebraska Department of Health and Human Services (2007) Refugee resettlement program population definitions. http://dhhs.ne.gov/children_family_services/Pages/refugees_definitions.aspx

[14]   Jaranson, J.M., Butcher, J., Halcon, L., Johnson, D.R., Robertson, C., Savik, K., Spring, M. and Westermeyer, J. (2004) Somali and Oromo refugees: Correlates of torture and trauma history. American Journal of Public Health, 94, 591-598. doi:10.2105/AJPH.94.4.591

[15]   Owens, C.W., Johnson, B. and Iman, H. (2003) Somali bantu refugees. Notes from the Refugee Community Building Conference, Sea Tac. http://ethnomed.org/cultures/somali/somali_bantu.html

[16]   Tompkins, M., Smith, L., Jones, K. and Swindells, S. (2006) HIV education needs among Sudanese immigrant and refugees in the Midwestern United States. AIDS and Behavior, 10, 319-323. doi:10.1007/s10461-005-9060-8

[17]   (2003) Nebraska department of health and human services system. HIV/AIDS surveillance report. http://dhhs.ne.gov/Documents/AIDSSurv06.pdf

[18]   UN-IADS and WHO (2005) Middle East and North Africa fact sheet. http://data.unaids.org/Publications/Fact-Sheets04/fs_mena_nov05_en.pdf

[19]   UNIAIDS AIDS Update (2006) Middle East and North Africa. http://data.unaids.org/pub/epireport/2006/2006_epiupdate_en.pdf

[20]   UNIADS and World Health Organization (WHO) (2004) Sudan: Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections 2004 update. Fact sheet. http://data.unaids.org/Publications/Fact-Sheets01/sudan_en.pdf

[21]   Holt, B.Y., Brady, W., Belay, E., Toole, M., Effler, P., Friday, J. and Parker, K. (2003) Planning STI/HIV prevention among refugees and mobile populations: Situation Assessment of Sudanese refugees. Disasters, 27, 1- 15. doi:10.1111/1467-7717.00216

[22]   Kaiser, R., Kedamo, T., Lane, J., Kessia, G., Handzel, T. et al. (2004) HIV/STI prevalence and risk factor surveys in Yei and Rumbek, South Sudan, 2002/2003. 15th International AIDS Conference, Bangkok, 11-16 July 2004, Abstract TuPeC4739.

[23]   Lacey, M. (2001) Somali Bantu, trapped in Kenya, seek a home. The New York Times. http://query.nytimes.com/gst/fullpage.html?res=9A03E5DB1E3CF93AA35751C1A9679C8B63

[24]   UNIADS and World Health Education. Somalia (2006) HIV epidemic and its response 2003-2005, draft report on the UNGASS declaration of commitment. December, summary country profile for HIV/AIDS treatment scale-up. http://data.unaids.org/pub/Report/2006/2006_country_progress_report_somalia_en.pdf

[25]   UNAIDS (2000) Joint United Nations Programme on HIV/AIDS. Migrant populations and HIV/AIDS. UN-AIDS technical update. http://data.unaids.org/publications/IRC-pub01/jc397-migrantpop_en.pdf

[26]   UNAIDS (2001) Joint United Nations Programme on HIV/AIDS. Edited by Margaret Duckett, Migrants’ right to health. http://data.unaids.org/publications/IRC-pub02/jc519-migrantsrighttohealth_en.pdf

[27]   UNIADS (2006) Country progress report 2006 Somalia (952K) monitoring the declaration of commitment on HIV/AIDS—2005 country progress reports. http://data.unaids.org/pub/Report/2006/2006_country_progress_report_somalia_en.pdf

[28]   Hankins, C.A., Friedman, S.R., Zafar, T. and Strathdee, S.A. (2002) Transmission and prevention of HIV and sexually transmitted infections in war settings: Implications for current and future armed conflicts. AIDS, 16, 2245-2252. doi:10.1097/00002030-200211220-00003

[29]   (2004) Ne-braska department of health and human services system. HIV/AIDS surveillance report. http://nlc1.nlc.state.ne.us/epubs/H8220/B002-2004.pdf

[30]   (2006) Nebraska department of health and human services system. HIV/AIDS surveillance report. http://dhhs.ne.gov/Documents/AIDSSurv06.pdf

[31]   Centers for Disease Control and Prevention (2005) Trends in HIV/AIDS diagnoses-33 States, 2001-2004. Morbidity and Mortality Weekly Report, 54, 1149-1153.

[32]   Centers for Disease Control and Prevention (2008) Persons tested for HIV-United States 2006. Morbidity and Mortality Weekly Report, 57, 845-849.

[33]   UNAIDS (2005) Uniting the world against AIDS: Women. http://www.who.int/hiv/mediacentre/200605-FS_SubSaharanAfrica_en.pdf

[34]   UNAIDS Global Coalition on Women and AIDS (2005) Empowering women, fighting aids. Economic security for women fights AIDS. Issue 3. http://www.unaids.org/en/media/unaids/contentassets/dataimport/publications/ircpub07/jc1251-keepingpromise-small _en.pdf

[35]   Krishnan, S., Dunbar, M.S., Minnis, A.M., Med-lin, C.A., Gerdts, C.E. and Padian, N.S. (2007) Poverty, gender inequities and women’s risk of HIV/AIDS. Scientific approaches to understanding and reducing poverty. Annals of the New York Academy of Sciences, 1-18.

[36]   Rankin, S.H., Lingren, T., Rankin, W.W. and Ngoma, J. (2005) Donkey Work: Women, religion, and HIV/AIDS in Malawi. Health Care for Women International, 26, 4-16. doi:10.1080/07399330590885803

[37]   UNAIDS Global Coalition on Women and AIDS (2007) Increase women’s control over HIV prevention fight AIDS. Newsletter Issue 4. http://www.unaids.org/en/media/unaids/contentassets/dataimport/publications/irc-pub07/jc1237-gcwa-prevention-4_en.pdf

[38]   UNAIDS/WHO (2004) Women and AIDS, and extract from December 2004 epidemic update. http://data.unaids.org/gcwa/jc986-epiextract_en.pdf

[39]   Ackermann, L. and de Klerk, G.W. (2002) Social factors that make South African women vulnerable to HIV infection. Health Care for Women International, 23, 163-172. doi:10.1080/073993302753429031

[40]   Duffy, L. (2005) Culture and context of HIV prevention in rural Zimbabwe: The influence of gender and inequality. Journal of Transcultural Nursing, 16, 25-31. doi:10.1177/1043659604270962

[41]   Harrison, A., O’Sullivan, L.F., Hoffman, S., Dolezal, C. and Morrell, R. (2006) Gender role and relationship norms among young adults in South Africa: Measuring the context of masculinity and HIV risk. Journal of Urban Health, 83, 709-722. doi:10.1007/s11524-006-9077-y http://www.springerlink.com/content/h074pg77g4t41726/fulltext.html

[42]   Mbirimtengerenji, N.D. (2007) Is HIV/AIDS epidemic outcome of poverty in sub-Saharan Africa? Croatian Medical Journal, 48, 605-617.

[43]   Wang, J., et al. (2001) Level of AIDS and HIV knowledge and sexual practices among sexually transmitted disease patients in China. Sexually Transmitted Diseases, 28, 171-175. doi:10.1097/00007435-200103000-00009

[44]   Lazarus, J.V., Himedan, HM., ?Stergaard, LR and Liljestrand, J. (2006) HIV/AIDS knowledge and condom use among Somali and Sudanese immigrants in Denmark. Scandinavian Journal of Public Health, 34, 92-99. doi:10.1080/14034940510032211

[45]   Foley, E.E. (2005) HIV/AIDS and African American immigrant women in Phila-delphia: Structural and cultural barriers to care. AIDS Care, 17, 1030-1043. doi:10.1080/09540120500100890

[46]   Organista, P.B., Organista, K.C. and Solof, P.R. (1998) Exploring AIDS related knowledge, attitudes, and behaviors of female Mexican migrant workers. Health and Social Work, 23, 96-103. doi:10.1093/hsw/23.2.96

[47]   Laverentz, M.L., Cox, C.C. and Jordan, M. (1991) The Nuer education program: Breaking down cultural barriers. Health Care for Women International, 20, 1-6.

[48]   Worth H., Denholm N. and Bannister J. (2003) HIV/ AIDS and the African refugee education program in New Zealand. AIDS Education and Prevention, 15, 346-356. doi:10.1521/aeap.15.5.346.23819

[49]   Ebrahim, S.E., Anderson, J.E., Weidle, P. and Purcell, D.W. (2004) Race/ethnic disparities in HIV testing and knowledge about treatment for HIV/AIDS: United States, 2001. AIDS Patient Care and STD’s, 18, 27-33.

[50]   Lawrence, J and Kearns, R. (2005) Exploring the fit between people and providers: Refugee health needs and health care services in Mt. Roskill, Auckland, New Zealand. Health and Social Care in the Community, 13, 451-461. doi:10.1111/j.1365-2524.2005.00572.x

[51]   Elfadil Wafaa (2005) WFP Sudan gender national office. Sudan gender profile. Available at: Foley, E.E. HIV/AIDS and African American immigrant women in Philadelphia: Structural and cultural barriers to care. AIDS Care, 17, 1030-1043. doi:10.1080/09540120500100890

[52]   Nebraska Department of Health and Human Services (2007) Refugee resettlement program funding. http://dhhs.ne.gov/children_family_services/Pages/refugees_funding.aspx

[53]   Kalichman, S.C., Simbayi, L.C., Kagee, A., Toefy, Y., Jooste, S., Cain, D. and Cherry, C. (2006) Associtions of poverty, substance use and HIV transmission risk behaviors in three South African communities. Social Science and Medicine, 62, 1641-1649. doi:10.1016/j.socscimed.2005.08.021

[54]   Mabunda, G. (2004) HIV knowledge and practices among rural South Africans. Journal of Nursing Scholarship, 36, 300-304. doi:10.1111/j.1547-5069.2004.04055.x

[55]   Wagner, D., Coordinated by The United Nations Educational Scientific and Cultural Organization (UNESCO) Literacy and adult education. http://unesdoc.unesco.org/images/0012/001233/123333e.pdf

[56]   Shedlin M.G., Decena C.U. and Olivier-Velez D. (2005) Initial acculturation and HIV risk among new Hispanic immigrants. Journal of the National Medical Association, 97, 32S-37S.

[57]   Library of Congress (2004) Federal research division country profile: Sudan. http://lcweb2.loc.gov/frd/cs/profiles/Sudan.pdf

[58]   Hargreaves, J.R. and Glynn, J.R. (2002) Educational attainment and HIV 1 infection in developing countries: A systematic review. Tropical Medicine and International Health, 7, 499-498. doi:10.1046/j.1365-3156.2002.00889.x

[59]   Hargreaves, J.R., Bonell, C.P., Boler, T., Boccia, D., Birdthistle, I., Fletcher, A., et al. (2008) Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in subSaharan Africa. AIDS, 22, 403-414.

[60]   UNAIDS (2000) The relationship between sexual behaviour and level of education in developing countries (UNAIDS—Best practice digest, 3 Pages. http://www.greenstone.org/greenstone3/nzdl;jsessionid=20143F6FE9D4BE45751F5675DD988BEA?a=dandd=HASH010746d58add0714a1d98354andc=unaidsandsib=anded=1andp.s=ClassifierBrowseandp.sa=andp.a=bandp.c=unaids

[61]   Michelo, C., Sand?y, I.F., and Fylkesnes, K. (2006) Marked HIV prevalence declines in higher educated young people: Evidence from population-based surveys (1995-2003) in Zambia. AIDS, 20, 1031-1038. doi:10.1097/01.aids.0000222076.91114.95

[62]   Mmbaga, E.J., Leyna, G.H., Mnyika, S.K., Hussain, A. and Klepp, K. (2007) Education attainment and the risk of HIV-1 Infections in Rural Kilimanjaro Region of Tanzania, 1991-2005: A reversed asso-ciation. Sexually Transmitted Diseases, 34, 1-7.

[63]   Bloom, S.S., Banda, C., Songolo, G., Mulendema, S., Cunningham, A. and Boerma, J.T. (2000) Looking for change in response to the AIDS epidemic: Trends in AIDS knowledge and sexual behavior in Zambia, 1990 through 1998. Journal of Acquired Immune Deficiency Syndromesd, 25, 77-85. doi:10.1097/00126334-200009010-00011

[64]   Yazdi, C.A., et al. (2006) Knowledge, attitudes and sources of information regarding HIV/AIDS in Iranian adolescents. AIDS Care, 18, 1004-1010. doi:10.1080/09540120500526284

[65]   Hesketh, T., Duo, L. and Tomkins, A.M. (2005) Attitudes to HIV and HIV testing in high prevalence areas of China: Informing the introduction of voluntary counseling and testing procedures. Sexually Transmitted Infections, 81, 108-112. doi:10.1136/sti.2004.009704

[66]   Lugalla, J., Emmelin, M., Mutembei, A., Sima, M., Kwesigabo, G., Killewo, J. and Dahlgren, L. (2004) Social, cultural and sexual behavioral determinants of observed decline in HIV infection trends: Lessons from the Kagera region, Tanzania. Social Science and Medicine, 59, 185-198. doi:10.1016/j.socscimed.2003.10.033

[67]   Cleland, J. and Ali, M.M. (2006) Sexual abstinence, contraception, and condom use by young African women: A secondary analysis of survey data. Lancet, 368, 1788-1783. doi:10.1016/S0140-6736(06)69738-9

[68]   Gausset, Q. (2001) AIDS and Cultural practices in Africa: The case of the Tonga (Zambia). Social Science and Medicine, 52, 509-518. doi:10.1016/S0277-9536(00)00156-8