Hrev_master Healthcare in Low-resource Settings 2024; volume 12:12020 HIV incidence, knowledge, attitude and practices of HIV/AIDS and antiretroviral therapy use in HIV-infected patients at Debre Elias district, North West Ethiopia Melese Birmeka,1 Damtew Bekele,2 Megabi Anteneh1 1Department of Biology, Hawassa University; 2Department of Biology, Ambo University, Ethiopia Abstract Due to hotspots as development schemes that attract mobile groups, HIV/AIDS infections are the biggest health issue in com- munities with low awareness and safe practice, especially in small- er towns. This study examined HIV/AIDS and Antiretroviral Therapy (ART) use-related knowledge, attitude, and practice in AIDS patients. Debre Elias Health Center conducted a cross-sec- tional study (N=384) from June 10 to January 20, 2021. Participants were selected using systematic random sampling and interviewed using a structured questionnaire. Logistic regression calculated significance and association between dependent and independent variables. 236 (384) or 61.4% of 384 HIV patients on antiretroviral therapy were female. HIV rates increased from 2014 to 2019. Age difference was associated with patient knowledge of ART use (p=0.005). Patients’ attitudes towards HIV/AIDS and ART use were significantly correlated with age, residence, marital status, and education (p<0.001). HIV patients 25-30 were 2.2 times more likely to know about ART use. HIV patients with a degree or higher were five times more likely to support ART. HIV patients aged 14-24 with a positive ART outlook were 94% protective. HIV prevalence is rising, especially among 15 to 24-year-old women. Public protection is needed to reduce HIV transmission. Introduction Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have emerged as a formidable global public health crisis claiming 36.3 million lives as of year 2021.1 The HIV/AIDS epidemic has brought about overwhelming threats to economically poor countries, about 95% are found in developing world, of which high infections were in Sub Saharan Africa.1 Young people were the most affected. An estimated 10 million HIV/AIDS infections occur in young people aged 15-24 years and more than 6000 new cases of the virus every day. In general, above 50% of all new HIV incidences occur between 15 and 24 year-olds.2 HIV and AIDS have become a major health problem and the main cause of morbidity and mortality in all parts of the globe. For instance, people living with HIV, new HIV infections, and AIDS- related deaths were 37.9, 1.8, and 1 million respectively, in the world in 2018.1 Similarly, new HIV infections were highest among women, constituting more than half of all people living with HIV and AIDS-related illnesses. Young women (aged 15-24 years), and adolescent girls (aged 10-19 years) in particular, account for more than one-third of all people living with HIV/AIDS (PLWHA) which is a disproportionate number of new HIV infections.1,3 Still, the disease continues to spread with no cure yet in sight. There is a need to fight the pandemic through evidence-based approaches that focus on reducing deficiency in knowledge, attitude, and response against the infection.4 Globally, most of the new HIV infections occur through sexu- al contact, and transmission occurs more commonly from persons unaware they have HIV.4 The growth rates of HIV and other sex- ually transmitted infections are higher in Africa. Out of 37.9 mil- lion HIV infections in the world, 25.7 million were in Africa. It accounts for almost two-thirds of the total new HIV incidence.1 About 70% of the total HIV-infected people in Africa were from sub-Saharan Africa (SSA). In this region, most of the new Correspondence: Damtew Bekele, Department of Biology, Ambo University, P.O. Box 19, Ambo, Ethiopia. E-mail: damtish2002@gmail.com Key words: anti-retroviral therapy use; HIV/AIDS patients; Debre Elias Health Center; HIV incidence. Acknowledgments: we would like to acknowledge Debre Elias Health Center health experts for their unfailing cooperation during the survey. Contributions: MB, project idea; MA, MB, DB, data collection, data analysis, manuscript interpretation and draft; MA, study protocol design. All authors reviewed and approved the final version to be published. Conflict of interest: the authors declare no potential conflict of interest. Funding: none. Ethical approval and consent to participate: the Institutional Review Board of Hawassa University approved and obtained ethical clearance at Ref. No. IRB /241/11. Availability of data and material: all data generated or analyzed during this study are included in this published article. Informed consent: all patients participating in this study signed a written informed consent form for participating in this study. Confidentiality of the data was kept as secured. Received: 24 October 2023. Accepted: 6 April 2024. Early access: 25 June 2024 This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:12020 doi:10.4081/hls.2024.12020 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [page 379] Non -co mmerc ial us e o nly HIV infection occurs among people aged 15-24 years old.1 Nearly 80% of the population in SSA is not aware of their infection. More than 90% do not know if their sexual partners are infected. Such situations invite the further spread of the epidemic.5 Discrimination against positive people can help the AIDS epi- demic to spread - if people are fearful of being tested for HIV, and then they are more likely to pass the infection to someone else without knowing.6 Experience in community counseling shows local communities can make healthy choices about preventing HIV and caring for those with AIDS.7 When communities act for care and change, self-measure for progress, and transfer to other com- munities, we know they are competent and confident in their own future.8 HIV testing is the main gate for individualized HIV care and treatment, and undiagnosed HIV infections undermine the effec- tiveness of HIV programs. Early initiation of Antiretroviral Therapy (ART) reduces HIV transmission and is an essential com- ponent of comprehensive prevention strategies. Effective Antiretroviral (ARV) drugs can control the virus and help to pre- vent transmission so that people with HIV, and those at substantial risk, can enjoy healthy, long, and productive lives.4 Since the intro- duction of the ART program in Cuba in 2001, deaths from AIDS have dramatically decreased.9 One of the basic reasons to analyze HIV/AIDS knowledge is to examine its direct linkage to improve the chances of self-protec- tion (e.g., enhanced knowledge allows for consistent and proper use of condoms).10,11 Recently due to the non-achievement of mil- lennium goals on HIV/AIDS in different countries in the world especially in developing countries, the joint United Nations pro- gram on HIV/AIDS has fixed new objectives to overcome HIV infections by 2030.12 However, the HIV/AIDS epidemic is still the most serious challenge in Ethiopia, where the adult population between the ages of 15-49, which comprises the vast majority of the workforce, is the worst affected. Youth age ranges from 13-30 years are the most sexually active ages that are mainly exposed to HIV because of the strong influence of peer pressure and the development of their sex- ual and social identities which often lead to conducting sexual practice. As they are initiating sexual behavior, counseling for safe practice is vital.13,14 Hence the measures to raise awareness and combat HIV/AIDS are vital to increase awareness among communities about HIV/AIDS, in order to bring about a change in people’s attitude and behavior which stimulates a sympathetic response towards people who are vulnerable to or affected by HIV.15 This study described the prevalence and incidence of HIV and ART use-relat- ed knowledge, attitude, and good practices among people with HIV living in Debre Elias district, North West Ethiopia. Materials and Methods Study area and study population Debre Elias town is an administrative town in Debre Elias woreda (district). It is one of the 105th districts in Amhara Region and the 18th district from East Gojjam Zone which is located between 9o50’00’’N-10o30’00’’N and 37o10’00’’E-37o30’00’’E latitude and longitude respectively (generated from Ethio GIS data CSA, 2007). Debre Elias town is approximately 342 kilometers distant from the capital city of Ethiopia (Addis Ababa). The study subjects were HIV-positive people of ART users in Debre Elias district. The district has a total population of about 100,797. From these, 50,842 are females and the remaining 49,955 are males. Debre Elias town has one health center, two private clinics, and one private drug store. It also has one Technical Vocational Education and Training college, one preparatory school, one sec- ondary school, and two governmental primary schools (Debre Elias district communication office). Study design The study used a health center-based cross-sectional study among people living with HIV (2014-2019) who had been on ART use for at least three months in Debre Elias Health Center. The inclusion criteria were: all newly infected HIV-positive patients who registered in Debre Elias Health Center from 2014- 2019 that use ART. The exclusion criteria were: patients whose clinical records were not complete or missing, transferred out, or died. Sample size determination and sampling tech- nique A sample size was determined using Daniel’s formula n=Z2 P(1-P)/d2.16 P=50%, since there was no previous study conducted around the Debre Elias district, where d was a 5% margin of error at a 95% confidence interval and Z was standard score corresponds to 1.96 with a none response rate of 5%. This would give a sample size of 403. To select the sample population, a systematic random sampling technique was used. Data collection Retrospective data, 2014-2019 were collected from document analysis. Primary data was collected by using questionnaires and interviews. Two data collectors participated in this task and the principal investigator checked the completeness of the data. Data management and analysis Following data collection, it was looked at for completeness and consistency, coded, and entered into Statistical Package for the Social Sciences version 20 program for analysis. Univariate and multivariate logistic regression was employed to measure associa- tions of socio-demographic variables on knowledge, attitude, and practice (KAP) towards HIV/AIDS and ART use. Values were con- sidered significant when P<0.05. Results Socio-demographic and clinical features of the study participants During the study period, a total of 384 HIV/AIDS patients at Debre Elias Health Center, and 95.3% of the initial sample were successfully followed up. Among these, 236 (61.5%) were females and 148 (38.5%) were males (Table 1). HIV infection was most common in those aged 15 to 24, 124 (32.3%), followed by age 25 to 34, 98 (25.5%). The majority of 206 (53.7%) PLWHA were from rural areas. 71% had attained grades 1-12, and nearly 29% held certificates, diplomas, degrees, and above. 230 (60%) had good ART adherence. Of the study subjects, 175 (45.5%) were determined to be at WHO clinical stage III. About 169 (44.1%) of the participants had a CD4 count of 200-500 cells/mm3, 128 (33%) had a level of 500 or more, and 88 (22.9%) had a CD4 count of fewer than 200 cells/mm3. Article [page 380] [Healthcare in Low-resource Settings 2024;12:12020] Non -co mmerc ial us e o nly HIV/AIDS incidence and antiretroviral therapy use at Debre Elias district, 2014-2019 As shown in Table 1, the retrospective data from 2014 to 2019 showed 585 individuals were found to be newly infected HIV-pos- itive individuals and ART users. The incidence of HIV gradually increased from 2014 to 2019 (Figure 1). Distribution of HIV/AIDS incidence by age and sex Out of the 585 HIV-positive individuals on ART, 226 (39%) were males and 359 (61%) were females, as seen in Figure 2. HIV/AIDS infections were higher in 15–24-year-olds (32.5%), fol- lowed by 25–34-year-olds (25.6%). Knowledge, attitude and practice of respondents about HIV/AIDS and antiretroviral therapy use Knowledge of patients towards HIV/AIDS and antiretro- viral therapy use Approximately 315 (82%) of HIV patients were aware of ART use and HIV/AIDS. 372 (96.9%) of the participants in total were aware that AIDS is not a curable disease. Furthermore, 286 (74.5%) of the participants were aware that HIV transmission occurs through unsafe sex. Only 114 (29.7 of the patients were aware that HIV infection is not transmitted through sharing food, clothing, or restrooms. The majority of the participants, 337 (87.8%), correctly know that abstaining from sex is a very good preventive method for HIV/AIDS. Furthermore, 282 (73.4%) of participants also knew that proper condom use can protect against HIV/AIDS. 337 (87.8%) of patients did not believe that HIV-pos- itive patients taking ART drugs cannot transmit HIV. Additionally, 299 (77.9%) and 317 (82.6%) of the respondents stated that ART does not consist of drugs to cure HIV/AIDS and missing ART doses can lead to disease progression respectively. Furthermore, 356 participants (92.7%) were aware that PLWHA require ART treatment for the duration of their lives (Table 2). Attitude towards HIV/AIDS Accordingly, 309 (80.5%) of the respondents had a positive attitude while 75 (19.5%) of participants were classified as having a negative outlook. The majority of participants, 304 (79.2%), had Article Table 1. Socio-demographic and clinical characteristics of people living with HIV/AIDS (n=384) at Debre-Elias district, Northwestern Ethiopia, 2014-2019. Characteristics Frequency % Sex Male 148 38.5 Female 236 61.5 Age (years) 0-10 27 7 11-14 7 1.7 15-24 124 32.3 25-34 98 25.6 35-44 78 20.4 >45 50 13 Marriage Married 130 33.8 Single 254 66.2 Residence Urban 178 46.3 Rural 206 53.7 Education Grade 1-12 274 71.4 Certificate 18 4.7 Diploma 39 10.1 Degree and above 53 13.8 ART adherence Good 230 60 Fair 123 32 Poor 31 8 WHO clinical stage WHO stage I 74 19.3 WHO stage II 121 31.6 WHO stage III 175 45.5 WHO stage IV 14 3.6 CD4 cell count <200cell/mm3 88 22.9 200-500cell/mm3 169 44.1 Above 500cell/mm3 127 33 ART, antiretroviral therapy; WHO, World Health Organization. Source: adapted from the Health Center’s Clinical Record Format. [Healthcare in Low-resource Settings 2024;12:12020] [page 381] Figure 1. HIV/AIDS incidence from 2014-2019 among people liv- ing with HIV/AIDS in Debre Elias district. Figure 2. Distribution of HIV/AIDS incidence by sex and age group in Debre Elias district, 2014-2019. Non -co mmerc ial us e o nly Article Table 3. Attitudes of people living with HIV/AIDS towards HIV/AIDS and antiretroviral therapy use in Debre Elias District, Ethiopia. Attitude item questions Responses N (%) 1. Should a person having HIV do sexual intercourse only with condom? Yes, agree 304 (79.2) No, disagree 80 (20.8) 2. A person with HIV/AIDS is hopeless? Agree 139 (36.2) Disagree 245 (63.8) 3. The presence of many sexual partners increase the chance of getting the virus Agree 370 (96.4) Disagree 14 (3.6) 4. It is shameful for HIV/AIDS patients to take ART drugs? Agree 108 (28.1) Disagree 276 (71.9) 5. ART gives more benefits than harm? Agree 258 (67.2) Disagree 126 (32.8) 6. ART drug does not cure HIV patients, So its treatment is a waste of time. Agree 100 (26) Disagree 284 (74) 7. An HIV patient takes ART drugs only when he feels sickness? Agree 11 (2.9) Disagree 373 (97.1) 8. Overall attitude status Positive 309 (80.5) Negative 75 (19.5) ART, antiretroviral therapy. Note: the calculated percentage for the respective characteristic is from the total examined. [page 382] [Healthcare in Low-resource Settings 2024;12:12020] Table 2. Knowledge of study participants on HIV/AIDS and antiretroviral therapy use in Debre Elias district, 2019. Knowledge question items Responses N (%) 1. Is it possible to cure from AIDS? Yes 12 (3.1) No 372 (96.9) 2. Is it HIV transmission mainly occurs through doing unsafe sex? Yes 286 (74.5) No 98 (25.5) 3. HIV can be transmitted through sharing of meals, clothes and latrines Yes 270 (69.3) No 114 (29.7) 4. Abstain from sex is a very good preventive method of HIV/AIDS transmission Correct 337 (87.8) Incorrect 47 (12.2) 5. Can proper condom use be protective to HIV/AIDS transmission? Yes 282 (73.4) No 102 (26.6) 6. HIV positive patients taking on ART drugs cannot transmit HIV? Correct 30 (12.2) Incorrect 354 (87.8) 7 Can low ART therapeutic doses lead to disease progression Yes 296 (77.9) No 88 (22.9) 8. Is it ART drugs curable to HIV/AIDS? Yes 67 (17.4) No 317 (82.6) 9. ART should be taken throughout the life span of the patient? Yes 356 (92.7) No 28 (7.3) 10. Over all knowledge status Knowledgeable 315 (82) Not knowledgeable 69 (18) ART, antiretroviral therapy. Note: the percentage of the respective characteristic is calculated from the total examined. Non -co mmerc ial us e o nly a positive attitude toward using condoms during sexual inter- course. Moreover, the majority of participants, 370 (96.4%), responded that the presence of multiple sexual partners can increase the chance of getting an HIV infection. In terms of their attitudes towards ART use, 276 (71.9%) thought that it was beneficial for HIV/AIDS patients to use ART medications, and 258 (67.2%) agreed that ART improves health. Furthermore, 284 (74%) of the participants thought that taking ART medications was a good idea rather than a waste of time (Table 3). Practices of people living with HIV/AIDS towards HIV/AIDS and antiretroviral therapy use In the current study, 215 (56%) of the PLWHA had good prac- tices, while 169 (44%) had poor practices. Of them, 155 (40.4%) had never used a condom during sexual activity. Many of them, 267 (69.5%), had engaged in unprotected sexual intercourse. The majority of the 210 individuals (54.7%) had a consistent sexual partner. In terms of their practice towards ART use, the majority of respondents, 273 (71%), began as soon as they knew they were HIV carriers or patients. Table 4 shows that 268 (69.8%) of the individuals showed good adherence to using ART. Socio-demographic variables vs. knowledge, atti- tudes, and practices Males outnumbered females in knowledge, 102 (82.9%), and good practice, 101 (81.2%), while females had a better attitude, 217 (83.1%), than males. The age group >30 had a good attitude, 172 (91.2%), and practice, 160 (84.7%), while PLWHA found in the 25-30 age group had almost positive knowledge, 349 (91%), and a good attitude, 325 (84.7%). Comparing PLWHA with mar- ried counterparts, the married group showed a better attitude (90.1%) and greater knowledge (87.4%). Good behavior was observed in lone PLWHA. Additionally, individuals who resided in urban areas knew, 144 (83.7%), regarding HIV and the use of ART, but they also practiced it poorly, 61(35.5%), whereas those who lived in rural areas had a positive attitude, 185 (86.7%), and good practices, 108 (50.9%). With respect to educational attainment, the majority of participants with promising knowledge had a degree or above (92.5%), while 36 respondents with strong practice had a diploma (92.3%). Furthermore, PLWHA with grades 1-12 had a better practice 144 (52.5%) compared to their respective counter- parts (Table 5). The use of KAP in multivariate analysis, the associations between various PLWHA characteristics, and ART use were exam- ined (Table 6). Compared to female HIV-positive patients, male patients were shown to be 5.0 times more likely to practice excel- lent ART use. When compared to other individuals in their age group, PLWHA between the ages of 25 and 30 were shown to be 2.2 times more likely to have superior knowledge of ART use. When compared to people at lower grade levels, PLWHA with educational standing (degree and above) were found to be five times more likely to have a positive attitude toward using ART. In addition, PLWHA of urban residents were shown to have a 1.73- fold higher likelihood of having good experience in using ART than occupants of rural areas. PLWHA in the 14-24 age range who were aware were shown to be 69% less likely to have poor ART adherence. PLWHA in the 14-24 age range who had a favorable prognosis for using ART were shown to be 65% less likely to have poor adherence to their treatment regimen. 94% of PLWHA in the 25-30 age group who had a positive attitude toward ART use were found to be protective. 84% of PLWHA in the 25-30 age group who practiced well were found to be protective. 50% of married PLWHA with strong com- prehension and abilities were found to be protective. Married PLWHA with a positive prognosis were shown to be 65% less like- ly to experience poor ART adherence. Urban inhabitants of PLWHA with a good attitude were found to be protected by 65% from bad adherence to ART use. Study participants with education- al status with a degree and above were found to be protected by Article Table 4. Practices in people living with HIV/AIDS towards HIV/AIDS and antiretroviral therapy use, in Debre Elias district, Ethiopia, 2019. Practice question items Responses N (%) 1. Have you ever used condom? Yes 155 (40.4) No 229 (59.6) 2. Have you practiced unprotected sex? Yes 267 (69.5) No 117 (30.5) 3. Do you have Constant sexual partner Yes 210 (54.7) No 174 (45.3) 4. Have you started ART As soon as you know with HIV? Yes 273 (71) No 111 (29) 5. Have you dropped ART after starting use? Yes 55 (14.3) No 329 (85.7) 6. Do you have good Adherence to ART? Yes 268 (69.8) No 116 (30.2) 7. Overall practice Good 215 (56) Poor 169 (44) ART, antiretroviral therapy. Note: for the respective characteristics, the percentage is calculated from the total examined. [Healthcare in Low-resource Settings 2024;12:12020] [page 383] Non -co mmerc ial us e o nly 74% compared to other lower grade levels from bad adherence to ART use. PLWHA with educational status with diplomas having good practice were found to be protected by 69% from bad adher- ence of ART use (Table 6). Discussion The incidence and prevalence of HIV/AIDS and ART use for the present study populations showed some differences as com- pared to earlier reports from different regions of Ethiopia. This might be due to the differences in the knowledge of HIV/AIDS prevention and ART use in different localities such as rural and urban areas, and small and big towns of the communities. Other investigators also reported that the prevalence of HIV/AIDS inci- dence and ART use varies in different regions of Ethiopia.16,17 These inconsistencies are due to comprehensive knowledge of HIV/AIDS that were subject to differences in time, place and con- ditions. On the other hand, knowledge of how the virus is spread will help people escape from the virus. Trends of HIV/AIDS incidence and ART use gradually increased between the years 2014 to 2019; this might be due to the Article [page 384] [Healthcare in Low-resource Settings 2024;12:12020] Table 6. Association of knowledge, attitude, and practices of patients towards antiretroviral therapy use in Debre Elias district, Northwestern Ethiopia, 2019. Variables, N (%) Knowledge Attitude Practice AOR (CI) p-value AOR (CI) p-value AOR (CI) p-value Sex Male 1.503 (0.815-2.773) 0.192 0.606 (0.336-1.090) 0.095 5.013 (2.868-8.763) <0.001 Female 1 1 1 Age 14-24 0.317 (0.160-0.628) 0.001 0.352 (0.198-0.629) <0.001 0.696 (0.418-1.160) 0.165 25-30 2.213 (1.120-4.372) 0.022 0.062 (0.014-0.274) <0.001 0.164 (0.074-0.362) <0.001 >30 1 1 1 Marital status Married 0.503 (0.258-0.978) 0.043 0.350 (0.168-0.729) 0.005 0.811 (0.486-1.354) 0.423 Single 1 1 1 Residence Urban 1.344 (0.757-2.386) 0.312 0.466 (0.263-0.826) 0.009 1.725 (1.072-2.775) 0.025 Rural 1 1 1 Education Grade 1-12 1 1 1 Certificate 0.556 (0.211-1.465) 0.235 0.351 (0.097-1.264) 0.109 0.228 (0.090 - 0.578) 0.002 Diploma 0.268 (0.090-0.805) 0.19 0.478 (0.192-1.187) 0.112 0.307 (0.146- 0.648) 0.002 Degree and above 0.262(0.08-0.6) 0.001 5.13 (1.698-15.514) 0.004 0.408(0.20-0.621) 0.001 AOR, adjusted odds ratio; CI, confidence interval. Note: the percentage for the respective characteristics is calculated from the total examined. Table 5. Effect of socio-demographic factors on knowledge, attitude and practices towards HIV infection and antiretroviral therapy use in Debre Elias district, Northwestern Ethiopia, 2019. Variables, N (%) Knowledge Attitude Practice Knowledgeable Not knowledgeable Positive Negative Good Poor Sex Male 102 (82.9) 21 (17.1) 92 (74.8) 31 (25.2) 101 (82.1) 22 (17.9) Female 213 (81.6) 48 (18.4) 217 (83.1) 44 (16.5) 114 (43.7) 147 (56.3) Age 14-24 97 (78.9) 26 (21.1) 79 (64.2) 44 (35.8) 56 (45.5) 67 (54.5) 25-30 172 (91) 17 (9) 160(84.7) 29 (15.3) 98 (51.9) 91 (48.1) >30 46 (63.9) 26 (36.1) 70 (97.2) 2 (2.8) 61 (84.7) 11 (15.3) Marital status Single 218 (79.9) 55 (20.1) 209 (76.6) 64 (23.4) 148 (54.2) 125 (45.8) Married 97 (87.4) 14 (12.6) 100 (90.1) 11 (9.9) 67 (60.4) 44 (39.6) Residence Urban 144 (83.7) 28 (16.3) 124 (72.1) 48 (27.9) 111(64.5) 61 (35.5) Rural 171 (80.7) 41 (19.3) 185 (87.3) 27 (12.7) 104 (49.1) 108 (50.9) Educational status Grade 1-12 218 (79.6) 56 (20.4) 219 (80) 55 (20) 130 (47.4) 144 (52.5) Certificate 15 (83.3) 3 (16.7) 8 (44.4) 10 (55.6) 12 (66.7) 6 (33.3) Diploma 33 (84.6) 6 (15.4) 36 (92.3) 3 (7.7) 32 (82.1) 7 (17.9) Degree and above 49 (92.5) 4 (7.5) 46 (86.8) 7 (13.2) 41 (77.4) 12 (22.6) Note: the calculated percentage for the respective characteristic is from the total examined. Non -co mmerc ial us e o nly Debre Elias district having good agricultural land for sesame oil seed cultivation and there is an increment of new investments that attract high numbers of labor migrants who are young and sexually active from the surrounding districts to the town in search of job opportunities that might contribute to the increase of HIV trans- mission. A study on ART in Ethiopia depicted a substantial expan- sion of access to HIV counseling and testing in Ethiopia.18 This increase is attributed to the integration work of health extension workers, non-governmental organizations, and other stakeholders who play a crucial role in HIV testing and education through dif- ferent approaches, such as campaigns. The uppermost incidences of HIV/AIDS were identified in 15- 24-year-olds, followed by 25-34 years of age; this could be due to the fact that it is the most sexually active age group. It is reported that worldwide, almost half of all new infections with HIV are in people aged 15-24 years.19 Data from Debre Elias Social Affairs Office showed that most of the migrants were dominantly young age groups. People within these age groups may have unprotected sex with more than one sexual partner which might contribute to the increase in HIV infection. This study was supported by a study.20 HIV/AIDS infections were higher in females (61.4%) than males (38.6%), giving a male-to-female ratio of 1:1.6. Gender dif- ferences in HIV/AIDS infection prevalence obtained in the present study showed a similar pattern to two studies,21,22 in which HIV prevalence rate for adult women was almost double that for male, which represent female to male ratio of 2:1. A study done by the Ethiopia Demographic and Health Survey indicated HIV/AIDS prevalence in adults was of 1.9% in females and to 1.0% in males.23 This is due to greater biological susceptibility in females to HIV infection through heterosexual intercourse than in males. Females’ greater biological susceptibility is due to the presence of more exposed surface areas in the female genital tract than males, the presence of HIV is higher in seminal fluids than vaginal fluids at the time of sexual intercourse, the greater amount of semen exchange than vaginal fluid, and the wall vaginal cell during inter- course for women was highly injured compared to men.24 KAP studies are very useful tools prior to any intervention to assess the extent to which individuals or communities are ready to adopt risk-free behaviors and valid KAP about HIV/AIDS and ART use are important in light of the increasing epidemic. This study was the first study on HIV/AIDS and ART use-related KAP among patients in Debre Elias town. The majority of HIV/AIDS patients in the Debre Elias Health Center have good knowledge, positive attitude and good practices towards HIV/AIDS and ART use. Similarly, studies conducted in Africa (e.g., Ghana and Ethiopia) show that level of knowledge regarding HIV/AIDS among sexually active community members are high.25,26 People’s new knowledge of HIV and AIDS led them to use condoms more often, and fewer sex workers got HIV.27 Knowledge, attitude and perceptions of 185 HIV/AIDS patients were assessed in Maiduguri (north-east Nigeria). Of these, 78% of respondents had good knowledge of the causative agents of HIV/AIDS and 90% had good knowledge of HIV transmission.28 As indicated in the present study, 73.4% of study participants responded that proper use of condoms is protective for HIV trans- mission. This is supported by a similar study;29 82.1% of the study participants agreed that proper use of condoms can protect from HIV/AIDS transmission. Another study that was carried out in Yola, Nigeria, showed good knowledge of the use of condoms for HIV prevention, and transmission was 88.1% to prevent the spread of HIV/AIDS. Furthermore, 87.8% of participants believed that abstaining from sex is a very good preventive method of HIV/AIDS transmission.30 Survey data obtained from 18 African countries showed that sexual abstinence and the use of condoms are important components to restrict the spread of HIV infection in developing countries.31 Many people in Ethiopia are aware of HIV and AIDS. However, the change of behavior that should have resulted from such awareness is regrettably not there. This is partly because of a lack of proper community facilitation. Knowledge about a devel- opment issue does not always result in taking action. Knowledge is only likely to change our behavior when the right level of motiva- tion is created through good facilitation. That funding didn’t influ- ence the number of sex partners hat people had, the age at which they started having sex, or teenage pregnancy rates.32 As shown in this study, most of the respondents had good knowledge about ART. The majority of participants (87.7%) believed that HIV/AIDS patients taking ART drugs can transmit HIV, and ARTs are not drugs to cure HIV/AIDS (82.6%). Moreover, 88% of them stated that taking ART on a therapeutic level can lead to a disease progression and the majority of partici- pants (92.7%) believed that ART medication should be taken throughout the patient’s life. This was comparable to a study done in a Nigerian treatment clinic.29 In contrast to this, some of the study participants had an opposing attitude towards ART medica- tion. For instance, 32.8% of the study participants were not con- vinced by ART benefits and 28.1% of respondents believed that it is shameful for HIV/AIDS patients to take ART drugs. Moreover, 26% of them agreed that ART treatment is not for curing medica- tions to HIV infection, and this led to a negative attitude towards ART adherence. So, effective counseling and follow-up are required to ensure ART therapy for HIV/AIDS as intended.29 Therefore, by lowering viral load in sexually active individuals, HIV transmission in the community may decrease and the avail- ability of ARV may encourage voluntary counseling and thus, help change sexual attitudes and practices. Conclusions This study investigates the incidence of HIV/AIDS and ART use among patients in the Debre Elias district. It can be concluded that HIV incidence is increasing every year, and females and the age group 15-24 are more disposed to HIV infections. 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