Joint modelling of correlated binary outcomes regarding the misconceptions of HIV transmission: a study with reference to the tertiary and vocational education trainees in Sri Lanka

Thilini Samarakoon, Niroshan Withanage, Nimalakith Samarakoon, Upul Lekamge, Nadesha De Silva


Background: Currently, people infected with HIV are largely discriminated and discredited. Misunderstanding about the mechanism of HIV transmission has been identified as one reason for discrimination. This study assessed the socio-demographic and behavioral risk factors of the two misconceptions about HIV transmission, namely HIV is transmitted by sharing cups and plates with an HIV infected person (Myth 1) and HIV is transmitted by mosquito bites (Myth 2) among the trainees who were selected to the Tertiary and Vocational Education Training (TVET) Centers in Sri Lanka.

Methods: This study applied stratified random sampling to select 955 respondents. A self-administered structured questionnaire was used to collect the data. Generalized linear mixed model (GLMM) approach was applied to find the associations between misconceptions about HIV and socio-demographic and behavioral risk factors of the trainees.

Results: Level of education of trainees, family relationship, knowledge on sexual and reproductive health (SRH), knowledge about the risk of getting HIV after sexual intercourse, whether the trainee had participated in seminar or workshop on sexually transmitted diseases were identified as the possible factors to detect the knowledge about the misconceptions of HIV transmission.

Conclusions: Even though the level of education among different social segments have not revealed remarkable differences in knowledge, the study convinced that the youth should be provided better awareness and education on STD and HIV through countrywide workshops and awareness programmes.


Correlated binary outcomes, Generalized Linear Mixed model, Joint modeling, HIV/AIDS knowledge, Misconceptions of HIV

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Ministry of Health. Annual Report National STD/AIDS Control Programme (NSACP) Sri Lanka, 2018. Available at: https:// Accessed on 10 April 2020.

Ministry of Health. Update 4th Quarter Report - HIV/AIDS Surveillance Data in Sri Lanka - 2019. Available at: https:/ /www. k/images/pdfs/hiv_data/quarter_report/HIV-4th-Q2019.pdf Accessed on 20 March 2020.

Madurapperuma BD, Nishad AAN, Borgesc JS, Solangaarachchi DIK, Kangathe RV, Hewage SAA. A preliminary assessment of sexual transmitted infections (STIs) in Sri Lanka: District-wise overview. Sri Lanka J Obst Gynaecol. 2018;40:31-8.

Thakuri DS, Thapa CB. Knowledge, attitude and perception regarding HIV/AIDS among postgraduate students of university of Pune. Int J Community Med Public Health. 2018;5(5):1750-5.

Saki M, Kermanshahi SMK, Mohammadi E, Mohraz M. Perception of patients with HIV/AIDS from stigma and discrimination. Iran Red Crescent Med J. 2015;17(6): e23638.

Niehaus I, Jonsson G, Wouter B. Americans, and wild beasts: men’s conspiracy theories of HIV/AIDS in the South African Lowveld. Medical Anthropology. 2005;24(2):179-208.

Rödlach AW, Westerners. HIV: AIDS and cultures of blame in Africa. Walnut Creek, California: Left Coast Press. 2006.

Bogart LM, Thorburn ST. Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? J Acquired Immune Def Synd. 2005;38(2):213-8.

Liddell C, Barrett L, Bydawell M. Indigenous representations of illness and AIDS in sub-Saharan Africa. Social Sci Med. 2005;60(4):691-700.

Choudhary HA, Ali RA, Altaf S. Knowledge, behaviour and attitudes regarding HIV/AIDS among undergraduate students in an Irish University. Int J Surg Med. 2015;1(2):58-66.

Department of Census and Statistics Sri Lanka. Annual Report, Demographic and Health Survey - 2016, Sri Lanka. 2017. Available at: Accessed on 15 December 2019.

Bogart LM, Skinner D, Weinhardt LS, Glasman L, Sitzler C, Toefy Y, Kalichman SC. HIV misconceptions associated with condom use among black South Africans: an exploratory study. Afr J AIDS Res. 2011;10(2):181-7.

Karthijekan k. Undergraduate students knowledge on AIDS/HIV and its associated factors in Eastern University, Sri Lanka. Int J Sci Res. 2017;7(10):198-203.

Qian HZ, Wang N, Dong S, Chen H, Zhang Y, Chamot E, et al. Association of misconceptions about HIV transmission and discriminatory attitudes in rural China. AIDS Care. 2007;19(10):1283-7.

Diaz RM, Ayala G, Bein E. Sexual risk as an outcome of social oppression: data from a probability sample of Latino gay men in three US cities. Cultural Div Ethnic Min Psychol. 2004;10:255-67.

Ghebremichael M. Joint modeling of correlated binary outcomes: HIV-1 and HSV-2 co-infection. J Applied Stat. 2015;42(10):2180-91.

Withanage N, Leon AR, Rudnisky C. Joint estimation of disease-specific sensitivities and specificities in reader-based multi-disease diagnostic studies of paired organs. J Applied Statistics. 2014;41(10):2282-97.

Agresti A. Categorical data analysis. 3rd edition. John Wiley and Sons. 2013.

Iqbal MM. Can we get AIDS from mosquito bites? J Louisiana State Medical Society. 1999;151:429-33.