HIV Awareness and Perceptions Among Citizens of the Eastern Province, Saudi Arabia: A Cross-Sectional Study (March–July 2024)

1. INTRODUCTION

The global impact of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continues to pose a significant global threat to public health. According to UNAIDS, as of 2024, an estimated 40.8 million people worldwide were living with HIV. The year 2024 saw a troubling increase of 1.3 million new HIV cases. Furthermore, AIDS-related illnesses claimed approximately 630,000 lives in the same year.

Despite advances in treatment, there remains no cure for HIV, highlighting the critical importance of preventive measures, particularly health education, in controlling the spread of the virus. HIV weakens the immune system over time, making individuals more susceptible to various infections and diseases. The primary modes of HIV transmission include unprotected sexual intercourse, sharing contaminated needles or syringes, and mother-to-child transmission during childbirth or breastfeeding [1–3].

In many regions, including Saudi Arabia, the incidence of new HIV infections continues to rise, highlighting the urgent need for comprehensive and effective HIV prevention strategies. As of 2020, an estimated 12,000 individuals were living with HIV in Saudi Arabia, with a rise of 1,000 cases of HIV annually, reflecting a 132% increase compared to 2010. Recent epidemiological assessments have highlighted shifting disease patterns and the importance of targeted surveillance in the kingdom [4–7].

The Eastern Province, with its diverse population, has experienced a notable increase in HIV cases, necessitating targeted interventions to address this growing public health challenge. Research has highlighted significant gaps in knowledge and misconceptions about HIV transmission among different population groups in this region. Similar findings have been reported across Saudi Arabia, where varying levels of HIV awareness and misconceptions persist among the general population [8–10]. Factors contributing to the rise in HIV cases include changing social norms, population mobility, and limited access to accurate information about HIV transmission and prevention.

The Ministry of Health (MOH) in Saudi Arabia has implemented national policies aimed at early diagnosis, mandatory notification, and free treatment for people living with HIV. HIV testing is offered confidentially at government hospitals and health centers, and positive cases are registered anonymously through the National AIDS Program. Treatment, including antiretroviral therapy, is provided free of charge to Saudi citizens. Additionally, the country adheres to a policy of mandatory premarital screening, which includes testing for HIV and other infectious diseases, as a preventive strategy.

Studies have shown that health education interventions can significantly improve knowledge about HIV transmission, reduce risky sexual behaviors, and increase the use of preventive measures such as condom use. By raising awareness and enhancing understanding of HIV/AIDS, health education empowers individuals and communities to make informed decisions that protect themselves and others.

This study aims to assess and evaluate the level of knowledge and perceptions regarding HIV among the population of the Eastern Province in Saudi Arabia. By focusing on both healthcare and non-healthcare workers, the research seeks to identify gaps in knowledge, attitudes, and practices related to HIV awareness. Understanding the current level of HIV awareness is crucial in developing targeted interventions and educational programs tailored to the specific needs of the population. The goal is to enhance HIV awareness, promote preventive behaviors, and reduce the incidence of new HIV infections, thereby contributing to a healthier society [8–10].

2. METHODS

3. RESULTS

4. DISCUSSION

The findings of this study highlight several key insights regarding the knowledge and perceptions about HIV/AIDS among the population of the Eastern Province in Saudi Arabia. This is the first study to date targeting this specific population.

Despite significant advancements in HIV treatment and prevention globally, this study highlights the persistent gaps in awareness and misconceptions prevalent in the region. The Eastern Province is of special interest as it has the third-highest number of HIV cases in Saudi Arabia, which can be attributed to the presence of undocumented migrant populations and heavy population migration. Most HIV cases in Saudi Arabia occur in non-Saudi nationals. Previous studies have also highlighted knowledge gaps among expatriate and vulnerable populations in Saudi Arabia [9–11].

While the high level of HIV awareness observed among participants is encouraging, further comprehensive studies are needed to evaluate Saudi Arabia's potential for HIV elimination. The relatively low incidence in Saudi Arabia may be attributed to the Islamic culture and its influence on the behaviors of the population, which is consistent with patterns observed in other countries with similar cultural and religious contexts. Religious and cultural perspectives have been shown to influence HIV-related attitudes and awareness in the region [12].

This study revealed a notable proportion of participants demonstrating a good understanding of the basic facts about HIV transmission and its causes. For instance, 92.0% correctly identified that AIDS is caused by a virus, and 92.7% recognized that HIV can be transmitted through sexual contact. However, misconceptions still exist, as evidenced by 25.7% believing that HIV can be transmitted through casual touch, handshakes, and kissing, and 27.7% thinking it can be transmitted through sharing public restrooms. These misconceptions about HIV could lead to unnecessary stigma and discrimination against individuals living with HIV, perpetuating myths about whether HIV-positive individuals can lead normal lives and the possibility of marriage to HIV-positive individuals. This study did not directly assess stigma levels; further research incorporating stigma measurement is recommended to better understand these relationships [11].

Recent studies conducted across Saudi Arabia have revealed similar misconceptions and overall levels of knowledge among the general population and students, underscoring the need for region-wide education initiatives [8–10].

The study revealed significant associations between demographic features and perceptions about HIV/AIDS. Educational level, age, marital status, and healthcare work status were influential factors. For example, higher educational attainment was generally associated with better knowledge about HIV transmission and treatment. Conversely, younger participants and those with lower educational levels were more likely to hold misconceptions about HIV. HIV is more prevalent among young people aged 18–24; Saudi Arabia, with more than half of its population under 25 years of age, faces particular vulnerability to HIV spread. This demographic group requires targeted educational approaches to maximize impact on HIV knowledge, especially given their theoretical access to internet-based and updated information [13–14].

Healthcare workers displayed a higher level of knowledge about HIV/AIDS compared to non-healthcare workers. This is expected given their professional background, but it also highlights the critical role healthcare professionals play in disseminating accurate information and educating the broader community. Therefore, strengthening training programs for healthcare workers can further enhance community education efforts.

Gender differences were also evident in the study, with males and females showing varied levels of knowledge and misconceptions. For instance, females were more likely to believe that HIV could be transmitted through shared public restrooms. Conversely, males presented better overall knowledge of HIV, which is consistent with findings from other studies. Various factors, such as access to education, cultural influences, and targeted health campaigns, often contribute to this disparity in HIV knowledge between genders. It is worth noting that approximately 90% of HIV cases in Saudi Arabia occur in males. This suggests that gender-specific educational interventions might be necessary to address misconceptions and improve overall HIV awareness [13, 15].

The study found that most participants were aware of the availability of confidential HIV diagnostic methods in government centers and hospitals. This is a positive indicator of trust in the healthcare system's ability to manage HIV confidentially. However, continuous efforts are needed to encourage regular testing and early diagnosis, which are crucial for effective HIV management and prevention.

Awareness about the lack of a definitive cure for HIV, but the availability of treatments to control the virus was relatively high among participants. Nonetheless, a significant proportion of the population was unaware of preventive treatments before and after exposure to HIV. Enhancing knowledge about pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) can play a vital role in reducing new HIV infections.

The study also highlighted misconceptions regarding the potential for HIV-positive mothers to breastfeed without transmitting the virus. According to current WHO guidelines and evidence, with maternal antiretroviral therapy and appropriate infant prophylaxis, the risk of Mother-To-Child Transmission (MTCT) can be substantially reduced to <2%. Exclusive formula feeding remains a safe option, though with effective maternal and infant treatment regimens, some women may choose to breastfeed under medical supervision.

5. LIMITATIONS

This study has several limitations that must be acknowledged. Firstly, the reliance on self-reported data collected through online and paper-based questionnaires may introduce sampling bias, as those with internet access or a greater inclination towards health surveys might not accurately represent the broader population.

Additionally, the cross-sectional design captures information at a single point in time, making it difficult to infer causality or changes in knowledge and perceptions over time. The structured questionnaire, while comprehensive, may not fully capture the nuances of participants' knowledge and perceptions, which could be better explored through open-ended questions or qualitative methods. Furthermore, the study does not assess the direct impact of existing health education programs on HIV awareness, which would require longitudinal studies and intervention-based research.

Information on non-responders and reasons for non-participation was not collected, which may introduce non-response bias and limit the ability to compare participants with those who declined or did not complete the survey.

Finally, unaccounted confounding variables, such as socioeconomic status, access to healthcare, and personal experiences with HIV/AIDS, may influence the findings. Moreover, given the sensitivity of the topic, responses may have been influenced by social desirability bias, with participants potentially overstating their knowledge or providing answers they perceived as socially acceptable. Addressing these limitations in future research can enhance the understanding of HIV/AIDS awareness and inform more effective public health interventions.

CONCLUSION AND IMPLICATIONS FOR PUBLIC HEALTH POLICY

These findings highlight the urgent need for comprehensive, targeted public health interventions in the Eastern Province of Saudi Arabia. Educational programs should be tailored to address the specific needs of various demographic groups, particularly those with lower levels of education. These initiatives should focus on correcting misconceptions and providing accurate information about HIV transmission, prevention, and treatment.

To enhance the reach and impact of these educational efforts, it is crucial to engage community leaders and leverage media platforms. By fostering a well-informed public, the region can more effectively combat the spread of HIV and support those living with the virus.

While significant strides have been made in HIV education and prevention, this study reveals ongoing challenges in the Eastern Province. Addressing these gaps through targeted, demographic-specific interventions can significantly improve HIV awareness, reduce new infections, and contribute to a healthier society. By implementing these strategies, the region can make substantial progress in its fight against HIV and improve overall public health outcomes.

REFERENCES