AIDSQuest: The HIV/AIDS Survey Library
HIV Research Domains: Topic A Attitudes

Overview
Attitudes can be defined as positive or negative mental positions or feelings toward a fact or a state. Attitudes are often based on a belief about the likely outcome of an event, and whether that outcome is considered to be good or bad. Questions related to attitudes are part of the typical "KAP," or knowledge, attitude, and practice surveys. Attitudes are important components of many theories that attempt to explain behaviors.

Attitudes are often correlated with behavior, that is, if a person answers that they like condoms, they are often more likely to use condoms. However, this is only sometimes the case, and attitudes provide only some information toward understanding behaviors.

Investigating attitudes is also important when setting up HIV-related services, as well for as understanding the reasons behind the success or failure of such services within an area. For instance, if negative attitudes toward condom use are common among a certain group, but positive attitudes toward communicating openly with a sexual partner about HIV risk exist, a program could focus on changing the first attitude and reinforcing the second. Also, stigmatizing attitudes toward people living with HIV/AIDS can significantly hinder care and prevention efforts.

Important distinctions can be made between knowledge and attitude questions. Knowledge questions usually attempt to get at basic knowledge and misconceptions about issues such as HIV risk and prevention, as an initial step of any HIV education. Attitude or belief questions usually attempt to uncover potential barriers to or facilitators of specific behaviors. Some of the questions can be similar, but depending upon how they are phrased, they can tap into either knowledge or attitudes.

As with other types of questions, it is important to keep comparability in mind when designing a survey. This is especially true if you are going to ask similar questions within the same survey, collect more than one round of data (e.g., pre-and post-tests), or if you will want to compare your results to other studies. For example, attitude questions can be asked in different ways:

"I believe that extramarital sex is wrong" and "I believe that extramarital sex is always wrong."

"Should a nurse who has HIV, but is not sick, be allowed to work?" and "I would be willing to be a patient of a nurse that has HIV."

The meaning of each statement is different, and responses to each could not be directly compared.

This topic has been separated into attitudes about two issues: attitudes about HIV risk, prevention, and treatment, and toward people living with HIV/AIDS. Negative attitudes toward people living with HIV/AIDS are often used to measure stigma, and similar questions can also be found in the stigma section. Certain attitudes can also reflect social norms and similar questions can be found in the social norms section.

Examples of questions relating to attitudes have been selected from the questionnaires below:

1. HIV risk, prevention, and treatment

• Horizons—Programming for HIV Prevention in Thai Schools
• MEASURE—Zambia Sexual Behavior Survey
• MEASURE DHS+—AIDS Module
• NORC—General Social Survey
• UCSF CAPS—Condom Use Among Hispanics
• Horizons—India Adherence and High Risk Behavior Survey

2. Toward people living with HIV

• Horizons—Programming for HIV Prevention in Thai Schools 
• FHI—Behavioral Surveillance Surveys
• MEASURE DHS+—AIDS Module
• UNAIDS/MEASURE Evaluation—HIV/AIDS Prevention Indicator Survey
• ICRW—Tanzania Stigma Indicator and Community Endline: Individual Questionnaire
• Horizons—Reducing HIV/AIDS-related Stigma and Discrimination in the Healthcare Setting in Vietnam