Introduction

Communicable diseases have long been a significant public health issue, and one of the most pressing emerging threats is Human Immunodeficiency Virus (HIV). HIV undermines the immune system by attacking CD4 cells, important white blood cells that help defend the body against infections [1]. As there is currently no complete cure for HIV, it remains a serious and life-threatening disease in the modern era [2]. Globally, HIV has imposed a considerable mortality burden, causing approximately 1.3 million deaths in 2010, though this number declined to about 630,000 by 2023 [3]. However, developing regions continue to bear a disproportionate share of HIV cases due to limited health literacy, lack of awareness and inadequate healthcare access. Although the United Nations Political Declaration on HIV has made significant strides in addressing the epidemic [4], HIV continues to be a major challenge in low and middle income countries of South Asia and sub-Saharan Africa [5].

India faces a double burden of disease, contending with persistent infectious diseases such as HIV, while simultaneously witnessing a rise in non-communicable diseases. Despite progress, the country continues to have the world’s third-largest HIV epidemic [6]. Approximately 2.3 million people were living with HIV in India, with an adult prevalence of around 0.22% by 2021 [7]. Among them, men had a higher HIV prevalence of 0.24% compared to 0.20% among women. According to the National AIDS Control Organization (NACO), this number increased slightly in 2023, with an estimated 2.5 million individuals affected [8]. The risk of HIV acquisition remains concentrated among specific populations, including people who use drugs, sex workers, men who have sex with men (MSM), transgender individuals, and those from economically disadvantaged backgrounds [9–13]. Given the slight increase in prevalence, it is evident that dissemination of knowledge about HIV is pertinent, particularly for men in high-risk populations. Access to accurate HIV-related information can empower men in these vulnerable groups to adopt protective behaviours and reduce their risk of infection. However, acquiring such knowledge depends on several factors, such as socio-economic status, regional disparities, and cultural barriers, which can significantly impact men’s willingness to seek out or discuss HIV information [14,15]. Approximately 87% of HIV cases in India are attributed to sexual transmission, with the remaining cases due to blood transfusions and intravenous drug use [16]. Intravenous drug use, is the primary mode of HIV transmission in the north-eastern states, which report the highest HIV prevalence in the country [17]. Therefore, enhancing HIV knowledge and awareness across India’s diverse population is a critical public health priority. Research has demonstrated that dissemination of accurate information about HIV is one of the most effective strategies to prevent and control its spread globally [18]. In line with this, Sustainable Development Goal (SDG) 3.3 explicitly calls for the ending epidemics such as HIV by 2030, emphasizing that increasing awareness and knowledge about HIV is essential to achieving this target [19].

A wealth of studies in India have investigated HIV knowledge across different population groups, employing varied sample sizes. Much of this research has primarily focused on women [13,20–24], students [25–28], youth [29,30], adolescents [31], teachers [32], and men who have sex with men [33,34]. Some studies have also examined HIV knowledge among Indian adults, including both women and men [35–37]. However a recent study aimed at identifying the proportion and predictors of comprehensive knowledge of HIV among Indian adults [38], combined male and female data, limiting the ability to discern gender-specific determinants. Given that knowledge-related factors may differ by gender, a focused analysis on men is crucial. The study by Pal et al. (2024 highlights the heightened vulnerability of certain male populations to HIV, emphasizing the role of social stigma, violence, healthcare barriers and most importantly knowledge about HIV in shaping their risk. Their findings reinforce the need for targeted interventions to address structural inequalities and gaps in HIV prevention [39]. Following this, the present study contributes to the literature by identifying key determinants of HIV knowledge among men in India.

Despite the critical role of awareness in HIV prevention, research focusing solely on men remains limited and underexplored. This study seeks to bridge that void by analyzing the factors influencing HIV knowledge among men aged 15–54, using the most recent data from the National Family Health Survey (NFHS-5), a nationally representative dataset. By incorporating novel variables not previously examined in similar studies [13,38], this research provides new insights into the socio-demographic determinants of HIV awareness and helps identify different regions with significant knowledge gaps and informs the development of more targeted and effective HIV education interventions.

Predictor variables

In line with previous studies [13,38,41–43], the present study considered various predictor variables, including age, marital status, educational level, history of HIV testing, place of residence, religion, social category, mass media exposure, and household wealth status. Additionally, occupation and geographical region were also included. A detailed description of the variable categorization is presented in Table 1.

Download:

• PNG
  larger image
• TIFF
  original image

Table 1. Description of the variable used in the study.

https://doi.org/10.1371/journal.pone.0327411.t001

Results

The association between comprehensive knowledge of HIV and various socio-economic and demographic characteristics among men aged 15–54 years is outlined in Table 2. Comprehensive knowledge of HIV was higher among non-adolescents as compared to adolescents and significantly associated with marital status (p < 0.001), with unmarried men showing slightly higher knowledge than married men. Both education and household wealth were positively associated with knowledge levels. Among those tested for HIV, 47% of men had comprehensive knowledge. Additionally, men with full mass media exposure were significantly more informed than those with partial or no exposure.

Download:

• PNG
  larger image
• TIFF
  original image

Table 2. Sample distribution and comprehensive knowledge of HIV by background characteristics of the study population, India, NFHS-5, 2019−21.

https://doi.org/10.1371/journal.pone.0327411.t002

Furthermore, Comprehensive knowledge of HIV was significantly higher among urban men, those with higher education (50% vs. 22% with no education), and men from the Western region (48%) compared to the Eastern region (28%) in India. Service sector employees and those classified under ‘other’ social and religious groups also showed greater knowledge.

Model 1 included age as the primary predictor. Model 2 added marital status, educational attainment, and HIV testing history. Model 3 further incorporated occupational status (Table 3). Finally, Model 4 included geographical region, social group, religion, mass media exposure, place of residence, and household wealth quintile. In Model 1, non-adolescent men were significantly more likely to have comprehensive knowledge of HIV than adolescent men (AOR: 1.20, 95% CI: 1.16–1.25). Model 2 revealed that men with secondary education were more than twice as likely (AOR: 2.14, 95% CI: 2.03–2.26), and those with higher education nearly three times as likely (AOR: 3.28, 95% CI: 3.09–3.48), to possess comprehensive knowledge compared to illiterate men. Additionally, men who had ever been tested for HIV were 47% more likely to have comprehensive knowledge than those who had never been tested (AOR: 1.47, 95% CI: 1.41–1.55).

Model 3, which included occupational status, showed that men employed in the service sector had greater odds of comprehensive knowledge (AOR: 1.11, 95% CI: 1.05–1.17). In the final model, men from the Western (AOR: 1.33, 95% CI: 1.26–1.42) and North-Eastern (AOR: 1.32, 95% CI: 1.24–1.41) regions were more likely to possess comprehensive knowledge compared to those from the Eastern region. Men belonging to OBC (AOR: 1.13, 95% CI: 1.08–1.18) and other categories (AOR: 1.22, 95% CI: 1.16–1.28) had higher odds than SC. Muslim men had lower odds (AOR: 0.83, 95% CI: 0.79–0.87). Men fully exposed to mass media were 67% more likely to have comprehensive knowledge (AOR: 1.67, 95% CI: 1.56–1.78). Moreover, wealth status was positively associated with knowledge, with men in the wealthiest quintile having 50% greater odds of comprehensive knowledge than those in the poorest quintile (AOR: 1.50, 95% CI: 1.41–1.60). The coefficient plot (Fig 1) also shows the significant impact of different socio-economic determinants on HIV knowledge, as revealed by the logistic regression in Model 4.

Download:

• PNG
  larger image
• TIFF
  original image

Fig 1. Coefficient plot of odds ratios for comprehensive HIV knowledge by socio-demographic predictors.

https://doi.org/10.1371/journal.pone.0327411.g001

Download:

• PNG
  larger image
• TIFF
  original image

Table 3. Factors influencing HIV knowledge among men (aged 15−54 years) in India, NFHS-5, 2019−21.

https://doi.org/10.1371/journal.pone.0327411.t003

Discussion

In assessing the knowledge of HIV among men aged 15–54 years in India, the study found that 36.3% of men had comprehensive knowledge of HIV. The study further identified several significant predictors of HIV knowledge, including age, religion, history of HIV testing, and, most notably, exposure to mass media. Regional disparities were evident, with men from Western India showing higher levels of knowledge compared to those from the Eastern region. Additionally, men in higher wealth quintiles were more likely to have a comprehensive knowledge of HIV.

We found that adolescent respondents demonstrated lower levels of HIV knowledge compared to non-adolescents. Adolescents represent a particularly vulnerable age group, as their limited knowledge of HIV may impede their ability to adopt protective behaviours, placing them at higher risk for engaging in high-risk sexual practices. These findings align with results from studies conducted in Iran [44], Bangladesh [42], India [45,46], and Nigeria [41]. Another reason could be the limited access to reliable information sources, as well as inadequate school-based HIV education, often due to a shortage of skilled teachers [47].

The likelihood of having comprehensive HIV knowledge increased with higher education, consistent with findings from several African and Asian countries [13,46,48–51]. People with higher levels of education are more likely to obtain, comprehend, and act upon health information, including public health campaigns and school-based interventions. This may be attributed to greater health awareness and a more proactive approach to obtaining health information among more educated individuals. Young people gain essential HIV knowledge through school-based interventions, and education on sexual and reproductive health is strongly linked to better understanding. Additionally, higher literacy enhances individuals’ ability to comprehend public health campaigns and fostering discussions about HIV prevention [13,51]. Consistent with previous findings in India [46], Bangladesh [52], USA [53,54] and Canada [43], the study showed that residents in urban areas had higher HIV knowledge. Urban residents are generally more likely to have access to education, leading to greater self-efficacy, awareness, and adherence to healthy behaviours. Access to health information, especially through mass media like television and newspapers [43] is more prevalent in urban areas, which contributes to increased HIV awareness, especially in developing nations [55,56].

A positive association between HIV testing and HIV knowledge among men is supported by research from Ethiopia [57], Kenya [58], Nigeria [59] and India [13,46]. This relationship may be attributed to the dissemination of key information during pre-test and post-test counselling, which reinforces awareness of HIV prevention and transmission [60,61]. The study also found that men belonging to religious groups categorized as ‘others’ such as Christianity, Jainism, Buddhism, and Zoroastrianism were more likely to possess comprehensive HIV knowledge compared to those identifying as Hindu or Muslim. Although these group represent a smaller proportion of the population in the country, their relatively higher literacy rates contribute to better access to HIV-related information and health education [62]. Furthermore the higher concentration of Christians in North-Eastern India, a region with a higher prevalence of HIV, suggests that local administration and socio-cultural organizations have effectively promoted HIV education and awareness [7].

In line with studies from Sub-Saharan [52,63,64] and South Asian countries [13,65],full exposure to mass media was associated with a higher likelihood of having comprehensive knowledge of HIV among men. Mass media through television, radio, and newspapers has become an important source of HIV information, often reaching large segments of the population at a low cost [66,67]. These channels are effective in spreading knowledge and encouraging healthier behaviours. In many developing countries, mass media is a key tool in HIV awareness campaigns because of its broad reach and affordability. Unlike formal education, which may not be accessible to everyone, mass media has the potential to reach individuals regardless of their location, education level, or income. Television and radio, for instance, are commonly available even in rural areas, bridging the information gap between urban and rural populations. Additionally, social networks contribute to the spread of HIV-related information, particularly among middle-aged groups. A study from Bangladesh further supports this, showing that reading newspapers was linked to improved knowledge about HIV, highlighting the importance of education and information spread through accessible media sources [51].

One of the crucial findings of this study is the higher likelihood of comprehensive HIV knowledge among men from Western and North-eastern India compared to those from Eastern India. This disparity can likely be explained by the focused efforts in these regions to raise awareness. For instance, in Mizoram, the Mizoram State AIDS Control Society (MSACS), established in 1998, has been spearheading HIV prevention and awareness efforts, following the creation of the State AIDS Cell in 1992 [7]. In a similar effort, the West Bengal State AIDS Prevention and Control Society has undertaken consistent initiatives to educate the public about HIV and ways to prevent it [68]. In addition, wealth quintile was found to be positively associated with HIV knowledge among men. This finding is similar to previous studies [35,57,69,70] Implementing HIV awareness in all settings is essential for ensuring people receive accurate information and dispelling misconceptions. Expanding access to HIV counselling and testing facilities can substantially improve HIV knowledge among Indian men. Comprehensive knowledge is crucial for promoting protective behaviours, reducing myths, and combating stigma around HIV. Identifying the determinants of HIV knowledge can help uncover cultural and societal barriers that limit access to accurate information. Effective educational programs, including behaviour change strategies and mass media campaigns, are needed to enhance awareness, especially in rural areas [51,71,72]. India has made substantial progress in its response to HIV. Although HIV prevalence has significantly decreased in recent years, continued efforts are crucial for raising awareness about its spread and prevention [73,74]. The National AIDS Control Programme (NACP) plays a central role in this by emphasizing widespread information, education, and communication on HIV prevention (NACO, 2024). Under the ‘Azadi ka Amrit Mahotsav,’ campaigns have promoted awareness and reduced stigma, involving students from hundreds of schools and colleges in awareness activities. The continued focus on education, especially in academic institutions has been instrumental in spreading accurate knowledge and changing public perceptions. The NACP also aims to reduce new HIV infections and AIDS-related deaths from 2010 levels, reflecting successful strides in raising public awareness and improving health outcomes [75].

Conclusion

This study highlights the critical importance of obtaining accurate and complete knowledge about HIV and examines the factors influencing such knowledge among Indian men aged 15–54 years. The findings revealed that only one in three adolescent men possesses comprehensive knowledge of HIV, emphasizing the need for targeted awareness efforts for this vulnerable group. Determinants such as marital status, education, HIV testing history, region, wealth, religion, and social category influence their knowledge. Men from Central India were less likely to have comprehensive knowledge, suggesting that government efforts should place additional focus in this geographical pocket. Policies should address knowledge gaps among men, particularly within underprivileged groups. Mass media campaigns and community-based educational efforts should target Muslims, less educated, and unemployed men. Furthermore, expanding access to HIV testing and counselling services, especially for marginalized populations, may further enhance awareness. These efforts are essential not only for improving public health outcomes but also for contributing tothe achievement of Sustainable Development Goal 3.3, which aims to end the AIDS epidemic by 2030.