Spatial Distribution and Multilevel Analysis of HIV/AIDS Awareness Among Women Aged 15–49 in Somaliland: Insight from DHS Data

Abstract

Understanding the determinants and spatial distribution of HIV/AIDS awareness is crucial for effective public health interventions, particularly among women of reproductive age in low-resource settings. This study investigates these factors among women in Somaliland, a region facing unique challenges in health service access. This cross-sectional study utilized data from 6,259 women aged 15-49 from the 2020 Somaliland Demographic and Health Survey. We employed multilevel logistic regression to identify individual and community-level determinants of HIV/AIDS awareness and used spatial analysis to map its geographic distribution. Overall, 73.7% of women in Somaliland reported having heard of HIV/AIDS. Multilevel analysis revealed that awareness was significantly higher among older and more educated women, with those having higher education being 24 times more likely to be aware (adjusted odds ratios [AOR] = 24.04). Conversely, rural (AOR = 0.65), nomadic residence (AOR = 0.33), and no radio exposure (AOR = 0.49) were associated with significantly lower odds of awareness. Significant regional variations were also identified. A substantial portion of the variance in awareness (ICC = 24.3%) was attributable to community-level factors, confirming the appropriateness of the multilevel approach. Women's awareness of HIV/AIDS in Somaliland is shaped by a complex interplay of spatial location, education, media access, and residence type. These findings underscore the necessity for targeted public health interventions that address both individual and community-level barriers. Priority should be given to reaching women in rural and nomadic settings and those with lower educational attainment. This dual-method analysis provides crucial insights to inform more effective and geographically-tailored HIV prevention programs in Somaliland.