| Abstract|| |
Background: The HIV epidemic poses significant challenges to the healthcare providers including dentists. The present study is aimed to estimate the knowledge of HIV/AIDS and the attitude of dental students towards HIV/AIDS patients and to know whether knowledge has any influence on the attitude and willingness to treat HIV/AIDS patients.
Materials and Methods: A cross-sectional survey was carried out on 219 dental students studying at the Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India. The students completed a predesigned self-administered questionnaire assessing the knowledge, attitude and willingness to treat HIV/AIDS patients. The data were analyzed using ANOVA test (all the results are calculated at 1% level of significance) and Pearson correlation test.
Results: The total mean knowledge score was 76.5% (excellent knowledge). There was a significant difference in knowledge among the third-year, final-year students and internees, which was found to be statistically significant (P>0.001%). The study showed that the overall mean attitude score was 62.9% (negative attitude). There was no significant difference in the attitude of the students among the three groups (P>0.001%). Karl Pearson correlation test showed no significant correlation between the knowledge of HIV/AIDS and the attitude of students towards HIV/AIDS patients (P>0.01%).
Conclusions: The findings suggest that although the students had adequate knowledge about HIV/AIDS, their attitude towards this group of people was negative. From the study, fear of HIV contagion was observed as a major reason for the negative attitude of students towards HIV/AIDS patients.
Keywords: AIDS, attitude, dental students, HIV, knowledge
|How to cite this article:|
Patil PB, Sreenivasan V, Goel A. Knowledge of HIV/AIDS and attitude of dental students towards HIV/AIDS patients: A cross-sectional survey. J Educ Ethics Dent 2011;1:59-63
|How to cite this URL:|
Patil PB, Sreenivasan V, Goel A. Knowledge of HIV/AIDS and attitude of dental students towards HIV/AIDS patients: A cross-sectional survey. J Educ Ethics Dent [serial online] 2011 [cited 2020 Jun 3];1:59-63. Available from: http://www.jeed.in/text.asp?2011/1/2/59/103676
| Introduction|| |
HIV (human immunodeficiency virus) infection and AIDS (acquired immunodeficiency syndrome) is a globally emerging public health problem. India alone accounts for over 2.5 million people living with HIV/AIDS (PLWHA)  and the estimated prevalence is 0.91%.  And this figure is expected to rise further. The success of antiretroviral therapy in reducing the viral load and significantly improving the CD4 counts has improved the life expectancy of PLWHA.  Oral healthcare needs among PLWHA are proportionally higher, since oral conditions occur in a large proportion of them.  With improved survival rates, it is expected that more PLWHA will be seeking dental care in the near future. Because of the possible transmission of HIV virus through direct contact with blood, the risk of cross-infection comes into particular focus in dental practice.  The risk of occupational transmission of the virus from a patient to a healthcare provider has been estimated at 0.3% after a single percutaneous exposure to HIV-infected blood.  Fear of HIV contagion or AIDS phobia among healthcare providers including dentists have been attributed as major obstacles in the successful delivery of dental care to PLWHA.  Dentists have a professional and ethical responsibility to provide oral healthcare to all individuals without discrimination.  According to the World Health Organization (WHO), it is imperative for all dentists to treat HIV-positive patients. , It is unethical and unlawful for a dentist or dental student to refuse to treat a HIV-positive patient. Despite these recommendations, dentists are reluctant or refuse to treat HIV/AIDS patients due to lack of knowledge and ignorance about the disease. Infectious diseases' including HIV/AIDS and cross-infection control forms a part of the curriculum of the dental course, beginning in the third year of the course. It is expected that HIV/AIDS education and knowledge eliminates the stigma and phobia among the students and prepares them to morally accept the responsibility to provide oral healthcare to PLWHA. The purpose of the present study was to assess the dental students' knowledge of HIV/AIDS, and their attitude towards and willingness to treat PLWHA. Further the influence of knowledge of HIV/AIDS on the attitude and willingness to treat HIV/AIDS patients was also studied.
| Materials and Methods|| |
A cross-sectional questionnaire survey was conducted among the dental students studying in the third and final year of the dental course and the internees at Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India. The sample was selected since they are taught about HIV infection and AIDS and the students treat patients in the clinics. The students filled the questionnaire [Table 1], during a regular theory class session. The questionnaire was adapted from the survey questionnaire used by Sadeghi M and Hakimi H  in a previous study with some modifications. All the students participated voluntarily in the study and were informed that participation would not affect their grade. All participants were asked to report about their gender, age and year of study.
The questionnaire included eleven closed questions to evaluate the knowledge of HIV infection. Participants had the options of correct and incorrect to answer the questions. Out of eleven questions five answers were true (correct in the questionnaire) and six answers were false (incorrect in the questionnaire). For every correct answer a score of 2 was assigned and a score 0 for every incorrect answer. The total score for each participant was obtained adding the score of each answer. Score of 75% and above, between 50-75%, between 25-50% and score less than 25% was considered as excellent, good, moderate and weak knowledge respectively. Eleven questions evaluating the attitude towards PLWHA and willingness to treat were incorporated in the questionnaire. The response was rated on five-point Likert scale using option of strongly agree, agree, neutral, disagree and strongly disagree. The scores were computed from five to one for a positive attitude and inversely for negative attitude. Score of 75% and above, between 50-75%, and less than 50% were considered as positive, negative and passive attitude respectively. The data were analyzed using ANOVA test (all the results are calculated at 1% level of significance) and Pearson correlation test.
| Results|| |
The survey was conducted on 219 dental students, out of which 46 (21%) students were studying in the third-year dental course, 112 (51.4%) students in final-year course and 61 (27.8%) were doing internship. The age of the participants ranged from 20-24 years and the male to female ratio was 1:3. The total mean knowledge score was 76.5% (excellent knowledge), and according to the year of study it was 69.3%, 80.1% and 80.3% for third year, fourth year and internees respectively [Table 2]. Majority of the internees (60.6%) and fourth-year students (62.5%) showed excellent knowledge about HIV/AIDS as compared to third-year students (58.6%) who had knowledge categorized as good [Table 3]. There was a significant difference in knowledge among the three groups of students which was found to be statistically significant (P>0.001%). Females (60.2%) exhibited significantly higher knowledge than males (41.5%). The overall knowledge score ranged from 6-22 (27.3-100%) [Table 4]. The maximum score (98.3%) was for the question "HIV/AIDS patients can be suspected from oral manifestations" by the internees and the minimum score (37.5%) was for the question "Treatment of HIV/AIDS patients requires special dental clinics" by the fourth-year students [Table 5].
The study showed that the overall mean attitude score was 62.9% (negative attitude); according to the year of study it was 62.4%, 64.0% and 62.3% for third year, fourth year and internees respectively [Table 6]. There was no significant difference in the attitude of the students among the three groups (P>0.001%). Majority of the students, irrespective of their year of study, showed negative attitude towards PLWHA [Table 7]. The attitude scores ranged from 10-46 (18.2-83.6%) [Table 4]. The highest positive attitude score (93.7%) was obtained for the statement "It is my moral responsibility to treat HIV/AIDS patients" by the internees. The statement "Risk of HIV contagion exists when treating HIV/AIDS patients" received maximum passive attitude (22.6%), also by internees [Table 8]. Karl Pearson correlation test showed no significant correlation between the knowledge of the students and the attitude to treat PLWHA (P>0.01%).
| Discussion|| |
The results of our study revealed several startling facts regarding the knowledge, attitude and willingness of dental students to treat HIV/AIDS patients. Majority of fourth-year students and internees showed higher level of knowledge about HIV/AIDS as compared to the third-year students. The level of knowledge was associated significantly with the year of study (P>0.001%), a finding that differs from previous reports by Seacat et al.,  and Shaikh et al.  This may be attributed to the improved knowledge acquired as one progresses through the curriculum. We found that students showed moderate knowledge with respect to modes of HIV transmission and infection control practices. A similar finding was reported by Sadeghi M  among Iranian dental students, by Ryalat et al.,  among Jordanian dental students and by Azodo et al.,  among Nigerian dental nursing students. Irrespective of the year of study, salivary and aerosols' contamination in dental practice was considered as means of HIV transmission by the majority of the students. Surprisingly, most students thought that special dental clinic setups are required to treat HIV/AIDS patients. This highlights the fact that there is lack of practical exposure for students in delivering dental care to PLWHA. Shan et al.,  in their study found that only 62% dental students were aware of universal precautions.
The attitude and willingness to treat HIV/AIDS patients was assessed using a five-point Likert scale. We found an overall negative attitude of students towards HIV/AIDS patients. The finding differs from previous researchers, who found students having adequate knowledge about HIV/AIDS and a positive attitude. ,,,,, On the other hand Seacat et al.,  and Azodo et al.,  reported dental students having negative attitude towards HIV/AIDS patients. In the present study the attitude of the students was not related to the year of the study (P>0.001%).
An encouraging finding from our study was that the majority of the respondents expressed greater willingness to treat HIV/AIDS patients. The students accepted that it is their moral responsibility to treat HIV/AIDS patients, with a positive attitude score of 89.5%, 92.3% and 93.7% by the third-year, fourth-year students and internees respectively. At the same time they felt that the risk of HIV contagion exists during the treatment, with an average passive attitude score of 24.6%. The fear of HIV contagion and AIDS phobia was further revealed from the average negative attitude score of 34.2%, stating that they will stop working with a colleague if he or she is HIV-infected and an average score of 32% by the students for the statement that they would end the relationship if a friend or spouse is HIV-seropositive. Previous researchers have also reported negative attitude of students rating the risk of HIV contagion from HIV/AIDS patients during treatment as high. ,, There exists longstanding limited access to healthcare for PLWHA, and negative attitude and unwillingness of the healthcare providers to treat have been cited as major barriers. Fear of HIV contagion has been found to be the primary reason behind the negative attitude and unwillingness of dental students and dentists to treat HIV/AIDS patients. , Further it is interesting to know that such fear and prejudice existed towards HIV/AIDS patients and was not encountered with other potentially infectious patients such as those suffering from Hepatits B. Kopacz et al.,  in their study found that students with homosexual and HIV-positive friends were significantly more tolerant with a positive attitude towards HIV/AIDS patients, arguing that friendship with homosexual or HIV-positive individuals may exert a positive impact on students' attitude.
In the study we found that students lack knowledge on ethical issues concerned with HIV/AIDS. The average attitude score of 44.9% by the students for the statement 'HIV infection status of the patient should be disclosed to all the family members' shows lack of comprehensive understanding on the matter of confidentiality in healthcare management.
Kopacz et al.,  found a negative attitude of medical students on the same issue.
From the study we found that the level of HIV/AIDS knowledge was not a significant predictor of attitude and willingness to treat HIV/AIDS patients (P>0.01%). The finding differs from previous investigators who found that higher knowledge scores about HIV/AIDS among students were significantly associated with a more positive attitude and willingness to treat HIV/AIDS patients. ,,,, In our study although the students exhibited excellent to good knowledge about HIV/AIDS, the majority of them felt that the risk of HIV contagion from needle stick injury, saliva and aerosols is high and there is a fear HIV contagion when treating these patients. This worry of occupational exposure may explain the reason of the negative attitude of the students towards PLWHA in the study. Many researchers therefore believe that the teaching methodology should go beyond a didactic communication of one-way transmission of knowledge and focus on problem-based learning that includes small experimental groups or affective component.  Also, incorporating psychological aspects of treating HIV/AIDs patients in the curriculum has been recognized as an effective method of improving the attitude of students towards PLWHA and sensitizing them to be sympathetic. 
The results of the present study should be interpreted with caution since it has been done on a limited sample size representing only one dental school that may limit the generalization of the findings.
| Conclusion|| |
From the present study we found that although the overall knowledge of students about HIV/AIDS was adequate, there were inadequacies in terms of modes of HIV transmission and universal precautions. Though the knowledge was appropriate students' attitude towards PLWHA was negative. The results indicate that the dental students are not well prepared to treat HIV/AIDS patients and are unsympathetic towards this group of patients. Dental students must therefore be made aware of and should understand the importance of treating HIV/AIDS patients. This can be achieved by proper modeling and making the students more sensitized towards PLWHA apart from giving appropriate knowledge of the disease, regarding its ways of transmission, recognition of oral manifestations, treatment and monitoring the condition.
| References|| |
|1.||Swaminathan S, Narendran G. HIV and tuberculosis in India. J Biosci 2008;33:527-37. |
|2.||Wig N, Lekshmi R, Pal H, Ahuja V, Mittal CM, Agarwal SK. The impact of HIV/AIDS on the quality of life: A cross sectional study in north India. Indian J Med Sci 2006;60:3-12. |
|3.||Seacat JD, Litt MD, Daniels AS. Dental students treating patients living with HIV/AIDS: The influence of attitudes and HIV knowledge. J Dent Educ 2009;73:437-44. |
|4.||Borsum KM, Gjermo PE. Relationship between knowledge and attitude regarding HIV/AIDS among dental school employees and students. Eur J Dent Educ 2004;8:105-10. |
|5.||Robert LM, Bell DM. HIV transmission in the health-care setting: risk to health-care workers and patients. Infect Dis Clin North Am 1994;8:319-29. |
|6.||Nasir EF, AstrØm AN, David J, Ali RW. HIV and AIDS related knowledge, sources of information and reported need for further education among dental students in Sudan - a cross-sectional study. BMC Public Health 2008;8:286. |
|7.||Lohrmann C, Valimaki M, Suominen T, Mulnonen V, Dassa T, Peate I. German nursing students knowledge of and attitude to HIV and AIDS: two decades after the first AIDS cases. J Adv Nurs 2000;31:696-703. |
|8.||AstrØm AN, Nasir EF. Predicting intention to treat HIV-infected patients among Tanzanian and Sudanese medical and dental students using the theory of planned behavior - a cross sectional study. BMC Health Serv Res 2009;9:213. |
|9.||Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ 2005;83:700-6. |
|10.||Sadeghi M, Hakimi H. Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. J Dent Educ 2009;73:740-5. |
|11.||Sheikh H, Shankar S, Vinay S. Knowledge and attitudes of undergraduate dental students in the oxford dental college hospital and research centre, Bangalore toward patients with HIV/AIDS. JIADS 2011;2:1-5. |
|12.||Ryalat ST, Sawair FA, Shayyab MH, Amin WM. The knowledge and attitude about HIV/AIDS among Jordanian dental students: (Clinical versus preclinical students) at the university of Jordan. BMC Res Notes 2011;4:191. |
|13.||Azodo C, Umoh A, Ezeja E, Ukpebor M. A survey of HIV related knowledge and attitude among dental nursing students in south western Nigeria. Benin J Postgrad Med 2007;9:1-12. |
|14.||Shan V, Shethwala ND, Bala DV. Knowledge, attitude and health behavior of dental students towards HIV patients. Health Line 2011;2:58-60. |
|15.||Kopacz DR, Grossman LS, Klamen DL. Medical students and AIDS: knowledge, attitudes and implications for education. Health Educ Res 1999;14:1-6. |
|16.||Azodo CC, Ehigiator O, Oboro HO, Ehizele AO, Umoh A, Ezeja EB, et al. Nigerian dental students' willingness to treat HIV-positive patients. J Dent Educ 2010;74:446-52. |
Prashant B Patil
Professor, Department of Oral Medicine and Radiology, Subharti Dental College, NH-58, Subhartipuram, Meerut, Uttar Pradesh - 250 005
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]