|Year : 2015 | Volume
| Issue : 1 | Page : 14-19
|Self-reported knowledge and attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute: A cross sectional study
Sukhvinder Singh Oberoi1, Vikrant Mohanty2, Nilima Sharma3, Avneet Oberoi4
1 Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
2 Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, Tagore Garden, New Delhi, India
3 Department of Public Health Dentistry Jamia Hamdard, Hamdard Nagar, Oberoi Dental Clinic and Orthodontic Centre, Tagore Garden, New Delhi, India
4 Private Practitioner, Oberoi Dental Clinic and Orthodontic Centre, Tagore Garden, New Delhi, India
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|Date of Web Publication||3-Mar-2016|
| Abstract|| |
Background: Dentists have a responsibility to provide HIV-infected patients, particularly because oral lesions are common among these patients. It is obvious that having adequate knowledge about HIV/AIDS enhances confidence in ability to manage infected patients.The present study was conducted to assess self-reported knowledge and attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute.
Materials and Method: The present study was a Questionnaire based study which studied the factors associated with "Self-reported knowledge and Attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute."
Results : The willingness to treat patients with HIV was satisfactory (72.0%) among the dental practitioners in the present study but 64% of the dentists thought that treating an HIV patient would have an effect on the other patient's attitude in rendering treatment/dental care. Also, majority (70.0%) of the dentists thought that infection control procedures necessary for the treatment of the patients with HIV is not a financial burden for the practice.
Conclusion : The level of knowledge regarding HIV and AIDS was acceptable in the present study. However, the dental school curriculum must be updated and improved in order to enhance the knowledge of students as well teachers in those aspects.
Keywords: AIDS, attitude, dental practitioners, HIV, self-reported knowledge
|How to cite this article:|
Oberoi SS, Mohanty V, Sharma N, Oberoi A. Self-reported knowledge and attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute: A cross sectional study. J Educ Ethics Dent 2015;5:14-9
|How to cite this URL:|
Oberoi SS, Mohanty V, Sharma N, Oberoi A. Self-reported knowledge and attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute: A cross sectional study. J Educ Ethics Dent [serial online] 2015 [cited 2019 Dec 15];5:14-9. Available from: http://www.jeed.in/text.asp?2015/5/1/14/178021
| Introduction|| |
Oral health is an essential aspect of overall medical care for individuals with HIV.  Oral care for HIV-positive individuals plays a vital role in improving their nutritional intake, medication tolerance/effectiveness, treatment success rate, and quality of life.  With improved survival rates, it is expected that more HIV-positive patients, with or without knowledge of their serologic status, will be seeking dental care in the near future. 
It is essential that every effort be made to protect both health care workers and patients from HIV exposure in the dental practice as the usual route of transmission is through an individual's contact with infected blood or other bodily fluids.  The reports indicated that about 90% of the HIV infections among healthcare workers occur in developing countries where occupational safety is a neglected issue. ,,
It is of major importance that attitude and knowledge regarding HIV/AIDS together with possible relationships are studied to highlight their role in fulfilling the intentions of the authorities and expectations of the consumers concerning the risk-group patients. The dental students (Dentists of future) play an important role in health care delivery of HIV/AIDS individuals and are therefore of special interest and importance in this respect. ,,
All dental students should have complete knowledge about the universal precautions which is an administrative control measure that calls for the implementation of practices and equipment to protect the health care workers whenever the potential exists for exposure to blood. Every patient is considered to be infected with a blood-borne pathogen regardless of the known sero-status. 
Clinical dental students in particular may encounter a number of incidents where infections, including AIDS, from patient's body fluids may occur. In comparison to other infectious diseases, dental students were found to be more willing to treat HBV- and HCV-infected patients than those with HIV infection. 
Several studies have been conducted to assess the willingness of oral health professionals to treat HIV-positive individuals either as a main survey or as part of knowledge, attitudes, and practice survey in Nigeria and in other parts of the world. ,,,
Thus, the present study was carried out to self-reported knowledge and attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute.
| Materials and Method|| |
The present study was a Questionnaire based study which studied the factors associated with "Knowledge and attitude regardingtreatment of HIV/AIDS Patients by the Dental Practitioners in a public sector institute." The study was carried out among the dental practitioners working in a public sector institute in New Delhi, India.
The permission to carry out the study was obtained from the Director-principal of the institute. The ethical committee clearance was taken from the institutional ethical committee. The study was explained to the dentists working in the institute and informed and written consent was taken from the respondents who agreed to participate in the study.
The Questionnaire assessed the knowledge and attitude regarding the Treatment of HIV/AIDS Patients by the Dental Practitioners. The Questionnaire used for the study was a structured Questionnaire which included 16 Questions of objective type. The response of the Questions were assessed in terms of Yes, No and Don't know [Table 1] and [Table 2].
|Table 1: Questions related to attitude towards treatment of HIV/AIDS patients|
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The data were tabulated and entered into Microsoft excel 2010. The results were expressed in the form of numbers and percentages.
| Results|| |
The present study assessed the attitude and knowledge regarding the Treatment of HIV/AIDS Patients among the Dental Practitioners. A total of 100 practitioners participated in the study with a response rate of 85%. The mean age of the study population was 35.84 ± 3.49with 28 (56%) male and 22 (44%) females. The mean years of practice of the study population was 12.23 ± 2.26.
The willingness to treat patients with HIV/AIDS was high (72, 72.0%) in the present study. Most (80.0%) of the dental practitioners agreed that treating an HIV positive patient is an ethical responsibility of the dentist whereas 12.0% respondents did not agree and 8.0% were not sure about it.
Thirty-four percent of the dentists had an opinion that treating an HIV positive patient places a dentist at an increased risk of HIV infection and 64.0% dentists had an opinion that treating an HIV positive patient in your clinic will affect other patient's attitude in rendering treatment/dental care from the dentist. But 64% dentists thought it is difficult to deal with the fear of the staff members.
When asked about whether infection control proceduresare a financial burden to the practice of the dentist was opinion of 22.0% of the dentist, 8% did not know and 70% did not regard it to be a financial burden. Almost 86% dentists were confident of treating a patient with HIV infection safely in dental practice whereas 6% were not sure and 8% could not decide. Majority (88.0%) of the dentists followed the practice of treating all patients as if they have HBV or HIV infection taking all universal precautions whereas 12.0% did not follow that practice.
Most (84%) of the dentists had knowledge regarding the precautions to be taken for treating the patients with HIV/AIDS. Most (82%) of the dentists were of the opinion that HBV is more infectious than HIV and (83.0%) of the dentists had opinion that Infection control practices for HBV are adequate for protection against HIV and 84% dentists thought that exposure to Saliva can readily transmit HIV. Most (83.0%) of the dentists were aware of the immediate measures to be taken in case of needle stick injury from an HIV-infected person.
The opinion regarding risk of contracting HIV infection from an HIV-contaminated Needle stick injury was less than 1% among 38 (38.0%) dentists, 1-10% among 20 (20.0%), 11-50% among 20 (20.0%), more than 50% among 6 (6.0%) and did not know among 16 (16.0%) dentists.
Most (92%) of the dentists had knowledge regarding the Oral Manifestations associated with the HIV/AIDS, 4% did not have and 4% were not sure. Ninety-four percent of the dentists knew about the drugs to be taken under ART therapy for the treatment of HIV/AIDS whereas 4% did not knew and 2% were not sure of the drugs to be taken.
| Discussion|| |
The present study was conducted to evaluate self-reported knowledge and attitude toward the treatment of HIV/AIDS infected individuals by the Dental Practitioners working in a public sector institute.
There are a lot of studies which have been conducted on the knowledge and attitude toward the treatment of HIV-infected individuals but most of them have been conducted on the student population. Differences in sampling methods, survey methods and experimental design may lead to very different conclusions. This study was unique in the sense it evaluated the knowledge and attitude of the faculty which is routinely involved in the training of the dental students in a public sector institute which caters to the maximum number of patientsspecially in a developing country like India.
As the number of people with HIV/AIDS will increase, the need of these individuals for medical care including dental care will increase, , so dental practitioners will be required to enhance their knowledge of the disease and its oral manifestations.  HIV-related oral conditions occur in a large proportion of individuals who are HIV-positive and frequently are misdiagnosed or inadequately treated.  The provision of dental care for people who are HIV-positive is essential for their overall health and well-being. Previous studies have suggested that knowledge may affect attitudes toward the treatment of HIV/AIDS patients. ,
The overall willingness to treat HIV-positive patients in the present study (72%) was higher than the study conducted by Clement Chinedu Azodo et al. (58.8%),  Forty-nine percent recorded among Taiwanese dental students  and 15 percent of Jordanian dentists.  The level of willingness found in this survey was similar when compared to previous reports of various groups' willingness to treat: 63.3 percent of Nigerian preclinical students,  63.6 percent,  78.4 percent  of Nigerian dentists, 62 percent of U.S. dental school seniors  and M. Elizabeth Bennett et al. (67%)  whereas it was lower to the study reported by 84.3 percent of final-year dental students in the United Kingdom,  and 83 percent of U.S. dental students. ,
Willingness to treat is thought to be the most significant predictor of actual treatment of an HIV-positive patient.  Consequently, if HIV-positive individuals feel abandoned by caregivers, they are less likely to understand the need for prevention and to be motivated to protect others.  It is important when using the social intervention approaches to HIV prevention to avoid discrimination against people who are HIV-positive. , The fear of treating HIV-infected patients may be due to inadequate knowledge of HIV transmission. Evidence indicates a low occupational risk for HIV infection among health care professionals. 
Clement Chinedu Azodo et al. conducted a descriptive cross-sectional survey among 67 final-year dental students of the University of Benin, Nigeria and found that 81 percent of the students in the study showed great interest in HIV-related information, and 82.7 percent desired more knowledge on safety precautions during treatment of HIV-positive patients.  This is similar to the 90 percent of Japanese dental health workers who requested additional education about HIV, particularly information about the prevention and spread of the virus and cross-infection requirements. 
Eighty percent of the patients thought that treating HIV positive patient is an ethical responsibility of the dentist which was almost similar to the findings by Ryalat et al., in which 73.7% of fifth-year students and 60.8% of third-year students thought that HIV/AIDS patients should be treated at any dental facility with same respect and dignity as other patients but after taking special precautionary measures. 
In the present study, 34% of the respondents had an opinion that treating an HIV positive patient places a dentist at an increased risk of HIV infection. This was similar to the study conducted by Crossley (34%)  and Bennett et al., where (31%) of the respondents had an opinion that they will eventually become infected if they treat HIV infected patients often  but lesser than the study conducted by McCarthy et al. (63%). 
A high (64.0%) number of respondents reported that treating an HIV patient would have an effect on the other patient's attitude in rendering treatment/dental care from you. This was very high in comparison to the study Crossley (34%)  but similar to the study conducted by McCarthy et al. (68%).  Whereas Bennett et al. reported that 75 percent of the subjects reported that they were afraid of displaying a willingness to treat HIV-positive patients for fear that they would lose other patients. 
The fear of respondents related to dealing with staff fears was reported with 64% of respondents expressing concern. This was similar to the findings reported by Crossley  who reported same concern among 59% of the respondents and McCarthy et al. (67%). 
In the present study, 22.0% of the dentists reported that Infection control procedures necessary for treatment of the patients with HIV/AIDS is a financial burden for the practice which was much lower than the study by Crossley (32%)  and McCarthy et al. (45%). 
Exposure to Saliva can readily transmit HIV was agreed by 84% of the respondents which was similar to the study conducted by Seacat et al. (84%)  and Samaranayake et al. (100%)  but was much higher than the study conducted by Mostafa Sadeghi et al.,  in which 24.5% students agreed that saliva can be a vehicle for the transmission of AIDS, sheikh et al. (33.6%)  and Jian et al. (36.9%).  There was no gap in knowledge among the dental practitioners in the present study in terms of route of transmission of HIV.
In the current study, 92% were sure of the oral manifestations associated with the HIV/AIDS which was similar to the study conducted by (95.2%). Regarding oral manifestations, 98.1 percent correctly identified oral candidiasis, 95.8 percent major aphthous, and 93.8 percent Kaposi's sarcoma. The female students had significantly higher knowledge about oral manifestations than the males (57.5 percent for females and 42.5 percent for males) (P = 0.01). The results showed the overall mean attitude score was 57.4 percent (negative attitudes; 57.8 percent for males and 57.2 percent for females). 
While further research is necessary to fully understand the reasons for these seemingly contradictory sentiments, we hypothesize that fear and stigma may play a role. HIV infection is a stigmatizing condition, and some theorists have noted that ambivalence is the most common reaction to stigmatized people. ,
Many researchers therefore believe that the teaching methodology should go beyond a didactic communication and focus on problem based learning that includes small learning groups or affective component.  Also, incorporating psychological aspects of treating HIV/AIDS patients  and continuing dental education programs should be conducted on a regular basis for updating of the knowledge of the dentists working in private practice and institutional based practice regarding the treatment of this special population.
However, the results of the present study cannot be generalized as it has been done on a limited sample size from one of the dental colleges in the public sector. Moreover, the questions employed were sufficiently simple and unambiguous to achieve a reasonable degree of validity on the different variables.
| Conclusion|| |
This study suggests the need to introduce into the dental curriculum a comprehensive educational and motivational program for the next generation of dentists in order to ensure adequate care of HIV-positive patients. It is suggested that health care workers should be instructed for the appropriate management and counselling HIV and AIDS patients and imparted sufficient knowledge of symptoms as well as how to diagnose and treat infected patients appropriately.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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