Attitude and knowledge of dental students of National Capital Region regarding HIV and AIDS.

BACKGROUND: India is estimated to have third highest number of Human Immunodeficiency Virus (HIV) infection in world with about 2.4 million people currently living with HIV/Acquired Immunodeficiency Syndrome (AIDS). There is a possibility of HIV transmission in the oral health care setting and thus adequate knowledge and proper attitude among dental students is vital to prevent the chances of transmission and for proper care of the patient. AIMS AND
OBJECTIVES: The present study aimed to investigate the knowledge of dental students about HIV infection and their attitude toward treating HIV/AIDS patients and behaviour practiced.
MATERIALS AND METHODS: A cross-sectional survey was conducted among 600 dental students of different colleges present in National Capital Region (NCR). The students were from third and fourth year and they completed a predesigned questionnaire assessing the knowledge, attitude and willingness to treat HIV/AIDS patients. One-way analysis of variance (ANOVA) was applied to compare mean level of knowledge and attitude toward HIV/AIDS. RESULT: The results showed that only 28% students have excellent knowledge regarding HIV/AIDS. Certain misconceptions were prevalent regarding mode of transmission. It also shows that around 43% of the dental students have an overall negative attitude.
CONCLUSION: The findings suggest that the students had adequate knowledge about HIV/AIDS and their attitude toward this group of people was significantly negative. There is need and scope to provide correct and detailed information on HIV/AIDS for dental students.

INTRODUCTION

The acquired immunodeficiency syndrome (AIDS) epidemic is continuing to grow[1] and global estimates indicated that over 40 million people are infected.[2] The fact that the number of human immunodeficiency virus (HIV)-infected patients under dental care is expected to increase[3] highlights the importance of providing healthcare, part of which is dental treatment, to all individuals indiscriminately.[4] The reports indicated that about 90% of the HIV infections among healthcare workers occurs in developing countries where occupational safety is a neglected issue.[56]

AIDS is the serious epidemic problem in India. The AIDS epidemic is one of the most destructive health crisis of modern times, ravaging families and communities throughout the world. In India, a semiautonomous body called National AIDS Control Organization (NACO) was established under ministry of health and family welfare to control the HIV epidemic.[7] According to joint United Nations (UN) Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO), approximately 34 million people are currently living with HIV and about 30 million people have died of AIDS-related causes since the beginning of epidemic.[8] According to new estimates released by NACO supported by UNAIDS and WHO, an estimated 23.9 lakh people are infected with HIV in India by 2009-2010. According to NACO, adult HIV prevalence at national level is 0.31% in 2009. HIV/AIDS has devastating effect on adolescents.[9] Till date very less work has been done to assess the knowledge and attitude among Indian dental students, hence a sincere attempt has been made on this front. The purpose of this study was to assess the dental student's knowledge of HIV/AIDS and attitude toward them and their willingness to treat patients living with HIV and AIDS (PLWHA).

MATERIALS AND METHODS

A cross-sectional questionnaire survey was conducted among 600 students studying in third and fourth years of dental colleges located in National Capital Region (NCR). The sample was selected, as they treat the patients in the clinics. The students were given a predesigned questionnaire [Table 1] during a regular theory class. All the students participated voluntarily in the study and were informed about the confidentiality of their response. All students were asked to report about their age, gender and year of study. The questionnaire included 25 questions out of which 15 questions represent knowledge of the subjects and 10 questions represent attitude of the subject towards HIV/AIDS. The questionnaires were distributed to the respondents and were asked to complete it individually. Each and every question was explained to them before they answered to prevent any ambiguity.

Table 1

Questionnaire

Statistics

Later the data were subjected to statistical analysis by using Statistical Package for Social Sciences (SPSS). One-way ANOVA (Analysis of Variance) was used to compare the mean level of knowledge and attitude toward HIV/AIDS between the genders, years of study and age groups. To calculate mean level of knowledge and attitude, ‘0’ score was assigned for negative knowledge and attitude and ‘1’ score was assigned for positive knowledge and attitude.

RESULTS

A total of 600 dental students returned a completed questionnaire giving an overall response of 100%. About 60% respondents fell into 21-23 years age group and majority of dental students were unmarried (89.5%). Male to female ratio was approximately 1:2 [Table 2]. According to the survey, only 28% subjects had excellent knowledge and 54% subjects had good knowledge regarding HIV and AIDS. In all, 7% responded poorly to the questionnaire [Table 3]. When the subjects were asked where they will refer the HIV/AIDS patients for the treatment, 86% responded for hospital but 21.5% subject said they will refer them to traditional healers and 16% to miracle center (P value: 0.00) [Table 4].

Table 2

Demographic characteristics

Table 3

HIV/AIDS knowledge

Table 4

Recommendation

There were more misconceptions regarding the mode of transmission among the subjects, 78.5% said the mode of transmission is unprotected sex, whereas 34 and 25% said breast feeding and kissing, respectively [Table 5]. The most important source of information about HIV/AIDS was electronic media (63.5%) followed by newspaper (57%) and text books (57%) [Table 6]. The study showed that there were very less involvement of parents (16.6%) regarding sharing the knowledge about AIDS/HIV [Table 7].

Table 5

Mode of transmission

Table 6

Source of information

Table 7

Interpersonal communication

Only 43% subjects were aware about their own HIV status and only 58% were willing for HIV testing [Table 8]. When asked about their attitude towards PLWHA, 43% subjects responded that they have the right to refuse the treatment and 29% said they should be quarantined [Table 9]. Five parameters were given regarding the risk perception, 67.6% subjects said that dentists are at high risk group, whereas 44.4% are not worried about HIV infection [Table 10].

Table 8

Attitude toward HIV testing

Table 9

Attitude toward PLWHA

Table 10

Risk perception

DISCUSSION

The response rate obtained in this survey was high and comparable with other surveys. Most of the survey has included less than 200 subjects, but in our study 600 subjects were involved. There was disproportionate gender distribution that was similar to the findings in study conducted by Soukaina T Raylat[10] on Jordanian dental students. 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[11] among Iranian dental students and by Azodo et al.,[12] among Nigerian dental nursing students. Nearly one-third (34%) of the students thought that HIV/AIDS could be acquired by the breast feeding and one-fourth (25%) thought that HIV could be contracted by kissing an infected person, which is a misconception.

The attitude and willingness to treat HIV/AIDS patient was assessed and found an overall negative attitude of students toward HIV/AIDS patients. Shan V et al.,[13] and Azodo et al.,[12] also reported dental students having negative attitude toward HIV/AIDS. According to our study, electronic media is main source of information regarding HIV/AIDS. Whereas in study conducted by Ajayi YO and Ajayi EO,[14] main source of information was health workers and textbooks. This negative attitude of the dental students will have a direct impact on the treatment of the PLWHA.

In this study, only 43% subjects were aware of their HIV status and 58% were willing for HIV testing. Kopacz et al.,[15] in their study reported that 84% were aware of their HIV status and only 20% were willing for HIV testing. It is quite alarming that more than 50% of the students are not aware of their HIV status.

The results of this survey can be interpreted as true representation of HIV/AIDS knowledge and attitude among dental students of NCR. Dental students have repeatedly reported good knowledge regarding HIV/AIDS with some misconception that was also supported by our survey findings.

CONCLUSION

From the present study, we conclude that knowledge regarding HIV/AIDS should be included from first year of dentistry or from school level, so that they are well trained in treating the PLWHA. Therefore, students must be made well aware of the importance of treating HIV/AIDS patients and help the society from this drastic disease. It is recommended that a comprehensive training of the dental students be done, to promote a good delivery of accurate information on HIV/AIDS to the public and to provide proper patient care. Dental students should work with different Non Governmental Organizations (NGOs) working for AIDS patients. A separate dental unit should be established in a hospital specially for treating PLWHA and dental students should be posted there for more exposure to the HIV/AIDS patients. Emphasis must be placed on in-depth discussion on HIV/AIDS issue by experienced health workers and lectures with dental students in order to clarify existing misconceptions and discourage discriminatory behaviour.