HIV-related knowledge and attitudes among medical students in China

A national survey of HIV knowledge, sexual practices and attitude towards homosexuality for HIV elimination among young people in China

Background Elimination of HIV is a public health priority in China, but there has been reports of an upsurge in HIV among young people. A nationwide cross-sectional survey was conducted to assess the awareness of HIV knowledge, attitudes towards homosexuality and practice of sexual behaviours among Chinese aged 15-24 years.

METHODS

The face-to-face survey was conducted from June to August 2017, collecting data on sociodemographic characteristics, HIV-related knowledge, attitudes towards homosexuality and practice of sexual behaviours among Chinese senior high school and university students. A generalised linear model (GLM) was used to assess the different levels of HIV knowledge between groups, and identify the key contributors to HIV knowledge scores.

RESULTS

The survey was completed by 73.6% (1355/1840) of the students approached. The overall level of HIV-related knowledge was low (58.9%, 10.6/18); 48.0% (650/1355) supported same-sex marriage; and 6.9% (93/1355) self-identified as homosexual or bisexual. The major factors associated with higher scores [mean ± standard deviation (s.d.)] in HIV knowledge among students included: having received school-based HIV education (11.47 ± 3.51 vs 9.02 ± 4.14, P < 0.05); support for same-sex marriage (11.69 ± 3.33 vs 9.49 ± 4.29, P < 0.05) and older age (11.61 ± 2.78 vs 9.87 ± 4.17, P < 0.05). Compared with females, males were significantly more likely (all P < 0.05) to report masturbation (60.7% vs 7.6%), pornography experiences (77.4% vs 35.3%), sexual encounters (24.6% vs 12.3%), casual sex (37.0% vs 18.1%) and sex under the influence of alcohol (29.5% vs 12.8%).

CONCLUSIONS

There is is still much room for improvement in terms of HIV/AIDS prevention and health education for Chinese young people, and more comprehensive and diverse models of education for HIV prevention are urgently needed.

Healthcare-related factors affecting the management of HIV infected patients: a systematic review of qualitative evidence

Human immunodeficiency virus (HIV) infection is a major health concern that is associated with high mortality and socioeconomic burden on both patients and healthcare authorities. This systematic review aimed to qualitatively explore the healthcare-related factors influencing the management of HIV in adult patients. Seven online databases (PubMed, Embase, Google Scholar, CINAHL, PsycInfo, PsycExtra, and International Pharmaceutical Abstract) were searched. Articles published in English language between September 2000 and September 2018 were eligible for inclusion. Quality assessment tool developed by the EPPI-Centre was used to assess the quality of the included studies. A cross-case thematic analysis was conducted using NVivo 10. A total of 30 studies were included in the review. The qualitative analysis identified four major themes influencing the management of HIV: awareness of healthcare professionals (HCPs), attitudes of HCPs, lack of healthcare infrastructure, and stigma associated with HIV. The findings of this review suggest that people living with HIV are at an increased risk of experiencing poor disease management due to various healthcare-related factors. HCPs and policy makers should acknowledge the presence of these factors with the aim of providing quality care to people living with HIV.

HIV conspiracy theory beliefs mediates the connection between HIV testing attitudes and HIV prevention self-efficacy

Objective: High rates of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) can be found in states in both the Appalachian and Southeastern regions of the United States. As infection rates increase, it is imperative to understand factors that improve HIV prevention. The current work explored whether HIV conspiracy beliefs influences the link between HIV testing attitudes and perceived prevention ability. Participants: Four samples were collected during Fall 2013 (N = 373), Spring 2014 (N = 231), Fall 2014 (N = 345), and Spring 2015 (N = 369) at a rural, Southeastern, Appalachian university. Methods: Participants in all samples completed an online survey. Results: Four studies showed that HIV conspiracy theory beliefs mediated the relationship between HIV testing attitudes and HIV prevention self-efficacy. Conclusions: HIV conspiracy theory beliefs at least partially explain the connection between testing attitudes and HIV prevention self-efficacy. Results have implications for the role of HIV testing attitudes, beliefs, and self-efficacy.

Medical and Nursing Students Perceived Knowledge, Attitudes, and Practices concerning Human Immunodeficiency Virus

Objective. To assess medical and nursing students’ knowledge, attitudes, and practices (KAP) regarding human immunodeficiency virus (HIV) in Fiji. Methods. A cross-sectional study of 275 medical and 252 nursing students that participated in a questionnaire survey on HIV KAP. Data was analysed according to their gender, program of study, and academic year. Results. The mean HIV knowledge (HK) and attitude scores were 16.0 and 41.3, respectively. Mean HK score was significantly higher in males compared to females. Significant positive correlations were found between HK and academic year for medical (R=0.459) and nursing (R=0.342) students and between HK and attitude scores (R=0.196). The majority of students indicated fear in contracting HIV through clinical practice and felt that health care workers have the right to know a patients HIV status for their own safety. The majority would wear gloves to touch a patient if suspected of HIV. Conclusions. The study found a high level of HIV knowledge and positive attitude towards HIV patients. However, respondents also displayed negative attitudes and unacceptable practices probably due to fear. Training institutions need to ensure that students gain accurate knowledge on HIV especially on transmission routes to allay the fear of caring for HIV-infected patients.

Assessment of the knowledge and attitudes regarding HIV/AIDS among pre-clinical medical students in Israel

BACKGROUND

Today's medical students are the future physicians of people living with HIV/AIDS (PLWHA). It is therefore essential that medical students possess the appropriate knowledge and attitudes regarding PLWHA. This study aims to evaluate knowledge and attitudes of pre-clinical Israeli medical students and to assess whether their knowledge and attitudes change throughout their pre-clinical studies.

METHODS

A cross-sectional study was conducted among all pre-clinical medical students from the four medical schools in Israel during the academic year of 2010/2011 (a total of 1,470 students). A self-administered questionnaire was distributed. The questionnaire sought student responses pertaining to knowledge of HIV transmission and non-transmission routes, basic knowledge of HIV/AIDS treatment and attitudes towards HIV/AIDS.

RESULTS

The study's response rate was 62.24 percent. Knowledge among pre-clinical medical students was generally high and showed a statistically significant improvement as students progressed through their pre-clinical studies. However, there were some misconceptions, mostly regarding HIV transmission via breastfeeding and knowledge of HIV prevention after exposure to the virus. Students' attitudes were found to include stigmatizing notions. Furthermore, the majority of medical students correlated HIV with shame and fear. In addition, students' attitudes toward HIV testing and providing confidential medical information were contradictory to health laws, protocols and guidelines. Overall, no positive changes in students' attitudes were observed during the pre-clinical years of medical school.

CONCLUSION

The knowledge of pre-clinical medical students in Israel is generally high, although there are some knowledge inadequacies that require more emphasis in the curricula of the medical schools. Contrary to HIV-related knowledge, medical students' attitudes are unaffected by their progression through medical school. Therefore, medical schools in Israel should modify their curricula to include teaching methods aimed at improving HIV-related attitudes and adherence to medical professionalism.

Hospital pharmacists' knowledge about and attitude toward HIV/AIDS and patients living with HIV/AIDS in Kedah, Malaysia

INTRODUCTION

The current study aims to explore the knowledge, attitude, and perception of hospital pharmacists towards HIV/AIDS and patients living with HIV/AIDS (PLWHA) in the state of Kedah, Malaysia.

MATERIAL AND METHODS

This was a cross-sectional study conducted among the hospital pharmacists in three government hospitals in Kedah, using a self-administered 43-item questionnaire. Data analysis was done using non-parametric and multinomial regression.

RESULTS

A total of 75 respondents participated in this study, resulting in a response rate of 60.8%. The majority were found to be well aware of the causes of HIV/AIDS. However, about 34 (45.3%) believed erroneously that HIV/AIDS cannot be transmitted through tattooing or body piercing. Nearly 25 (33.3%) of the respondents believed that preventing the use of intravenous drugs may not be effective to prevent HIV/AIDS and endorsed social isolation as a measure to prevent HIV/AIDS. The majority (66.6%) had negative attitudes and about 20% held extremely negative attitudes. Findings from regression modelling revealed that hospital (-2 log likelihood = 215.182, χ(2) = 18.060, Df = 8, p = 0.021) and gender (-2 log likelihood = 213.643, χ(2) = 16.521, Df = 8, p = 0.035) were more likely to affect the attitudes of respondents.

CONCLUSIONS

Overall, more than one third of the respondents were found to have negative attitudes towards PLWHA. Gender, job experience, and hospitals with more HIV/AIDS patient visits were the main factors affecting attitudes.

Media Exposure, Gender Stereotype and Contextual Stigma Perceptions about HIV and AIDS

This article examines whether variation in media exposure and gender would yield diverse stigma perceptions on HIV AIDS, and finds the mechanism behind these phenomena. It employs data from 2005–06 NFHS (National Family Health Survey) for Gujarat, a major western state of India, supplemented with some qualitative information. Logistic regressions were undertaken modelling five different stigma perceptions for women and men in varying contexts such as maintaining secrecy of HIV infection, care and support to and service from HIV infected persons. A chi-square test on response from men and women reveals that significant gender differential exists in terms of nature of HIV-related stigma perceptions. While women prefer to keep family member’s HIV infection secret, men rebuff providing care to HIV infected relatives in their own households and disapprove infected persons continue teaching in schools. The exposure to electronic as well as print media has consistent effect on HIV-related stigma perceptions. Newspaper and TV significantly influence men’s perceptions, whereas cinema and radio also play important roles in altering the stigma perceptions of women in different contexts. Qualitative information reveals that gender stereotype added with some socio-cultural factors (roles, knowledge and vulnerability) also generate perception differential regarding HIV and AIDS in varying circumstances.

Relationship between HIV/AIDS knowledge and attitude among student nurses: a structural equation model

With the rising incidence of HIV/AIDS in China, nurses will increasingly be caring for patients with HIV/AIDS. Thus, it is necessary that they have enough knowledge to reduce the risk of occupationally acquired HIV infection and that they change their attitude to care for HIV/AIDS patients. The objective of this study is to explore the relationship between student nurses' HIV/AIDS knowledge and their attitude using a structural equation model (SEM). A cross-sectional survey was conducted in January 2008 among 528 student nurses at the technical secondary school of the China Medical University. An SEM is proposed to determine the direction and magnitude of the interdependent effects between the latent factors. The SEM was built using LISREL version 8.5. The measurement properties of the latent factors underlying the questionnaire were based on a confirmatory factor analysis (CFA). Our results as following, HIV/AIDS knowledge and attitude may be measured by seven underlying constructs, namely, preventive knowledge, knowledge of transmission routes, specialty knowledge, knowledge of nontransmission routes, positive attitude toward HIV/AIDS, negative attitude toward HIV/AIDS, and occupational attitude. The SEM fits the data well. The interdependent relationships between these constructs identified the factors of preventive knowledge, specialty knowledge, and attitude toward HIV/AIDS as having both direct and indirect effects on occupational attitude. In conclusions, our results represent an initial effort to assess the relationship between student nurses' HIV/AIDS knowledge and their attitude toward the disease. CFA and SEM analysis have demonstrated their usefulness in evaluating multifactor complex constructs.

A brief HIV stigma reduction intervention for service providers in China

This study assessed the effect of a brief intervention aimed at reducing HIV-related stigma among service providers in China. From December 2005 to June 2006, 138 service providers from four county hospitals in the Yunnan province of China were randomly assigned into either an intervention or a control condition. HIV stigma reduction concepts were conveyed through participatory small group activities, including role-plays, games, group discussions, and testimony by an HIV advocate. Participants were assessed at baseline before the intervention, and at 3- and 6-month follow-ups. Data were analyzed using a logistic regression mixed-effects model. Service providers in the brief intervention condition were significantly more likely to report better protection of patients' confidentiality and right to HIV testing, lower levels of negative feelings toward people living with HIV/AIDS, and more accurate understanding and practice of universal precautions. This brief intervention pilot showed potential in reducing HIV stigma and discrimination among service providers in China. Further intervention trials are needed to test the efficacy and long-term outcomes of this intervention.

Diffusion of positive AIDS care messages among service providers in China

There is great potential in adapting the popular opinion leader (POL) intervention model to address HIV-related stigma and quality of care among service providers in China. Using a representative sample of 1,101 service providers in China, this study provides preliminary descriptions of POL provider characteristics. Multiple regression analyses revealed that diffusion of positive AIDS care messages among service providers in China was associated with factors such as gender, ethnicity, medical education, level of care, personal contact with people living with HIV/AIDS, and HIV-related training. Those who were more knowledgeable about HIV and those with a lower level of discriminatory attitude at work were more likely to diffuse the positive messages to co-workers and friends. Reported characteristics of a potential provider opinion leader in China will inform the design and implementation of future intervention programs.

HIV-related stigma in health care settings: a survey of service providers in China

We examined how individual and institutional factors in health care settings affected discrimination toward persons with HIV/AIDS. A representative sample of 1101 Chinese service providers was recruited in 2005, including doctors, nurses, and laboratory technicians. Multiple regression models were used to describe associations among identified variables, the relationships with HIV-related personal prejudicial attitudes, and perceived institutional support and discrimination at work. Multivariate analyses revealed that respondents' general view of persons living with HIV/AIDS and their perceived levels of support from their institutions regarding protection procedures were both important predictors for discrimination intent. Perceived institutional support varied according to age, gender, ethnicity, and training background. A better understanding of HIV-related discrimination in health care settings requires consideration of both individual and institutional factors.

Inequality and unwillingness to care for people living with HIV/AIDS: a survey of medical professionals in Southeast China

This study was aimed at assessing physicians' and physician assistants' knowledge and attitudes toward HIV/AIDS and identifying determinants of willingness to care for infected individuals in Southeast China. From May to June 2004, 454 physicians and physician assistants from 5 different medical facility levels in Fujian Province, China, undertook a survey on knowledge, attitude, behavior, and practice (KABP). Only 40.4% (95% confidence intervals: 35.9, 44.9) were willing to provide healthcare services for people living with HIV/AIDS (PLWHAs). Knowledge (p < 0.001) and attitude scores (p = 0.01) as well as the proportion of those willing to provide care (p < 0.001) significantly differed by facility level. Multivariate analysis identified supportive attitudes toward PLWHAs (p < 0.001), self-confidence in providing care (p < 0.001), and facility level as significant predictors of willingness to care for infected individuals. Village medical stations showed the most unfavorable outcomes. Enhanced education as well as specific programs promoting supportive attitudes and willingness to care is therefore required, especially among those working at lower facility levels in remote areas.

Chinese health care providers’ attitudes about HIV: a review

China has one of the fastest growing HIV epidemics in the world with an increase in reported cases of about 30% yearly (UNAIDS, 2004). As the epidemic has grown, there have been several studies of health care provider attitudes towards HIV in China over the last 15 years. While attitudes have evolved, misconceptions about transmission of HIV, low levels of support for people living with HIV/AIDS and stigmatized groups, and a poor understanding of the importance of condoms in HIV prevention, remain. The studies are limited by a weakness of survey instruments and an absence of focus on the gendered nature of the HIV epidemic. Recommendations for future research in this area include development of a theoretical base, consideration of gender and stigma, and incorporation of these issues into the survey instruments.

Effectiveness of an HIV/AIDS educational programme for Chinese nurses

AIM

This paper reports a study examining the effect of a multifaceted HIV/AIDS educational intervention on the knowledge, attitudes and willingness of Chinese nurses in caring for patients with human immunodeficiency virus.

BACKGROUND

The expanding HIV/AIDS epidemic challenges nurses to increase their knowledge about this devastating illness to provide effective HIV/AIDS prevention and care to their patients. HIV/AIDS educational interventions, which were developed for North American and European nurses, have not been studied among nurses in other societies.

METHODS

The study employed a pretest, post-test experimental design with 208 nurses from seven Chinese provinces. The intervention consisted of a 5-day workshop comprising didactic lectures interspersed with activities designed to elicit discussion of participants' values and personal feelings about HIV/AIDS. Bloom's Taxonomy and principles of good HIV/AIDS educational practice guided the educational intervention. Outcome variables were HIV/AIDS knowledge, attitude toward patients with HIV/AIDS (including empathy for and desire to avoid these patients) and willingness to provide nursing care to these patients. The data were collected in 2003.

FINDINGS

At baseline, HIV/AIDS knowledge was not high and attitudes and willingness to care were neutral. Knowledge, attitudes toward patients with HIV/AIDS and willingness to provide nursing care to these patients were each improved at the conclusion of the workshop (P<0.001).

CONCLUSIONS

As the HIV/AIDS epidemic expands, nurses will be called upon to deliver competent, compassionate and comprehensive care to patients and their significant others. Intensive, interactive HIV/AIDS professional workshops can contribute to the national effort by increasing knowledge and improving attitudes towards and willingness to provide nursing care for patients with HIV/AIDS.

The needs of AIDS-infected individuals in rural China

The purpose of this exploratory case study was to describe the needs and present the voices of 21 AIDS-infected individuals who contracted the disease through the selling of blood in rural China. Data sources included interviews, field notes, and letters. Three themes emerged: living in a vicious circle, awakening from the dead end, and escaping the vicious circle through education. Education emerged as an overarching theme and was identified as the catalyst that would either keep the families of those affected trapped in the vicious circle or rescue them from it. Findings are explained within the theoretical contexts of social capital, motivation theory, and Confucius's philosophy on education. The authors discuss implications for researchers, educators, relief workers, human service workers, policy makers, and human rights advocates. They conclude with suggestions for further study.

Attitudes to HIV and HIV testing in high prevalence areas of China: informing the introduction of voluntary counselling and testing programmes

OBJECTIVES

To assess knowledge and attitudes towards HIV and its testing among pregnant women and health professionals in Yunnan Province, south west China, to inform the introduction of voluntary counselling and testing (VCT) programmes.

METHODS

The study design was a cross sectional survey using self completion questionnaires. It was carried out in 12 hospitals in four high prevalence areas of Yunnan Province. Questionnaires were completed under examination conditions by health professionals, and at the routine antenatal examination by pregnant women.

RESULTS

Completed questionnaires were obtained from 840 pregnant women and 780 health professionals. Knowledge of HIV and its modes of transmission were good in health professionals but patchy in pregnant women. The weakest area in both groups was knowledge of maternal to child transmission. There was strong support for compulsory testing in pregnancy and at the premarital examination. But attitudes towards HIV/AIDS were negative: 23% of health professionals and 45% of pregnant women thought HIV was a disease of "low class and illegal" people, 48% of health professionals and 59% of pregnant women thought that HIV positive individuals should not be allowed to get married, and 30% of the health professionals were not willing to treat an HIV positive individual. Levels of knowledge were higher and attitudes more positive in younger health professionals and better educated pregnant women.

CONCLUSIONS

Community education programmes and intensive training of health workers must precede or accompany VCT programmes. They must particularly address negative attitudes towards people with HIV. Pilot VCT programmes are now under way in two of the areas studied.

HIV/AIDS knowledge and attitudes in Chinese medical professionals and students before and after an informational lecture on HIV/AIDS

The rapid increase in human immunodeficiency virus (HIV) prevalence and incidence requires that Chinese health professionals mobilize for HIV prevention. The article describes an HIV/acquired immune deficiency syndrome knowledge and attitude assessment administered before and after a lecture. HIV transmission knowledge was good, with 90 percent to 100 percent of participants correctly identifying means of transmission. Prior to and after the lecture, 43 percent and 21 percent, respectively, were unwilling to sit or work with an HIV-infected person. To increase the likelihood of prevention activities' success, HIV knowledge and attitudes of health care personnel in China must be monitored and improved.

Stigma and rejection: living with AIDS in villages in southern Thailand

The problems that face HIV/AIDS patients are now fairly well documented. These include experiences of guilt, anger, grief, fear of abandonment, and potential economic hardship and marginalization due to others' fear of infection and associated stigma. However, limited attention has been paid to the effects of AIDS-related stigma on access to, and the provision of, health services. Understanding how the stigma of AIDS affects the processes and experiences of diagnosis, treatment, prevention, and care is critical to effective public health policy and the delivery of health care programs and medical services. In this article, we examine stigma as experienced by people with HIV and AIDS, and by their families, in village Thailand. We also identify areas for improvement pertaining to people with HIV/AIDS and other stigmatizing diseases.

A study of sexual behavior among rural residents of China

OBJECTIVE

Although the recent spread of HIV/AIDS and other sexually transmitted diseases (STDs) in China has been associated with sexual activities, little information has been available about sexual behavior in rural areas with high HIV prevalence. Studies identifying high-risk sexual behaviors are needed to formulate effective prevention programs.

METHODS

A cross-sectional study design was used to measure sexual activities using a two-stage cluster sampling method. A two-part anonymous questionnaire was used. Sensitive questions related to sexual behavior were administered using a tape recorder, earphones, and an answer sheet which did not include the text.

RESULTS

In total, 1057 subjects were interviewed. Among 886 sexually active individuals, 7.8% had >1 sexual partner, 22.8% had premarital sex, 2.4% had anal intercourse, 4.1% had oral intercourse, and 2.3% had both anal and oral intercourse. Less than 2% reported past or current sexually transmitted diseases. Overall, 10.4% used condoms; only 11.2% for every sexual act. History of premarital and extramarital sex was higher in younger people.

CONCLUSIONS

Sexual norms in rural China are changing rapidly and high-risk sexual behavior among young rural residents is increasing. Strategies to prevent HIV/AIDS should include education to promote delayed onset of sexual activity, safer sexual behavior, and condom use.

Attitudes of professionals, students and the general public to HIV/AIDS and people with HIV/AIDS: a review of the research

This paper provides a review relating to the attitudes of health care professionals, students and the general public to HIV/AIDS and people with HIV/AIDS. This is done by describing the literature on attitudes to HIV and AIDS in three fields of research: medicine/nursing, psychology and the social sciences. In addition, we look at the countries in which research has been conducted in these issues and at the variety of tools and methodological approaches used and at the participants studied. The review shows that, during the 1990s, the research interest in issues related to HIV/AIDS attitudes has rapidly increased. Most of the work on HIV and AIDS has been done in the United States, with the main focus on empirical research using questionnaires. The attention has mostly been on students and their attitudes to AIDS/HIV and sexual behaviour, but increasing interest has also been shown in the attitudes of health care personnel and students. As it seems that attitudes have been highly resistant to change, more consideration needs to be given to finding appropriate ways of educating the general public, students and health care professionals. A comprehensive analysis is also needed of the different tools used in measuring attitudes and in international comparisons of the attitudes of adolescents, health care professionals and students towards AIDS and AIDS patients.