Human immunodeficiency virus related discrimination in general dentistry

A Cross-Sectional Study to Assess HIV/AIDS-Related Stigma and Its Drivers Among Dental Healthcare Providers in Islamabad, Pakistan

Introduction HIV-related stigma and discrimination among healthcare providers are some of the strongest obstacles to effectively responding to HIV and achieving health-related quality of life. In the Pakistani context, HIV-related discrimination has been explored mainly among people living with HIV (PLHIV), and no study has investigated HIV-related stigma from the perspective of dental healthcare providers. Aim This study aimed to investigate the HIV-related stigma among dental healthcare workers in Pakistan and understand the factors associated with it. Methodology This cross-sectional study was conducted for a period of three months (December 2021 to February 2022) among 601 consenting dental healthcare providers in all public and private dental healthcare facilities in Islamabad, Pakistan. Pretested questionnaires collected information on demographics, work-related characteristics, knowledge, attitudes, and practices regarding HIV/AIDS. HIV-related stigma was assessed through "the stigma index" developed by USAID and was measured as a continuous variable. Multivariate linear regression analysis evaluated the independent effect of different factors associated with HIV-related stigma. Results HIV-related stigma remains highly prevalent within both public and private dental healthcare facilities in ICT and among all cadres of dental healthcare providers. Among associated factors, misconceptions in HIV knowledge are highly significant (p < 0.001) and those with a higher score of incorrect HIV knowledge had higher levels of stigma. Healthcare providers who read any HIV-related manual or guidelines were found to be less stigmatized as compared to those who have not been exposed to any such literature (p=0.029). Dentists (p=0.04) showed higher levels of stigma as compared to dental assistants and dental hygienists, while employees of private hospitals (p=0.0) and private clinics (p=0.0) were far more stigmatized by HIV in comparison to dental healthcare providers in public hospitals. Conclusion This study provides the first-ever analysis of HIV-related stigma and its drivers in the dental healthcare settings in Pakistan and highlights multiple individual, clinical, and policy-level factors associated with it. In order to address this stigma, it is essential for healthcare institutions to create supportive and inclusive healthcare settings, by providing education and training to care providers in order to increase their understanding of the disease itself. In addition, healthcare institutions can take steps to ensure that their policies and practices are inclusive and non-discriminatory, such as implementing policies that prohibit discrimination based on HIV status and providing confidential care. On the other hand, care providers must work to recognize their own biases and strive to provide non-discriminatory and culturally sensitive care to all patients. The findings of this study could be used as a baseline and insight by organizations like the National AIDS Control Program into possible targets for future exploration and interventions to effectively reduce the stigma toward PLHIV in dental healthcare settings.

Attitudes and practices of dentists treating HIV+ patients in the era of new antiretroviral therapy: A 12-year update

During the first years of the HIV pandemic, the virus diffusion was responsible for discriminatory behavior from medical and dental care workers towards HIV-infected patients, as described by our research group in 2009. The aim of the current study was to provide an update on the previous data, investigating the presence of discriminatory behaviors, evaluating the level of dentists' knowledge about the virus and proposing strategies to be implemented to avoid professional exposure and cross-infections. This study was a cross-sectional, online, national survey on dentists, members of the main national dental associations (ANDI and AIO). The questionnaire was divided into four major sections, with the same structure as the questionnaire administered in 2009. The differences between groups were analyzed using the software program IBM SPSS Statistic, version 21.0. A total of 1054 dentists filled out the questionnaire completely. Among them 0.04% revealed a discriminatory attitude towards HIV-infected patients. The univariate analysis showed that discrimination towards HIV + patients was statistically associated with personal experiences and the level of fear associated with treating them (p = 0.001) and with the type of dental treatments performed (p = 0.01). This cross-sectional study revealed the persistence of dentists who still discriminate against HIV + patients, and the percentage of these dentists was only slightly lower than that in the previous survey (4.3% in the present survey vs. 4.5%). The survey also depicted other information worthy of consideration, such as a perceived ability to detect HIV + patients based on their appearance, complaints about not having received adequate training for treating HIV + individuals, and a lack of scientific knowledge about the virus. From the evidence reported by the present survey, it can be argued that universities, professional boards, and training institutions must increase their efforts in spreading correct knowledge about HIV among all dental care workers.

Knowledge and attitude of dental students toward HIV infection in Umm Al-Qura University, Saudi Arabia

Context

Immunodeficiency virus infection is a major health crisis. It can spread to other people by transmission of the body fluid. The knowledge about this viral infection can aid in preventing its transmission and help in delivering successful dental care to these patients.

Aims

To evaluate the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-related knowledge and attitude of dental students and also to compare knowledge and attitude between a student's gender and different clinical levels (second, third vs. fourth to seventh years).

Settings and Design

A cross-sectional study was conducted among dental students at the college of dentistry in Umm Al-Qura University in Makkah, KSA.

Methods and Material

A validated survey was sent electronically to dental students from the second year to seventh year. The questionnaire contained 12 knowledge and 13 attitude questions about treating HIV/AIDS patients. Descriptive statistics were presented for the knowledge and attitude of the dental students about HIV/AIDS. Also, the knowledge and attitude were compared using t-test in relation to gender and clinical year.

Results

The response rate was 65%. The mean and standard deviation (SD) for the knowledge score was 8.32 ± 1.60 out of 12. There was no significant difference between gender and a student's clinical level. In the majority of the attitude questions, more than half of the students had favorable attitude toward HIV/AIDS subjects. Females had more favorable attitude as well as students with more clinical years of experience.

Conclusions

Dental students showed acceptable knowledge and positive attitude toward HIV/AIDS patients. Students who were females and with higher clinical years demonstrated better attitude but similar knowledge to males.

Massive Open Online Courses for Health Worker Education in Low- and Middle-Income Countries: A Scoping Review

Background

Massive Open Online Courses (MOOCs) have the potential to improve access to quality education for health care workers (HCWs) globally. Although studies have reported on the use of MOOCs in low- and middle-income countries (LMICs), our understanding of the scope of their utilization or access barriers and facilitators for this cohort is limited. We conducted a scoping review to map published peer-reviewed literature on MOOCs for HCW education in LMICs. We systematically searched four academic databases (Scopus, Web of Science, PubMed, ERIC) and Google Scholar, and undertook a two-stage screening process. The analysis included studies that reported on MOOCs relevant to HCWs' education accessed by HCWs based in LMICs.

Results

The search identified 1,317 studies with 39 studies included in the analysis, representing 40 MOOCs accessed in over 90 LMICs. We found that MOOCs covered a wide range of HCWs' including nurses, midwives, physicians, dentists, psychologists, and other workers from the broader health care sector, mainly at a post-graduate level. Dominant topics covered by the MOOCs included infectious diseases and epidemic response, treatment and prevention of non-communicable diseases, communication techniques and patient interaction, as well as research practice. Time contribution and internet connection were recognized barriers to MOOC completion, whilst deadlines, email reminders, graphical design of the MOOC, and blended learning modes facilitated uptake and completion. MOOCs were predominantly taught in English (20%), French (12.5%), Spanish (7.5%) and Portuguese (7.5%). Overall, evaluation outcomes were positive and focused on completion rate, learner gain, and student satisfaction.

Conclusion

We conclude that MOOCs can be an adequate tool to support HCWs' education in LMICs and may be particularly suited for supporting knowledge and understanding. Heterogeneous reporting of MOOC characteristics and lack of cohort-specific reporting limits our ability to evaluate MOOCs at a broader scale; we make suggestions on how standardized reporting may offset this problem. Further research should focus on the impact of learning through MOOCs, as well as on the work of HCWs and the apparent lack of courses covering the key causes of diseases in LMICs. This will result in increased understanding of the extent to which MOOCs can be utilized in this context.

Evaluating Knowledge, Attitude, and Behavior of Dentists on HIV/AIDS in West Java, Indonesia, in the COVID-19 Era

Purpose

HIV/AIDS is still a serious public health problem in Indonesia. It has been concerned that the coronavirus disease 2019 (COVID-19) pandemic has a serious impact on people living with HIV (PLWH). Therefore, dentists remain to have a significant role to play in the overall healthcare delivery to PLWH and reducing new HIV infections. The purpose of this study was to assess the knowledge, attitudes, and behavior of dentists in West Java about HIV/AIDS in the COVID-19 era.

Methods

This cross-sectional study was conducted by distributing online questionnaires using a Google form to dentists in West Java. We used the purposive sampling technique to recruit the participants. The questionnaire consists of characteristics of respondents, 13 questions about knowledge, 9 questions about attitudes, and 6 questions about behaviors, which has previously been tested for validity and reliability. Data were analyzed using the Spearman correlation test and the Chi-square test. Results. The Questionnaire was sent to 435 dentists in the West Java region, Indonesia, with the assistance of the Indonesian Dental Association West Java region, to participate in this study. We received completed questionnaires from 209 (48%) respondents. The results of this study showed that 44% of dentists have good knowledge, 53% have a positive attitude, and 53% have positive behavior. No significant relationship was found between knowledge and attitudes (p=0.202) and behavior (p=0.087), but there was a significant relationship between attitudes and behavior (p=0.0001).

Conclusion

About half of the dentists in West Java have good knowledge, positive attitudes, and behavior towards HIV/AIDS, but the others lack knowledge, negative attitudes, and behavior. Continuing HIV/AIDS education and training programs for dentists are still needed to keep improving their knowledge and awareness to support disease prevention and control in this COVID-19 era.

HIV and stigma in the healthcare setting

People living with HIV (PLHIV) continue to endure stigma and discrimination in the context of health care despite global improvements in health outcomes. HIV stigma persists within healthcare settings, including dental settings, manifesting itself in myriad, intersecting ways, and has been shown to be damaging in the healthcare setting. Stigmatising practices may include excessive personal protective equipment, delaying the provision of care or unnecessary referral of PLHIV to specialist services in order to access care. The workshop entitled "HIV and Stigma in the Healthcare Setting" provided an overview of the concept and manifestation of HIV stigma and explored the disproportionate burden it places on groups that face additional disadvantages in accessing care. The final part of the workshop concluded with a review of institutional and community-based interventions that worked to reduce HIV stigma and group discussion of the ways in which these strategies might be adapted to the dental workforce.

HIV/AIDS-knowledge and attitudes in the Arabian Peninsula: A systematic review and meta-analysis

BACKGROUND

HIV/AIDS prevention has been widely adopted worldwide, but little is known about HIV/AIDS knowledge and attitudes in the Arabian Peninsula.

AIM

To summarize the level of knowledge and attitude about HIV/AIDS in seven Arabian Peninsula countries (Saudi Arabia, Oman, Kuwait, Qatar, Bahrain, Yemen, and the United Arab Emirates (UAE)).

METHODS

A systematic literature search was performed using combined keywords in four scientific databases of peer-reviewed publications from January 2010 to June 2019. Twenty-five articles were included in the systematic review, and twenty studies in the meta-analysis. The data was analyzed using a random-effect model due to the heterogeneity between the studies.

RESULTS

Seventeen studies reported on the level of knowledge and overall knowledge about HIV/AIDS in this region: 74.4% (95% confidence interval (CI): 66.8%-82.0%, p<0.001) and the attitude was 52.8% (95% CI: 36.9%-68.6%, p<0.001). A study from Oman reported higher knowledge levels (95.5%, 95% CI: 94.2%-96.8%) while less than a quarter of the Bahrain population had positive attitudes 22.5% (95% CI: 20.5%-24.5%). Medical doctors showed higher knowledge (94.1%, 95% CI: 92.9%-95.3%), but a positive attitude was only observed in 32.5% (95% CI: 28.8%-36.2%) of the dentists toward HIV/AIDS.

CONCLUSION

The overall knowledge about HIV/AIDS was found to be satisfactory (74.4%), but about half (52.8%) of those displayed negative attitudes toward HIV/AIDS. Regular training courses as well as reviewing and reinforcing HIV/AIDS prevention guidelines can be useful to update knowledge and improve attitudes in this region.