Knowledge, Attitude and Practice about HIV amongst the Medical Undergraduates of Bastar Region

Sanat Sharma*, Tabish Ahmed, Syed Sajid Ali, Raj Sharma, Devender Sachdev

Late Shree Baliram Kashyap Memorial Government Medical College Jagdalpur, Chhattisgarh

*Corresponding Author E-mail: sanatsharma.17@gmail.com

ABSTRACT:

“AIDS” is the acronym of “Acquired Immune-Deficiency Syndrome” which is a fatal disease described variously as modern plague, modern scourge, devastating disease, insidious microbiological bomb, biological disaster and so-on. It is a world health problem of extraordinary scale and extreme urgency. AIDS has emerged as one of the most important public health issues of the late twentieth and early twenty- first centuries and is now one of the leading causes of global morbidity and mortality.

HIV/AIDS, the disease, whose mode of transmission is known and is largely preventable, but due to lack of knowledge and practices about HIV in general population causes its rapid spread.

It is a well-known fact that the estimated prevalence of HIV infection among people of 15-49 years in India is almost1%. It has made our country to stand in second position among the list of countries having more number of HIV patients.

To assess the knowledge, Attitude, Practice amongst medical undergraduates of Government Medical College, Jagdalpur, Chhattisgarh.

The present cross sectional study was conducted on 100 medical undergraduates. The information concerning basic knowledge of HIV infection, its mode of transmission and methods of prevention were gathered in a predesigned and pretested questionnaire. The results of our study showed that all the medical undergraduates (100%) students heard about the infection. Television (95%) and Newspaper (81%) were the most common sources of information about HIV. Although, all of them had correct knowledge about the causative agent, but only 43% had knowledge about availability of drugs to halt the progression of infection in the body. The students excelled in their knowledge about availability of centres for diagnosis (73%). Majority of them (98%) were well informed about sexual route being the commonest mode of transmission. Misconceptions about transmission were also prevailing in the students. The study recommended the need for development and organization of HIV/AIDS training sessions at regular intervals from high school level to inception of medical curriculum.

KEYWORDS: Knowledge, Attitude, Practice, Medical undergraduates, HIV, Bastar region.

INTRODUCTION:

Acquired Immune Deficiency Syndrome or Acquired Immunodeficiency Syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). The HIV was first recorded in 1981 in gay men in USA. Within about two decades of the pandemic of HIV/AIDS has emerged as one of the most important and serious health problem.

HIV/AIDS has reached the pinnacle of the global health agenda. According to UNAIDS, an estimated 33.2 million people worldwide were living with HIV infection or disease by the end of 2007. HIV/AIDS is a life threatening disease. The majority of new infections occur in young adults. It is estimated that more than 40 million people between the ages of 15-24 will have contracted HIV by 2020¹. It affects all body systems as well as the mental health and social relationship of carriers and asymptomatic patients. WHO also reports that more than 45% of all new infections occur in people aged 15-24 years. Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS) is seen as one of the most devastating infection/disease known to have attacked the human population; reported to often affect the economically productive young adults. Developmental characteristics of young populations include a tendency toward risk-taking behavior and indifference to the importance of preventative measures. According to National AIDS Control Organization (NACO), the total number of people living with HIV/AIDS (PLHA) in India is estimated at 24 lakh (19.3-30.4) in 2009. Children (<15 yrs) account for 3.5% of all infections, while 83% are the in age group 15-49 years. Of all HIV infections, 39% (9.3 lakh) are among women. However, the adult HIV prevalence at national level has continued its steady decline from estimated level of 0.41% in 2000 through 0.36% in 2006 to 0.31% in 2009. All the high prevalence states show a clear declining trend in adult HIV prevalence².

The doctors would have to play a key role in providing care to HIV positive /AIDS patients. The medical students are the future doctors. Their responsible attitudes, which largely stemmed from adequate knowledge, may in turn help in educating and providing useful information to all other different kinds of health personnel in their surroundings and would also help to provide care to AIDS/HIV positive patients. Therefore, the comprehensive knowledge of the first year students who directly come from the common population is important to decrease fear and increase empathy in the community. Several studies have been conducted in our country regarding awareness and practices of various groups including various types of health personnel. The World Health Organization’s report on the role of HIV-related medical education in the South Asia region has also underscored the importance of including training in sensitivity, communication skills, and the development of compassionate attitudes toward HIV infected patients in the medical curricula³. Studies in India concerning HIV-related knowledge and attitudes amongst both health professionals and medical students suggest that early educational intervention has the potential to address the gaps both in knowledge and the negative attitudes directed towards those with HIV infection^4-6. But, only few studies are available with respect to medical undergraduates in our country.

MATERIALS AND METHODS:

In this present cross-sectional study, the participants were students studying in 1^styear, 2^nd year and final year of MBBS at Government Medical College. The students not present on the day of data collection were excluded from the study. Therefore, the total numbers of students enrolled in the study were 100. Data collection was done on a fixed day in the first week of February 2014. The questionnaire with different statements concerning basic knowledge of HIV infection, its mode of transmission and methods of prevention was distributed to all the enrolled students. A pre-designed, structured and self-administered questionnaire was used for the data collection. Questions were close ended with multiple answer type. The responses were noted and analyzed as correct response only. The overall response rates were computed for each response and presented in percentage form.

RESULTS:

All the students who were present on the day of data collection were included in our study. Completely filled up questionnaires were selected for analysis. The ages of the students were between 17 – 26 years. In our study, it was observed that all the students had heard the name of HIV/AIDS. They reported correctly that Human Immunodeficiency Virus was the causative agent of AIDS. The two most common sources of information regarding HIV were Television and Newspaper (Figure -1).

Figure-1 Sources of information*

*Multiple responses so total does not add up to100

However, 73% of them had the correct knowledge about the availability of ART centre to detect the infection among human beings in the college premises. Few students (43%) had knowledge about anti-retroviral drugs which are effectively used against progression of infection inside the body and about (92%) of them had correct knowledge about unavailability of vaccines to prevent or cure the infection (Table-1).

Table- 1 Knowledge about HIV

Awareness of student	Number	Percentage
Full form of AIDS	100	100
Attacks Immune System	100	100
Infectious Disease	100	100
Unavailability of Vaccine	92	92
Centre for Performing the test	73	73
Asymptomatic presentation of HIV possible	96	96
Availability of Medicines	43	43

Regarding awareness about established routes of transmission, majority of students (78-98%) had correct information about different modes of transmissions viz. sexual route (unsafe sexual practices – 98%), transmission through infected blood or its products (90%), Contaminated dentistry tools (78%), and sharing of food or utensils of the infected person (2%) (Figure-2).

The attitude of medical students towards people living with HIV either patients or staff living with HIV was diverse. Some of them had the misconception that the HIV positive patient should not to be treated as it may risk their life (4%) and the Hospital staff to be removed if tested positive (13%). (Table -2).

Table-2 Misconceptions amongst medical students towards people living with HIV

Misconception	Number	Percentage
HIV positive patient not to be treated as it may risk my life	4	4
Hospital staff to be removed if tested positive	13	13

In our study it was found that the knowledge about diagnosis, treatment and prevention of HIV as regards to the role of CD4 count (12%), level of decline of CD4/year required for diagnosis (32%) and groups of drugs used in HAART (Highly Active Antiretroviral Therapy) was low (30%) as also the knowledge regarding PEP (Post Exposure Prophylaxis) was inadequate (4%). (Table-3).

Table-3 Knowledge amongst medical students regarding diagnosis, treatment and prevention of HIV

Knowledge	Number	Percentage
Role of CD4 count	12	12
Decline of CD4cells/ul/year required for diagnosis of HIV(>100/ul/yr)	32	32
Initiation of ART if CD4 count is(<200/ul)	77	77
Testing for HIV should be made mandatory after completing internship	78	78
What is HAART?	34	34
Groups of drugs used in HAART	30	30
What are the regimens for PEP of HIV?	4	4

DISSCUSSION:

People living with HIV in India often experience discrimination while receiving health care. Inadequate knowledge and fear of HIV infected people have been identified as a serious problem among health care professionals considering themselves to be at risk of contracting the infection in India. These feelings of anxiety and fear concerning HIV infected people among Indian health care professionals results in their meting out derogatory behavior towards their HIV infected patients. Research in other countries has indicated the central role of medical education in improving knowledge of HIV risk and transmission and changing the attitudes of medical students as it is related to care of HIV-infected people^7-8.

The only way to combat a disease that has no effective treatment is by prevention. The best single way to prevent this disease is through education. Prevention of HIV/AIDS infection through continuing education is a key strategy for the control of the HIV/AIDS epidemic at least until vaccines and drugs are available, accessible and affordable to all the infected persons. Our study found that mass media (newspapers, magazines, television and radio) were the most common ways for participants to receive information about HIV/AIDS. This study confirms previous research findings from Yemen that television is the current and probably the future leading source of knowledge about HIV⁹. The fact that television is one of the few sources of information that is used equally by both males and females and is also important as it can be used to increase knowledge that was underlined by this study. The results of our study focused on the critical knowledge regarding the spread and risk of transmission among the newly admitted medical undergraduates. Though all the students in our study had heard about the HIV/AIDS and its causative agent, still their knowledge about availability of drugs was unsatisfactory (43%), whereas their response about unavailability of vaccines was good (92%).

However, the knowledge about availability of centres for diagnosis in our study was 73% as compared to the medical students of other countries, but better than the nursing students in our country^10-11. Knowledge about HIV infection pertaining to vaccine unavailability among the students in this study is ninety two (92%). Whereas knowledge regarding availability of medicines for halting the progression of infection in the body was moderate (43%). The similar results were also observed in the study conducted by Samant and Mankeshwar¹². In a study conducted by Brij Mohan andVashist among nursing students in India, they found that 10% of nursing students reported vaccine availability to prevent HIV¹³. Similar responses were also observed in nursing students in south western Nigeria¹⁴.

It is encouraging to note that the knowledge about transmission of infection through the sexual route (98%), by blood or its product (90%) and by use of contaminated dentistry tools were fairly high (78%) in our study subjects.

In our study, there were certain important misconceptions about transmission of infection by the treatment of the infected patient and also the removal of the staff afflicted by HIV. These misconceptions may reduce their efficiencies in providing care to affected groups in the community. These misconceptions need to be allayed during their medical teaching and trainings as it may have a great impact on the mindset of budding clinicians. It has been shown that people in the community who do not know much about AIDS or do not know anyone with AIDS have less positive attitudes towards people living with HIV/AIDS¹⁵.

There is a dire necessity that the medical curriculum emphasizes upon the diagnosis, prevention and treatment of HIV particularly as regards to the CD4 count (12%), its level of decline required for the initiation of treatment (32%) and special concern about the post exposure prophylaxis (4%) as the response of students was markedly low at these areas.

CONCLUSION:

This study is pertinent in the group of respondents, medical undergraduates in their basic medical sciences, who have little or no contact with patients yet, to view their knowledge towards the global fight against the spread of HIV. Findings of this study suggest that the students had satisfactory levels of knowledge on transmission and prevention of HIV/AIDS. The students still harbor negative attitude towards HIV/AIDS patients. Knowledge alone is not enough to change attitudes towards people having HIV/AIDS, but deep seated social and cultural factors such as religion, attitude towards ill-health and risk behaviors especially sexual behaviors can affect attitude too. The study thus concludes that educational intervention definitely has a positive impact on student’s knowledge. Thus, the Government should take initiative for the compulsory inclusion of HIV/AIDS education in school curriculum and train teachers to specifically teach issues pertaining to HIV/AIDS. It is recommended from these data that the need for development and organization of HIV/AIDS training sessions at regular intervals from high school level to inception of medical curriculum. Besides this, there is need to follow up the implementation of policy on HIV/AIDS education This will promote a good delivery of accurate information on HIV/AIDS to the public and health care personnel to provide proper patient care.

ACKNOWLEDGEMENT:

The authors would like to express their heartfelt gratitude to the medical undergraduates of Government Medical College Jagdalpur who participated in this study, needed a special mention for their cooperation in the successful completion of this study.

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Received on 26.03.2014 Modified on 12.04.2014

Res. J. Pharmacology & P’dynamics. 6(2): April- June 2014; Page 82-85