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Journal of Infectious Diseases and Medicine
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HIV Knowledge and Awareness Status of the Medical Students in Romania: An Awareness Study

Florida Parcaoglu1 and Habip Gedik2*

1School of Medicine, Grigore T. Popa University of Medicine and Pharmacy Strada Universității 16, Iași, Romanya

2Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Türkiye

*Corresponding Author:
Gedik H
Department of Infectious Diseases and Clinical Microbiology
Ministry of Health Bakırköy Sadi Konuk Training and Research Hospital
İstanbul, Turkey
Tel: +90 212 414 53 09
E-mail: [email protected]

Received date: August 03, 2017; Accepted date: August 07, 2017; Published date: August 14, 2017

Citation: Parcaoglu F, Gedik H (2017) HIV Knowledge and Awareness Status of the Medical Faculty Students in Romania: An Awareness Study. J Infect Dis Med 2: 111.

Copyright: © 2017 Parcaoglu F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Objective: We aimed to evaluate the status of knowledge and attitudes of medical students about HIV/ AIDS. Material and methods: In this descriptive, cross-sectional survey study, the status of knowledge and attitudes of medical students of Grigore T. Popa University of Medicine and Pharmacy about HIV/AIDS in June 2017 were evaluated. Results: A total of 85 medical students answered all of our 19 survey questions. The mean age was 21.80 ± 1.37 years (Range: 19-24 years). In the second question, six out of the 15 choices were correct and the mean of correct answers was 4.41 ± 1.49. There was a significant relationship between the grade of the students and the level of knowledge in the responses to the seventh question (p: 0.024). Conclusion: It is obvious that there are needed more health- informative organizations targeting the young population especially at schools and universities about sexually transmitted diseases, especially HIV/AIDS – transmission routes, misconceptions about HIV, prevention measures and life expectancy after HIV acquirement. Those programs may raise the HIV awareness and be useful to change the behaviour against HIV patients eliminating stigma.

Keywords

HIV; AIDS; Awareness; Students; Medical faculty; Attitude; Romania

Introduction

Human immunodeficiency virus (HIV) has been causing one of the devastating pandemics and has a great impact on society due to its history of evolution. Acquired immunodeficiency syndrome (AIDS) was publicly reported in 1981 by the Centres for Disease Control (CDC) in the USA. Doctors reported the unexpected clusters of extremely rare diseases, such as Pneumocytis carinii pneumonia and Kaposi’s sarcoma. Those conditions manifested in a defined risk group, such as young homosexual men. After a short time, the disease had been recognized in other groups, including hemophiliacs, blood transfusion recipients, and intravenous drug users. By 1982, cases were being seen among the partners and infants of those infected with HIV [1,2]. HIV is transmitted by contact with an infected persons’ certain body fluids, such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, breast milk and by sharing needles/syringes (primarily for drug injection), and rarely through the transfusions of infected blood [3].

The World Health Organization (WHO) and the Joint United Nations Program on HIV and AIDS (UNAIDS) reported that 36.7 million people were living with HIV globally; 2.1 million people became newly infected, and 1.1 million people died of HIV related causes at the end of 201 [4]. The first HIV case was reported in Romania in 1985. Of 18,797 HIV/AIDS cases registered between 1985 and 2013, 55% were male [5]. The rates of new cases with HIV increased 17.9%; 47.3% between 2009 and 2010; and 20.3% between 2011 and 2012 [6,7]. According to report of Romanian Ministry of Health, National Institute for Infectious Diseases “Prof. Dr. Matei Bals” Compartment for Monitoring and Evaluation of HIV/AIDS Data 2012, the number of HIV cases was 416 in the age group 1-19 years, while it was 4813 in the age group 20-24 years [7]. The age group 20-24 years is generally the college students at high risk for the sexually transmitted diseases due to the risky attitudes in their sexually active life.

The studies, which were conducted in different countries regarding awareness of HIV/AIDS among college students, have reported that students had insufficient knowledge about HIV prevention, the protection against HIV, and transmission routes of HIV [8-11]. Throughout the world, young people are the highest risk group. Their awareness and knowledge on the transmission routes and prevention of HIV/AIDS is very important. It was reported that the HIV awareness programs had a significant impact on the community [12]. Medical students are also trained about all HIV during their education, so their knowledge about HIV should be at the top level to inform their circles and the community. For that reason, we aimed to evaluate the level of knowledge and attitudes of medical students about HIV and AIDS.

Material and Methods

The purpose of this descriptive, cross-sectional survey was to evaluate the knowledge and perceptions of the medical students of Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania about HIV and AIDS. The samples were not selected for the survey study, and the survey was applied to students that agreed to participate in June 2017 at Grigore T. Popa University of Medicine. The characteristics of the students included gender, age, and grade in the faculty. The duration of training is six years in the medical faculty, so students were categorized into six grades. There was no question about the identity of the participant.

The questionnaire was written in English. The structured questionnaire included 19 questions. Students were asked to choose single answer, multiple answers, or yes/no in the questionnaire. The questions were about HIV definition, early sign and symptoms, modes of transmission, attitudes, and perceptions towards HIV positive patients, prevention measures, detection of disease, consultations choices.

Statistics

Data are analysed using SPSS 23.0 (Chicago, IL, USA). Continuous variables were described as mean ± standard deviation and range. Percentile values were described with decimals. Dichotomous variables were compared by Fisher's exact test for two by two comparisons or Pearson χ2 for greater than two responses. P-value < 0.05 was considered as significant. The P1 indicates the statistical comparison of the responses between men and women. The P2 indicates the statistical comparison of the responses by the grades of the students.

Results

A total of 85 medical students, who comprised of 46 females and 39 males, answered all of our 19 survey questions. The mean age was 21.80 ± 1.37 years (Range: 19-24 years). The numbers of students with the grades of medical faculty were four (4.7%) in 1st grade, 12 (14.1%) in 2nd grade, 23 (27.1%) in 3rd grade, 10 (11.8%) in 4th grade, 30 (35.3%) in 5th grade, 6 (7.1%) in 6th grade.

The questions and responses of the students have been revealed in Table 1. On the second question, six out of the 15 choices were correct and the mean of correct answers was 4.41 ± 1.49 (Range: 1-6). There was a significant relationship between the grade of the students and the level of knowledge in the responses to the seventh question (p: 0.024). Since the fourth and fifth graders had more knowledge about HIV than those in other grades. There was found a significant relationship between choosing the correct answer and the grades of the students in the eighth question about the protection of the contraceptive pill against HIV (p: 0.0005). The high rates of wrong answers (26%) of fifth graders caused that significant relationship. There was found a significant relationship between the correct response and the grade of the students in the 17th question about HIV prevention (p: 0.001). The numbers of wrong answers were higher in the first and second graders, and the fact that nearly half of the students in third grade responded false caused a significant difference.

Questions   n % P1 P2
1. HIV stands for Human Immunodeficiency Virus Correct 82 96.50%    
FALSE 3 3.50%    
2. HIV can be transmitted by Coughing and sneezing 3 3.50%    
Sharing glass with someone 3 3.50%    
Sexual Intercourse 81 95.30%    
Sharing toilet seats with an infected person 5 5.90%    
Mosquito bite 12 14.10%    
Blood 82 96.50%    
Semen 56 65.90%    
Vaginal fluids & rectal fluids 68 80%    
Saliva, urine, sweat 11 12.90%    
breast milk 41 48.20%    
Hugging and kissing with an infected person 4 4.70%    
Sharing razor blades 47 55.30%    
Sharing towels 2 2.40%    
  Mouth to mouth resuscitation 8 9.40%    
3. Choose the wrong answer regarding AIDS AIDS and HIV refer to same thing, a virus. 25 29.40%    
AIDS stands for Acquired Immunodeficiency Syndrome        
AIDS is a stage of HIV infection 60 70.60%    
HIV leads to AIDS        
If HIV infection is left untreated, immune system fails to        
fight and this stage is called AIDS        
4. HIV attacks and destroy the immune system  Correct 85 100%    
 False - -    
5. I have a friend or relative infected with HIV Yes 3 3.50%    
No 82 96.50%    
6. If I know a person is infected with HIV I would never meet with that person again 2 2.40%    
I would still keep my friendship or relationship with that person 78 91.80%    
I would never eat the meal that person cooks 6 7.10%    
I would never touch that person 3 3.50%    
I would never use the items of that person 22 25.90%    
I would never kiss that person 15 17.60%    
I would never shake hands with that person 1 1.20%    
I would tell that person’ s disease to everyone 4 4.70%    
I would never share the same apartment 13 15.30%    
7. I have information about HIV   - -   0.024
 not at all          
 little 12 14.10%    
enough 59 69.40%    
too much 14 16.50%    
8. Is birth control pill effective for HIV prevention? Correct 65 76.50%   0.0005
FALSE 20 23.50%    
9. If you have a sexual course with a person whom you do not know before or history of diseases, would you use condom? Depends on person 11 12.90%    
Depends on my feelings 2 2.40%    
No  2 2.40%    
I always use condom   70 82.40%    
Condom is too tiring - -    
10. Do you know the early signs or symptoms of HIV infection? Correct 82 96.50%    
FALSE 3 3.50%    
           
11. If your mother, or father, or wife, or husband, or child acquired HIV after a blood transfusion, how would you behave him/her after you knew that situation? I would not be in the same room 1 1.20%    
I would never meet again 1 1.20%    
I would meet but avoid close relationship 9 10.60%    
I would keep my relation like in the past 77 90.60%    
12. Do you know how HIV diagnosed is? Blood test 83 97.60%    
Chest X-RAY - -    
MRI/CT 1 1.20%    
Visual Acuity Test 1 1.20%    
Testing of hormone levels in blood        
13. If I have a question about HIV, I would ask to my friend 1 1.20%    
I would ask to Goggle 31 36.50%    
I would ask to a doctor 53 64.20%    
14. If I have a HIV suspicious event or a situation, I would not mind, it cannot be transmitted to me 1 1.20%    
I would commit suicide 2 2.40%    
I would go to hospital 76 89.40%    
I would search in Google 6 7.10%    
15. Choose the wrong answer regarding the stages of HIV infection 3 stages; Acute, Chronic and AIDS        
Acute infection is the earliest stage, develops within 2-4 weeks        
Chronic infection is the second asymptomatic stage        
AIDS is the last stage of the HIV infection        
Opportunistic infections occur in chronic stage        
 Correct 29 34.10%    
FALSE 56 65.90%    
16.  Choose the correct answer regarding HIV If a pregnant woman is infected with HIV, her baby will be infected with HIV too        
Showering after sexual intercourse prevents HIV transmission        
HIV can be transmitted by blood transfusion        
Every person who is infected with HIV has AIDS        
Female condoms are not effective in prevention of HIV transmission        
Correct 71 83.50%    
FALSE 14 16.50%    
17. Choose the correct answer regarding HIV       0.001  
There is a vaccine for HIV prevention        
Antibiotics are first line treatment for HIV infection        
HIV is not transmitted by anal intercourse and oral intercourse        
Condoms are absolute protection against HIV        
HIV can be transmitted by getting a tattoo        
Correct 52 61.20%    
FALSE 33 38.80%    
18. Which one of those is not preventive measure for HIV transmission? Consistent and correct use of latex condom during sexual intercourse        
Avoiding multiple sexual partners        
Healthy diet and exercise        
Avoiding contact with people living with AIDS         
Avoiding use of others personal hygiene belongings        
Correct 55 64.70%    
FALSE 30 35.30%    
19. If you were informed to have HIV infection, what would you do? I would commit suicide 1 1.20%    
I would never meet with any person 1 1.20%    
I would never mind, I would keep my life living 2 2.40%    
I would receive HIV counseling from a HIV-specialist, and try to start antiretroviral treatment as soon as possible 3 3.60%    
I would transfer the virus other people not to inform them during sexual course 78 91.8    

Table 1: Survey questions and response rates.

Discussion

College students are one of the groups at higher risk of HIV infection, and some of them lack proper knowledge regarding the disease due to lack of knowledge and training at educational institutes [13]. HIV awareness should be kept at a higher level, as they may instruct people about HIV during their social contact. In this study, the majority of students demonstrated a sufficient knowledge about HIV transmission routes, risky behaviours, and HIV prevention. However, there are still some misconceptions needed to be corrected among students [13].

Our study findings indicated that medical doctors and medical centers are commonly preferred to receive information about HIV/ AIDS, followed by the Internet. Preparing brochures and the training programs about HIV and other sexually transmitted diseases are performed at hospitals and community health centers may be useful to instruct students and people. Since people commonly hesitate to ask questions and to receive information about HIV. The Internet, which was the second preferred information source in our study, may be an important tool to inform the people and to increase their awareness about HIV/AIDS. The projects, including a direct counselling by an interview on the Internet or a communication with HIV related associations or non-governmental organizations as well as the websites to provide correct information about HIV/AIDS [14]. Since people frequently use the Internet to obtain information. Although all the students have revealed that they have information about HIV/AIDS, 30% of them did not know the difference between HIV and AIDS and several students did not know the all transmission routes of HIV exactly. The misconceptions about the transmission of HIV, such as hugging and kissing, sharing glasses with an infected person, mosquito bites, and sharing toilet seat, cause stigma against HIV positive people. Our findings were consistent with the findings of the other published studies in China, Turkey, India, and the USA [15-19]. Therefore, it is essential to introduce and provide the accurate information about the transmission routes of HIV to decrease the misconceptions, prejudice, and stigmatization [20].

Almost all of the students revealed that their attitudes towards people living with HIV/ AIDS were positive. However, approximately 20% of the students responded that they would not share an apartment, not use items of an infected person, and not kiss in related to the misconception of transmission routes, in. It should be emphasized in the seminaries about HIV/AIDS that HIV is not transmitted during a social relationship with HIV-positive people. There could be a social problem when HIV positive people are stigmatized in the society [21]. HIV related associations, foundations, and non-governmental organizations should organize informative meetings for the community to prevent the stigma.

There was a sufficient knowledge among the students about using condom as a way of prevention of sexually transmitted diseases, but some of the students revealed that they use condom depend on their feelings or partners. Condom use is not at the desired level yet. The cognitive and emotional variables, cultural aspects of perceptions regarding condom were reported to be factors related to insufficient condom use [22,23]. Condom use should be encouraged by the advertisements and projects [24]. Only 76% of the students knew the ineffectiveness of birth control pills against HIV protection. That shows the gap in the knowledge about protection against HIV.

Even though most of the students responded that they would receive HIV counselling from an HIV specialist and try to start antiretroviral treatment as soon as possible, some students might either commit suicide or get isolated from the community, if they were diagnosed with HIV. HIV- related stigma, discrimination, prejudice, negative attitudes, and abuse were reported to be in 35% of countries and over 50% of people as the main reasons related to suicide and isolation from community [25]. Stigma, which causes poor treatment, detergency in educational and work settings, erosion of HIV-positive patients’ rights, and psychological damage, is still a big problem through the world for HIV-positive patients. At this point, it should be pointed out that HIV is a chronic disease and it is possible to live a healthy and quality life for many years with antiretroviral therapy.

We found a significant difference between knowledge of pre-clinical (grade 1 and 2) and clinical medicine (grade 3, 4, 5, and 6) students. It was reported that informative activities should be started in the early years of study to increase the knowledge [26,27]. Superficiality and insufficiency of information about HIV/AIDS in the curriculum of preclinical years in the medical schools can be related to our findings [28].

The limitation of this study include that there were an insufficient number of students from each grade, as the number of students in each grade were different. It would be more appropriate if a study were conducted with the sufficient number of students from each grade in order to evaluate students' knowledge status. The curriculum of the medical faculty and the presence of informative organizations about HIV were not evaluated to assess the effectiveness of them among the students in our study as well.

As a result, it is obvious that there are needed more healthinformative organizations targeting the young population especially at schools and universities about sexually transmitted diseases, especially HIV/AIDS – transmission routes, misconceptions about HIV, prevention measures and life expectancy after HIV acquirement. Those programs may raise the HIV awareness and be useful to change the behaviour change against HIV patients eliminating stigma. The dissemination and integration of HIV modules in the pre-medical faculties are needed to raise the information level about HIV and the social responsibility projects should be encouraged to raise the awareness of targeted social groups.

Acknowledgement

There is no conflict of interest.

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