A cross-sectional study of knowledge, attitude and practices on HIV/AIDS among nursing students at a tertiary care centre, Hyderabad, India

INTRODUCTION

In 1981, when a growing number of young homosexual men died from odd opportunistic infections and rare cancers, the disease known as acquired immunodeficiency syndrome (AIDS) was first identified as a new disease. AIDS is a disease caused by the Human immunodeficiency virus (HIV).^1,2 It is one of the most serious infectious disease threats to public health, as well as a worldwide health issue.³

AIDS is a disease with a known route of transmission that is mostly preventable, but because the general public lacks knowledge and practice regarding HIV/AIDS, it spreads quickly in our nation. At the end of 2021, there were estimated 38.4 million HIV-positive individuals living in the world. Infections with HIV are expected to drop from 1.5 million in 2020 to 3,35,000 by 2030, and deaths from 6,80,000 in 2020 to under 2,40,000 in 2030, according to the WHO’s 2022-2030 global health sector strategy on HIV.⁴

According to the adult HIV estimated prevalence rates of 2019, Telangana has a prevalence of 0.49 percent compared to the national rate of 0.22 percent for 2019.⁵

The majority of health care is provided by nurses worldwide. Regarding the patients’ diagnostic requirements, therapeutic assistance, and psychological support, the nursing staff is crucial. They are primarily in charge of gathering blood and other laboratory samples, administering oral and parenteral medications, bed making, sending laundry, etc. They can be considered the lifeblood of every hospital.⁶

Patients with HIV and AIDS need specialised knowledge and attitudes from nurses. However, research has indicated that healthcare professionals, such as nurses, may have unfavourable attitudes toward those who are HIV and AIDS-positive. Discrimination and stigma are two examples of such negative attitudes. All initiatives to provide persons with HIV information, testing, treatment, and preventive measures to lower their risk of infection are thwarted by stigma and discrimination.⁷

In order to improve patient outcomes and thereby raise the standard of nursing care given, it is important to evaluate the knowledge, attitude, and practice of nursing students when caring for HIV patients.

METHODS

A cross-sectional study was done from January 2022 to February 2022 at a tertiary care centre involving first to fourth year nursing college students to assess the knowledge, attitude, practice on HIV/AIDS. Students were approached in their classrooms and allowed to participate in the study after detailed explanation regarding it.

The nursing students who gave informed consent for the participation in the study were included in the study. Out of the total 200 students (50 students intake per year) 156 agreed to participate in the study. Complete confidentiality of the information provided by the study participants was maintained and they’re free to drop from the study at any time. Details of the study subjects were recorded using a standard questionnaire which was used in several other studies.^8-12

Participants were asked to fill out a 48-item HIV/AIDS KAP questionnaire. with a 28-item HIV/AIDS knowledge scale, a 10-item attitude scale and a 10-item practices scale. The knowledge measure was based on an Eckstein (1987) instrument that asked respondents to respond with “true”, “false”, or “don't know” to items about disease presentation, transmission, precaution, and prevention. Correct answers were added up on a 28-point rating scale, which was then transformed into a 20-point scale score. Higher scores indicated greater levels of knowledge. The attitude scale, which included questions probing avoidance and empathic behaviour, was based on a tool for measuring attitudes among nurses toward patients with HIV/AIDS.¹³ A 5-point Likert scale was used to grade the scale, with higher scores indicating greater agreement, ranging from “strongly disagree” through “neither disagree nor agree”, to “strongly agree”.

The practice scale included items about the use of general precautions, and behaviour related to HIV testing and referral etc. Questions probing the use of universal precautions were scored as “yes”, “no” with higher scores indicating more adherence.

All the data collected was entered and analysed with MS excel software 2013 and Epi info 7.2.5.

RESULTS

HIV/AIDS-related knowledge of participants

In the present study, the participants had good knowledge about various aspects of HIV/AIDS. 97.4% responded correctly that HIV could be transmitted via blood transfusion, and 59% felt that all pregnant women infected with HIV would have babies born with AIDS. Almost 38.5% of the study participants responded that gloves and gowns are required to contact patients with HIV/AIDS. 92.3% felt contaminated needles should be recapped immediately after use on patients with HIV/AIDS to prevent accidental injury. 65.4% did not know that pulmonary TB is classified as a WHO clinical stage 2 condition (Table 1).

HIV/AIDS-related attitude of participants

The participants’ attitude was scored on a Likert scale (strongly disagree-strongly agree). 30.8% of the study participants disagreed that patients who are HIV- positive should not be put in rooms with other patients when admitted to the hospital. A similar number (30.8%) agreed that patients with HIV/AIDS have the right to the same quality of care as any other patient. Only 10.3% were always worried about getting HIV/AIDS from caring for a person with HIV/AIDS in their work environment. However, 33.3% strongly disagreed with marking the beds and files of HIV-infected persons as the means of identification to prevent medical and legal hazards (Table 2).

HIV/AIDS-related practice of participants

The frequency and percentage of response to various questions on the HIV/AIDS practice scale showed that 89.7% of the study participants encouraged people to get tested and counselled for HIV/AIDS. Most participants (82.1%) practiced universal blood and fluid body precautions in the workplace and most reported wearing gloves the last time they took a blood sample (89.7%). The study respondents (82.1%) also said they treated their patients respectfully irrespective of their HIV status (Table 3).

DISCUSSION

The overall knowledge in this study was similar to Boakye et al, Kiyene et al, Famoroti et al, Marranzano et al.^7,13-15 About 97.4% correctly identified that HIV spreads through blood transfusion. This is consistent with the findings of Boakye et al, Kiyene et al, Marranzano et al, and Shahzadi et al.^7,13-16 In a study by Kiyene et al, the study participants had a misconception that HIV can spread through casual contact.¹³ However, in the present study, there was no such problem. Contrary to CDC guidelines which note that to prevent needle stick injuries, health workers are mandated to discard used needles immediately after use and not recap them, 92.3% felt contaminated needles should be recapped immediately after use on patients with HIV/AIDS to prevent accidental injury. However, the knowledge gap noticed in the study by Kiyene et al was only 25%.¹³ In the present study, 59% felt that gloves and gowns are needed for any contact with HIV/AIDS.

Similar to the findings of this study, Boakye et al found that study subjects put on gowns and gloves for any contact with people living with HIV (65.7%).⁷ 51% of the health workers wore gloves for non-invasive procedures on HIV-positive patients in a study by Famoroti et al.¹⁴ Also, a study by Pudpong et al found that 31.8% of health workers use extreme personal protection measures, such as wearing double gloves when interacting with people living with HIV.¹⁷

In the present study, a good number agreed with the statement that patients with HIV/AIDS have the right to the same quality of care as any other patient (30.8%). This was similar to the findings of Boakye et al (29.8%) and Kiyene et al (40.5%).^7,13 However, the response to the statement that patients with HIV/AIDS should be treated with the same respect as any other patient was neutral in the present study, in contrast to studies by Boakye et al and Kiyene et al.^7,13

About 89.7% of the study participants encouraged people to get tested and counselled for HIV/AIDS, similar to Kiyene et al (78.9%) and Boakye et al (91.2%).^7,13 The practice of universal precautions by nurses (82.1%) was consistent with the findings of Boakye et al (86.2%).⁷ It was higher than the Kiyene et al study (61.8%).¹³ About 89.7% of nurses wore gloves before taking a blood sample, similar to Boakye et al and Kiyene et al.^7,13

CONCLUSION

Training regarding HIV/AIDS for nursing students is a critical aspect in boosting understanding, correcting misconceptions, fostering a positive attitude, and improving compliance with universal precautions and other preventative behaviors. It also helps to deliver effective and appropriate care to PLHIV while protecting themselves from infection.

ACKNOWLEDGEMENTS

The authors would like to thank the nursing college and tertiary care centre for allowing the researcher to conduct this study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

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