|Year : 2014 | Volume
| Issue : 2 | Page : 56-61
A survey of human immunodeficiency virus-related knowledge and attitude among dental professionals and students
Syeda A Ara1, Sajna Ashraf1, Syed Zakaullah2, Bhagyashree Patil1
1 Department of Oral Medicine and Radiology, Al Badar Rural Dental College and Hospital, Gulbarga, Karnataka, India
2 Department of Oral and Maxillofacial Surgery, Al Badar Rural Dental College and Hospital, Gulbarga, Karnataka, India
|Date of Acceptance||12-Jun-2015|
|Date of Web Publication||3-Jul-2015|
Syeda A Ara
Department of Oral Medicine and Radiology, Al Badar Rural Dental College and Hospital, Gulbarga, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Kimberly. A. Bergalis was one among the six patients infected with human immunodeficiency virus (HIV), the first reported case after visiting a dentist with acquired immunodeficiency syndrome (AIDS). As the number of patients with HIV/AIDS is increasing, the need for medical and dental care is also increasing. Practitioners have to enhance their knowledge about the disease, its manifestations, prevention, and management. Aim: The aim was to evaluate HIV-related knowledge and attitude among dental professionals and students. Methodology: This cross-sectional study was conducted using a questionnaire survey, which was distributed among 140 participants belonging to Al Badar Dental College and Hospital, Gulbarga, Karnataka. Result: The respondents overall mean knowledge score was good, 62.88%. The overall mean attitude score was 72.05% (7.92 ± 2.86) with a statistical significance (Z = 2.37, P < 0.05) shown by the males (79.68%, 8.76 ± 3.21) than females (67.72%, 7.44 ± 2.6). Conclusion: "Higher level of knowledge has higher attitude and willingness to treat HIV/AIDS patients," thus proving a need for a greater awareness among the undergraduates whose present level of knowledge is inadequate to function as part of a dental health care team in a country with a high prevalence of HIV. This article attempts to assess and reflect how much we need to improve our education system so as to be foolproof against this virus of mass destruction because forewarned is forearmed.
Keywords: Attitude, dental professionals, human immunodeficiency virus/acquired immunodeficiency syndrome, knowledge
|How to cite this article:|
Ara SA, Ashraf S, Zakaullah S, Patil B. A survey of human immunodeficiency virus-related knowledge and attitude among dental professionals and students. J HIV Hum Reprod 2014;2:56-61
|How to cite this URL:|
Ara SA, Ashraf S, Zakaullah S, Patil B. A survey of human immunodeficiency virus-related knowledge and attitude among dental professionals and students. J HIV Hum Reprod [serial online] 2014 [cited 2018 Feb 14];2:56-61. Available from: http://www.j-hhr.org/text.asp?2014/2/2/56/159971
| Introduction|| |
Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is a globally emerging public health problem. India alone accounts for over 2.5 million people living with HIV/AIDS (PLWHA) with a prevalence of 0.91%. 
Dental therapeutic procedures frequently involve blood and saliva that may contain a variety of blood-borne pathogens and microorganisms. The oral environment has become a tool for early detection as most lesions of HIV infection present orally during the first stages of the disease. Hence, the dentists fall into the high-risk category for cross-contamination. ,
According to the World Health Organization, it is imperative for all dentists to treat HIV-positive patients. Despite these recommendations, dentists are reluctant or refuse to treat HIV/AIDS patients due to lack of knowledge and ignorance about the disease.  Willingness to treat patients with HIV/AIDS appears to be related to knowledge of the disease process, recognition of oral manifestations, and understanding of modes of transmission. Increasing knowledge of issues concerning HIV has led to increased willingness to treat HIV-positive patients by dental professionals. 
Aim of the study was to assess knowledge, attitudes, and practices among dental professionals and students in Dental College and Hospital, Gulbarga, Karnataka.
| Methodology|| |
This cross-sectional study was conducted utilizing questionnaire survey format among 140 participants belonging to Al Badar Dental College and Hospital and Private practitioners in and around Gulbarga, Karnataka. The questionnaire was adapted from the survey questionnaire used by Shinde et al.  in a previous study with some modifications.
Study samples were divided into three groups, which were chosen as representatives of the strata of hierarchy in dental education.
The study subjects participated voluntarily in the study and were asked to report about their gender, age, year of study, and years of experience.
- Group A: 37 MDS and 23 BDS faculty
- Group B: 34 post-graduate students
- Group C: Dental students including 17 intern dentists and 29 final year dental students.
The questionnaire included 32 close-ended questions to evaluate participants' knowledge and attitude toward PLWHA and willingness to treat these patients. For every correct answer, a score of 1 was assigned and a score of 0 for every incorrect answer. The total score for each participant was obtained by adding the score of each answer. Score of 75% and above, between 50% and 74%, between 25% and 49%, and score <25% was considered as excellent, good, moderate, and weak knowledge, respectively. Score of 75% and above, between 50% and 74%, and <50% were considered as positive, negative, and passive attitude, respectively.
All the statistical data were analyzed using SPSS statistics version 10.0 software (IBM). Z-test for comparing the knowledge and attitude score distribution among different groups and unpaired t-test for comparing the gender score distribution.
| Results|| |
The response rate was 140 (100%). The sample was composed of 63 (45.0%) males and 77 (55.0%) females [Table 1].
The age of the participants ranged from 22 to 40 years with a mean age 28 ± 4.36 years and the male: female ratio was 1:1.14. There were 21 questions in the questionnaire to test their knowledge on HIV/AIDS. The respondents overall HIV/AIDS knowledge score was good, 63.03%. The knowledge score of different groups was 68.0%, 60.79%, and 60.37% for groups A, B, and C, respectively. There was no statistical significant difference in the knowledge among males and females (Z = 0.84, P > 0.05) [Table 2].
|Table 2: Percentage of knowledge score distribution of different groups and statistical significance |
Click here to view
When the comparison of knowledge between different groups were done, there was a statistical significance with Group A to Group B and Group A to Group C, but statistically no significance with Group B to Group C [Table 3].
When comparison of knowledge score among males and females in each group were done, no statistical significance (NS) were shown among groups A and B. However, there was a statistical significance among group C indicating female's higher knowledge than males [Table 4].
The maximum score (99%) was for the question "sexual intercourse can spread HIV/AIDS" and the minimum score (5.76%) was for the question "contact feces can spread HIV/AIDS" [Table 5].
There was a statistically significant difference in the mean knowledge percentage score of MDS faculties when compared to the BDS faculties [Table 6].
|Table 6: Comparison of knowledge percentage score of MDS to BDS faculties |
Click here to view
The total average attitude score was 79.58%, 67.9%, and 64.91% for group A, B, and C, respectively, which was highly statistically significant with Group A to Group B and Group A to Group C, but not significant with Group B to Group C [Table 7]. The overall mean attitude score was 72.05% (7.92 ± 2.86) with a statistical significance (Z = 2.63, P < 0.05) shown by the males (79.68%, 8.83 ± 3.42) than females (67.70%, 7.44 ± 2.6) [Table 8]. The highest positive attitude score (94%) was obtained for the question no. 1 by Group B and minimum negative attitude score (16.17%) for question no. 8 by Groups C by referring the patient to HIV specialty center [Table 9].
|Table 8: Percentage of attitude score among males and females in different groups |
Click here to view
|Table 9: Attitude toward and willingness to treat HIV/AIDS in percentage |
Click here to view
Comparison of attitude percentage score of MDS to BDS faculties was statistically not significant [Table 10].
|Table 10: Comparison of attitude percentage score of MDS to BDS faculties |
Click here to view
The results show a positive correlation between attitude and knowledge score (r = 0.86, P < 0.01) thus stating "higher the knowledge has higher the attitude and willingness to treat HIV/AIDS patients."
| Discussion|| |
This study reveals that the comparison between genders had no statistical significance, but when compared between the groups, females in Group C had higher knowledge than males agreeing with Al-Naimi et al.; whereas no statistical difference was noticed in Group A and B. The female participants in the study showed less positive attitude and willingness to treat such patients.
The group wise comparison results showed higher statistical significance in group A in their knowledge and attitude toward treating HIV/AIDS patients than group B and C.
In our study, the mean knowledge about HIV/AIDS patients was good (Group A = 68.01%, Group B = 60.79%, Group C = 60.37%) which agrees with Ragavendra et al., but contradicts with the study conducted by Shinde et al. where it was poor.
A study done among slum dwellers in another metropolitan city of India (Chennai),  showed that 67% males and 55% females were aware of the sexual mode of transmission, as compared to 90% in Ragavendra et al. and 99% in our study population. In the same study,  45% males and 62% females thought AIDS could spread through mosquito bites when compared to 22.75% in our study.
The results also show that only 58.36% knew about HIV transmission through breastfeeding but 98.51% were aware of HIV transmission through needle sharing, agreeing with 48% and 94%, respectively, of study population from coastal Karnataka. 
Irrespective of the study group, salivary and aerosols contamination in dental practice was considered as means of HIV transmission by the majority of the study subjects and most participants thought that special dental clinic setups were required to treat HIV/AIDS patients, both statements agreeing with Patil et al. study. This highlights the fact that there is a lack of practical exposure for students in delivering dental care to PLWHA.
It is noteworthy that when 95.28% responded the necessity of routine HIV/AIDS test for all surgical patients, 80.62% and 79.36% responded that it is not necessary to do routine HIV/AIDS test for all exodontia and periodontia patients, respectively. However, considering the risk of HIV/AIDS transmission through blood and blood products, the routine HIV/AIDS tests must be made mandatory before any major or minor surgical procedure.
Overestimation of the transmission risk of HIV seemed to be the most important reason for fear in providing dental care to HIV/AIDS patients.  Universal precaution is adequate for prevention of HIV transmission in oral healthcare setting, yet 98.21% in our study and 87.6% in Ragavendra et al.'s study population believed that extra infection control precaution is needed while treating HIV-positive patients. This response is an obvious revelation of deficiencies in HIV/AIDS knowledge and infection control among respondents. A moderate knowledge with respect to modes of HIV transmission and infection control practice was reported by Sadeghi and Hakimi  and among Iranian dental students, by Ryalat et al. in Jordanian student. 
In our study, when made to indicate the most common opportunistic infection, majority answered pseudomembranous candidiasis, which agrees with the results from Ragavendra et al.  Al-Naimi and Al-Saygh,  and Sadeghi and Hakimi. 
Our study found that attitudes toward treating HIV/AIDS patients were positive and were high with male participants than female participants (79.68% and 67.72%, respectively). Attitude factors significantly associated with the willingness to treat these patients were the following: Ability to treat infected patients safely, feeling a moral responsibility, and believing that HIV/AIDS patients can live with others.  In this study, the general willingness to treat HIV-positive patients was 72.05%. However, our results regarding this factor were lower than the findings of Shinde et al.  Only 43.82% participants in our study had no previous professional contact with HIV/AIDS patients. This is less when compared to Ragavendra et al. (77.9%).
In our study, 52.31% and 62.15% stated that they will accept and will provide care and support to a colleague and a friend or spouse if he or she is HIV-seropositive. This again agrees with the findings from Patil et al. study. It was noted that 91.44% respondents were in support premarital HIV testing which coincides with Azodo et al. 
From the study, we also found that Group A had the higher knowledge (68.01%) so also the willingness to treat such patients (79.54%) when compared to the other groups.
| Conclusion|| |
Only education can dispel ignorance. From this study, it can be concluded that, 86.48% of MDS participants declared that they will treat HIV/AIDS patients which is more when compared to BDS faculties, post-graduate students, dental interns, and dental students; once again stating the high knowledge level of MDS (71.78%) in this situation. The results also indicate that the dental students are not well prepared to treat HIV/AIDS patients and are unsympathetic toward this group of patients. Dental students must, therefore, be made aware of and should understand the importance of treating HIV/AIDS patients. This can be achieved by proper modeling and making the students more sensitized toward PLWHA apart from giving appropriate knowledge of the disease, regarding its mode of transmission, recognition of oral manifestations, treatment, and monitoring the condition. To achieve these aims, an essential improvement in the dental school curriculum is required.
| References|| |
Patil PB, Sreenivasan V, Goel A. Knowledge of HIV/AIDS and attitude of dental students towards HIV/AIDS patients: A cross-sectional survey. J Educ Ethics Dent 2011;1:59-63.
Sadeghi M, Hakimi H. Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. J Dent Educ 2009;73:740-5.
Ragavendra TR, Mhaske S, Mandora D, Gouraha A. Awareness toward AIDS: A dental perspective. J Orofac Res 2013;3:81-5.
Shinde N, Baad R, Nagpal DK, Prabhu PR, Surekha LC, Karande P. Managing HIV/hepatitis positive patients: Present approach of dental health care workers and students. J Contemp Dent Pract 2012;13:882-5.
Kalasagar M, Sivapathasundharam B, Einstein TB. AIDS awareness in an Indian metropolitan slum dweller: A KAP (knowledge, attitude, practice) study. Indian J Dent Res 2006;17:66-9.
Unnikrishnan B, Mithra PP, Rekha T, Reshmi B. Awareness and attitude of the general public toward HIV/AIDS in coastal Karnataka. Indian J Community Med 2010;35:142-6.
Ryalat ST, Sawair FA, Shayyab MH, Amin WM. The knowledge and attitude about HIV/AIDS among Jordanian dental students: (Clinical versus pre clinical students) at the University of Jordan. BMC Res Notes 2011;4:191.
Al-Naimi RJ, Al-Saygh GD. Knowledge, attitude and health behavior of dental students towards HIV patients. Al Rafidain Dent J 2009;9:110-9.
Azodo C, Umoh A, Ezeja E, Ukpebor M. Survey of HIV-related knowledge and attitude among dental nursing students in South Western Nigeria. Benin J Postgrad Med 2007;9:1-12.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]