Knowledge about HIV and Stigmatizing Attitudes of Medical Students in Saudi Arabia Towards Patients with HIV/AIDS: A Cross-Sectional Nationwide Study
- Authors: Hakami E.1, Alghamdi A.2, Alwayel Z.A.3, Hakami F.1, Almurakshi M.4, Alghamdi O.5, Ghazzawi M.4, Alhazmi A.1
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Affiliations:
- Faculty of Medicine, Jazan University
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences
- , Ministry of Health
- Faculty of Medicine, Umm al-Qura University
- Department of Preventive Medicine, King Abdulaziz Medical City, National Guard Health Affairs
- Issue: Vol 22, No 4 (2024)
- Pages: 249-258
- Section: Medicine
- URL: https://rjsvd.com/1570-162X/article/view/644115
- DOI: https://doi.org/10.2174/011570162X306347240617192913
- ID: 644115
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Full Text
Abstract
Background:The Human Immunodeficiency Virus (HIV) and the social stigma directed toward patients with HIV are serious public health issues. We aimed to evaluate the HIV knowledge base and stigmatizing attitudes toward patients with HIV among students enrolled in medical schools in Saudi Arabia.
Methods:This cross-sectional study included students at medical colleges in Saudi Arabia and was conducted between February and March 2023. We used non-random convenience sampling with an online chain referral via a validated Arabic questionnaire composed of 35 questions. Data were analyzed using descriptive and comparative statistics.
Results:A total of 1,213 medical students (women: 56.6%) participated in the study. Students in clinical years had a higher level of HIV knowledge than their pre-clinical colleagues. Logistic regression analysis revealed that participants who gave incorrect answers to questions related to mother-to-child and casual contact HIV transmission had a higher likelihood of harboring a negative attitude towards patients with HIV. Conversely, those who correctly answered queries on prevention and treatment were less likely to have stigmatizing attitudes. A significant proportion of this cohort harbored negative attitudes toward patients with HIV, with the sex and geographic location of participants being significant predictors of negative attitudes.
Conclusion:Our data have revealed a significant percentage of medical students in Saudi Arabia to have misconceptions about HIV transmission and prevention, and stigmatizing attitudes toward patients with HIV, indicating a need for targeted interventions to enhance the HIV knowledge base in this population of future caregivers.
Keywords
About the authors
Ehab Hakami
Faculty of Medicine, Jazan University
Email: info@benthamscience.net
Abdulaziz Alghamdi
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences
Email: info@benthamscience.net
Zahraa Ali Alwayel
, Ministry of Health
Email: info@benthamscience.net
Fatimah Hakami
Faculty of Medicine, Jazan University
Email: info@benthamscience.net
Muhjah Almurakshi
Faculty of Medicine, Umm al-Qura University
Email: info@benthamscience.net
Ohoud Alghamdi
Department of Preventive Medicine, King Abdulaziz Medical City, National Guard Health Affairs
Email: info@benthamscience.net
Manar Ghazzawi
Faculty of Medicine, Umm al-Qura University
Email: info@benthamscience.net
Abdulaziz Alhazmi
Faculty of Medicine, Jazan University
Author for correspondence.
Email: info@benthamscience.net
References
- Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system. BMC Infect Dis 2020; 20(1): 663. doi: 10.1186/s12879-020-05379-8 PMID: 32907539
- Vidya Vijayan KK, Karthigeyan KP, Tripathi SP, Hanna LE. Pathophysiology of CD4+ T-Cell Depletion in HIV-1 and HIV-2 Infections. Front Immunol 2017; 8: 580. doi: 10.3389/fimmu.2017.00580 PMID: 28588579
- Jahagirdar D, Walters MK, Novotney A, et al. Global, regional, and national sex-specific burden and control of the HIV epidemic, 19902019, for 204 countries and territories: The global burden of diseases study 2019. Lancet HIV 2021; 8(10): e633-51. doi: 10.1016/S2352-3018(21)00152-1 PMID: 34592142
- Piot P, Bartos M, Ghys PD, Walker N, Schwartländer B. The global impact of HIV/AIDS. Nature 2001; 410(6831): 968-73. doi: 10.1038/35073639 PMID: 11309626
- De Cock KM, Jaffe HW, Curran JW. The evolving epidemiology of HIV/AIDS. AIDS 2012; 26(10): 1205-13. doi: 10.1097/QAD.0b013e328354622a PMID: 22706007
- Al-Mozaini M, Alrahbeni T, Dirar Q, Alotibi J, Alrajhi A. HIV in the kingdom of Saudi Arabia: Can we change the way we deal with co-infections. Infect Drug Resist 2021; 14: 111-7. doi: 10.2147/IDR.S270355 PMID: 33500633
- Shaw GM, Hunter E. HIV Transmission. Cold Spring Harb Perspect Med 2012; 2(11): a006965-5. doi: 10.1101/cshperspect.a006965 PMID: 23043157
- Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol 2004; 2(1): 33-42. doi: 10.1038/nrmicro794 PMID: 15035007
- Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk. AIDS 2014; 28(10): 1509-19. doi: 10.1097/QAD.0000000000000298 PMID: 24809629
- Forbes JC, Alimenti AM, Singer J, et al. A national review of vertical HIV transmission. AIDS 2012; 26(6): 757-63. doi: 10.1097/QAD.0b013e328350995c PMID: 22210635
- Hethcote HW, VanArk JW. Modeling HIV transmission and AIDS in the United States. Berlin Heidelberg. Lecture notes in biomathematics. Springer 1992. doi: 10.1007/978-3-642-51477-7
- Ronen K, Sharma A, Overbaugh J. HIV transmission biology. AIDS 2015; 29(17): 2219-27. doi: 10.1097/QAD.0000000000000845 PMID: 26418086
- Board NL, Moskovljevic M, Wu F, Siliciano RF, Siliciano JD. Engaging innate immunity in HIV-1 cure strategies. Nat Rev Immunol 2022; 22(8): 499-512. doi: 10.1038/s41577-021-00649-1 PMID: 34824401
- Cohen MS, Smith MK, Muessig KE, Hallett TB, Powers KA, Kashuba AD. Antiretroviral treatment of HIV-1 prevents transmission of HIV-1: Where do we go from here? Lancet 2013; 382(9903): 1515-24. doi: 10.1016/S0140-6736(13)61998-4 PMID: 24152938
- Arts EJ, Hazuda DJ. HIV-1 antiretroviral drug therapy. Cold Spring Harb Perspect Med 2012; 2(4): a007161-1. doi: 10.1101/cshperspect.a007161 PMID: 22474613
- Cambiano V, OConnor J, Phillips AN, et al. Antiretroviral therapy for prevention of HIV transmission: Implications for Europe. Euro Surveill 2013; 18(48): 20647. doi: 10.2807/1560-7917.ES2013.18.48.20647 PMID: 24308982
- Fowler MG, Qin M, Fiscus SA, et al. Benefits and risks of antiretroviral therapy for perinatal HIV prevention. N Engl J Med 2016; 375(18): 1726-37. doi: 10.1056/NEJMoa1511691 PMID: 27806243
- Bhatti AB, Usman M, Kandi V. Current scenario of HIV/AIDS, treatment options, and major challenges with compliance to antiretroviral therapy. Cureus 2016; 8(3): e515. doi: 10.7759/cureus.515
- Bai RJ, Dai LL, Wu H. Advances and challenges in antiretroviral therapy for acquired immunodeficiency syndrome. Chin Med J 2020; 133(23): 2775-7. doi: 10.1097/CM9.0000000000001226 PMID: 33273324
- Gandhi RT, Bedimo R, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults. JAMA 2023; 329(1): 63-84. doi: 10.1001/jama.2022.22246 PMID: 36454551
- Tran BX, Phan HT, Latkin CA, et al. Understanding global HIV stigma and discrimination: Are contextual factors sufficiently studied? (GAPRESEARCH). Int J Environ Res Public Health 2019; 16(11): 1899. doi: 10.3390/ijerph16111899 PMID: 31146379
- Genberg BL, Kawichai S, Chingono A, et al. Assessing HIV/AIDS stigma and discrimination in developing countries. AIDS Behav 2008; 12(5): 772-80. doi: 10.1007/s10461-007-9340-6 PMID: 18080830
- Monjok E, Smesny A, Essien EJ. HIV/AIDS-related stigma and discrimination in Nigeria: review of research studies and future directions for prevention strategies. Afr J Reprod Health 2009; 13(3): 21-35. PMID: 20690259
- Anderson M, Elam G, Gerver S, Solarin I, Fenton K, Easterbrook P. HIV/AIDS-related stigma and discrimination: Accounts of HIV-positive Caribbean people in the United Kingdom. Soc Sci Med 2008; 67(5): 790-8. doi: 10.1016/j.socscimed.2008.05.003 PMID: 18565635
- Florom-Smith AL, De Santis JP. Exploring the concept of HIV-related stigma. Nurs Forum 2012; 47(3): 153-65. doi: 10.1111/j.1744-6198.2011.00235.x PMID: 22861652
- Chambers LA, Rueda S, Baker DN, et al. Stigma, HIV and health: A qualitative synthesis. BMC Public Health 2015; 15(1): 848. doi: 10.1186/s12889-015-2197-0 PMID: 26334626
- Mawar N, Saha S, Pandit A, Mahajan U. The third phase of HIV pandemic: social consequences of HIV/AIDS stigma discrimination future needs. Indian J Med Res 2005; 122(6): 471-84. PMID: 16517997
- Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS 2008; 22(Suppl 2): S67-79. doi: 10.1097/01.aids.0000327438.13291.62 PMID: 18641472
- Cao X, Sullivan SG, Xu J, Wu Z. Understanding HIV-related stigma and discrimination in a "blameless" population. AIDS Educ Prev 2006; 18(6): 518-28. doi: 10.1521/aeap.2006.18.6.518 PMID: 17166078
- Paxton S, Gonzales G, Uppakaew K, et al. AIDS-related discrimination in Asia. AIDS Care 2005; 17(4): 413-24. doi: 10.1080/09540120412331299807 PMID: 16036226
- Devi ND. Women living with HIV/AIDs in Manipur: Relations with family and neighbourhood. Indian J Gend Stud 2016; 23(2): 324-35. doi: 10.1177/0971521516635329
- Cuca YP, Onono M, Bukusi E, Turan JM. Factors associated with pregnant womens anticipations and experiences of HIV-related stigma in rural Kenya. AIDS Care 2012; 24(9): 1173-80. doi: 10.1080/09540121.2012.699669 PMID: 22799618
- Greenwood GL, Wilson A, Bansal GP, et al. HIV-related stigma research as a priority at the National Institutes of Health. AIDS Behav 2022; 26(S1): 5-26. doi: 10.1007/s10461-021-03260-6 PMID: 33886010
- Sallam M, Alabbadi AM, Abdel-Razeq S, et al. HIV knowledge and stigmatizing attitude towards people living with HIV/AIDS among medical students in Jordan. Int J Environ Res Public Health 2022; 19(2): 745. doi: 10.3390/ijerph19020745 PMID: 35055566
- Govender RD, Hashim MJ, Khan MAB, Mustafa H, Khan G. Global epidemiology of HIV/AIDS: A resurgence in North America and Europe. J Epidemiol Glob Health 2021; 11(3): 296-301. doi: 10.2991/jegh.k.210621.001 PMID: 34270183
- Adetola Odugbesan J, Rjoub H. Evaluating HIV/Aids prevalence and sustainable development in sub-Saharan Africa: the role of health expenditure. Afr Health Sci 2020; 20(2): 568-78. doi: 10.4314/ahs.v20i2.4 PMID: 33163018
- Umeh CN, Essien EJ, Ezedinachi EN, Ross MW. Knowledge, beliefs and attitudes about HIV/AIDS-related issues, and the sources of knowledge among health care professionals in southern Nigeria. J R Soc Promot Health 2008; 128(5): 233-9. doi: 10.1177/1466424008092793 PMID: 18814404
- Battegay M, Haerry DHU, Fehr J, Staehelin C, Wandeler G, Elzi L. Psychosoziale aspekte bei der behandlung der HIV-infektion. Ther Umsch 2014; 71(8): 509-13. doi: 10.1024/0040-5930/a000545 PMID: 25093317
- Haroun D, El Saleh O, Wood L, Mechli R, Al Marzouqi N, Anouti S. Assessing knowledge of, and Attitudes to, HIV/AIDS among university students in the United Arab Emirates. PLOSONE 2016; 11(2): e0149920.
- Alwafi HA, Meer AMT, Shabkah A, et al. Knowledge and attitudes toward HIV/AIDS among the general population of Jeddah, Saudi Arabia. J Infect Public Health 2018; 11(1): 80-4. doi: 10.1016/j.jiph.2017.04.005 PMID: 28579268
- Badahdah A. Saudi attitudes towards people living with HIV/AIDS. Int J STD AIDS 2005; 16(12): 837-8. doi: 10.1258/095646205774988208 PMID: 16336775
- Zarei N, Joulaei H, Darabi E, Fararouei M. Stigmatized attitude of healthcare providers: A barrier for delivering health services to HIV positive patients. Int J Community Based Nurs Midwifery 2015; 3(4): 292-300. PMID: 26448956
- Green G. Attitudes towards people with HIV: Are they as stigmatizing as people with HIV perceive them to be? Soc Sci Med 1995; 41(4): 557-68. doi: 10.1016/0277-9536(94)00376-5 PMID: 7481950
- Ndinda C, Chimbwete C, McGrath N, Pool R. Community attitudes towards individuals living with HIV in rural KwaZulu-Natal, South Africa. AIDS Care 2007; 19(1): 92-101. doi: 10.1080/09540120600888378 PMID: 17129863
- Beer L, Tie Y, McCree DH, et al. HIV stigma among a national probability sample of adults with diagnosed HIVUnited States, 20182019. AIDS Behav 2022; 26(S1): 39-50. doi: 10.1007/s10461-021-03414-6 PMID: 34374919
- Kumar N, Unnikrishnan B, Thapar R, et al. Stigmatization and discrimination toward people living with HIV/AIDS in a coastal city of South India. J Int Assoc Provid AIDS Care 2017; 16(3): 226-32. doi: 10.1177/2325957415569309 PMID: 25656862
- Vorasane S, Jimba M, Kikuchi K, et al. An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR. BMC Health Serv Res 2017; 17(1): 125. doi: 10.1186/s12913-017-2068-8 PMID: 28183300
- Dahlui M, Azahar N, Bulgiba A, Zaki R, Oche OM, Adekunjo FO. HIV/AIDS related stigma and discrimination against PLWHA in Nigerian population. PLOS ONE 2015; 10(12): e0143749.
- Sekoni OO, Owoaje ET. HIV/AIDS stigma among primary health care workers in Ilorin, Nigeria. Afr J Med Med Sci 2013; 42(1): 47-57. PMID: 23909094
- Owolabi RS, Araoye MO, Osagbemi GK, Odeigah L, Ogundiran A, Hussain NA. Assessment of stigma and discrimination experienced by people living with HIV and AIDS receiving care/treatment in University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. J Int Assoc Physicians AIDS Care 2012; 11(2): 121-7. doi: 10.1177/1545109711399443 PMID: 21521807
- Alharbi HO, Al-Dubai SR, Almutairi RH, Alharbi M. Stigmatization and discrimination against people living with HIV/AIDS: Knowledge, attitudes, and practices of healthcare workers in the primary healthcare centers in Madinah, Saudi Arabia, 2022. J Family Community Med 2022; 29(3): 230-7. doi: 10.4103/jfcm.jfcm_136_22 PMID: 36389032
- Malli IA, Hamdan D, Aljahdali A, et al. Medical interns knowledge, attitude, and practice toward people living with HIV: Multicenter experience from Saudi Arabia. HIV AIDS 2023; 15: 571-82. doi: 10.2147/HIV.S418948 PMID: 37744212
- Qashqari FS, Alsafi RT, Kabrah SM, et al. Knowledge of HIV/AIDS transmission modes and attitudes toward HIV/AIDS infected people and the level of HIV/AIDS awareness among the general population in the kingdom of Saudi Arabia: A cross-sectional study. Front Public Health 2022; 10: 955458. doi: 10.3389/fpubh.2022.955458 PMID: 36238245
- Elghazaly A, AlSaeed N, Islam S, Alsharif I, Alharbi L, Al Ashagr T. Assessing the knowledge and attitude towards HIV/AIDS among the general population and health care professionals in MENA region. PLOS ONE 2023; 18(7): e0288838.
- Mahfouz AAR, Alakija W, Al-Khozayem AA, Al-Erian RAG. Knowledge and attitudes towards AIDS among primary health care physicians in the Asir Region, Saudi Arabia. J R Soc Health 1995; 115(1): 23-5. doi: 10.1177/146642409511500108 PMID: 7738977
- Omer T, Lovering S, Shomrani MA. The lived experience of living with HIV/AIDS in the western region of Saudi Arabia. Divers Equal Health Care 2014; 11(4) doi: 10.21767/2049-5471.100022
- Badahdah AM. Stigmatization of persons with HIV/AIDS in Saudi Arabia. J Transcult Nurs 2010; 21(4): 386-92. doi: 10.1177/1043659609360873 PMID: 20592063
- Badahdah AM, Sayem N. HIV-related knowledge and AIDS stigma among college students in Yemen. East Mediterr Health J 2010; 16(8): 901-6. doi: 10.26719/2010.16.8.901 PMID: 21469573
- Kontomanolis EN, Michalopoulos S, Gkasdaris G, Fasoulakis Z. The social stigma of HIVAIDS: Societys role. HIV AIDS 2017; 9: 111-8. doi: 10.2147/HIV.S129992 PMID: 28694709
- Asrina A, Ikhtiar M, Idris FP, Adam A, Alim A. Community stigma and discrimination against the incidence of HIV and AIDS. J Med Life 2023; 16(9): 1327-34. doi: 10.25122/jml-2023-0171 PMID: 38107709
- Li X, Yuan L, Li X, et al. Factors associated with stigma attitude towards people living with HIV among general individuals in Heilongjiang, Northeast China. BMC Infect Dis 2017; 17(1): 154. doi: 10.1186/s12879-017-2216-0 PMID: 28212610
- Saki M, Mohammad Khan Kermanshahi S, Mohammadi E, Mohraz M. Perception of patients with HIV/AIDS From stigma and discrimination. Iran Red Crescent Med J 2015; 17(6): e23638. doi: 10.5812/ircmj.23638v2 PMID: 26290751
- Kalichman SC, Eaton L, Cain D, Cherry C, Pope H, Kalichman M. HIV treatment beliefs and sexual transmission risk behaviors among HIV positive men and women. J Behav Med 2006; 29(5): 401-10. doi: 10.1007/s10865-006-9066-3 PMID: 16944306
- Boer H, Emons PAA. Accurate and inaccurate HIV transmission beliefs, stigmatizing and HIV protection motivation in northern Thailand. AIDS Care 2004; 16(2): 167-76. doi: 10.1080/09540120410001641011 PMID: 14676023
- Bishop GD, Oh HM, Swee HY. Attitudes and beliefs of Singapore health care professionals concerning HIV/AIDS. Singapore Med J 2000; 41(2): 55-63. PMID: 11063203
- Brooks RA, Etzel MA, Hinojos E, Henry CL, Perez M. Preventing HIV among Latino and African American gay and bisexual men in a context of HIV-related stigma, discrimination, and homophobia: Perspectives of providers. AIDS Patient Care STDS 2005; 19(11): 737-44. doi: 10.1089/apc.2005.19.737 PMID: 16283834
- Cloete A, Simbayi LC, Kalichman SC, Strebel A, Henda N. Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa. AIDS Care 2008; 20(9): 1105-10. doi: 10.1080/09540120701842720 PMID: 18608067
- Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav 2015; 19(1): 41-9. doi: 10.1007/s10461-014-0758-3 PMID: 24715226
- Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: Does age matter? AIDS Care 2015; 27(4): 520-8. doi: 10.1080/09540121.2014.978734 PMID: 25397643
- Adebajo SB, Bamgbala AO, Oyediran MA. Attitudes of health care providers to persons living with HIV/AIDS in Lagos State, Nigeria. Afr J Reprod Health 2003; 7(1): 103-12. doi: 10.2307/3583350 PMID: 12816317
- Yimer A, Kebede Kassaw AA, Surur S, Mussa E. Prevalence of misconception about HIV/AIDS transmission and associated factors among reproductive age women in Ethiopia: A nationwide study. BMC Infect Dis 2024; 24(1): 54. doi: 10.1186/s12879-023-08884-8 PMID: 38184543
- Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: What works? J Int AIDS Soc 2009; 12(1): 15-5. doi: 10.1186/1758-2652-12-15 PMID: 19660113
- Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV‐related stigma and discrimination from 2002 to 2013: How far have we come? J Int AIDS Soc 2013; 16(3S2): 18734.
- Alali FM, Tarakji B, Alqahtani AS, et al. Assessment of knowledge and attitude of dental students towards hiv and its oral manifestations in Saudi ArabiaA cross-sectional study. Healthcare 2022; 10(8): 1379. doi: 10.3390/healthcare10081379 PMID: 35893201
- Viola F, Formenti B, Arsuffi S, et al. Knowledge and attitudes towards HIV and HCV among the population attending the fast-track cities mobile unit in Brescia, Italy. Int J Environ Res Public Health 2023; 20(19): 6878. doi: 10.3390/ijerph20196878 PMID: 37835148
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