Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 548-554  

Knowledge and attitude toward human immunodeficiency virus infection and acquired immunodeficiency syndrome among ayurveda medical students: A single institute experience


1 Department of Physiology, M. K. C. G Medical College, Ganjam, Odisha, India
2 Department of Physiology, Medical College and Hospital, Kolkata, West Bengal, India
3 J. B. Roy State Ayurvedic Medical College, Kolkata, West Bengal, India

Date of Submission28-Feb-2017
Date of Acceptance29-May-2017
Date of Web Publication17-Jan-2018

Correspondence Address:
Dr. Himel Mondal
Department of Physiology, M. K. C. G. Medical College, Ganjam - 760 004, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_38_17

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  Abstract 


Background: Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are global health issue with estimated 21.17 lakhs infected people living with HIV/AIDS (PLHIV) in 2015 in India. Ayurveda doctors are working in different health settings especially in rural India. Adequate knowledge about HIV/AIDS and positive attitude toward PLHIV are desired in treatment and counseling of HIV/AIDS patients. Aim: The aim of the study was to evaluate the level of knowledge about HIV/AIDS and attitude toward PLHIV among Ayurveda medical students. Materials and Methods: A cross-sectional study was conducted with 151 Bachelor of Ayurveda Medicine and Surgery (B.A.M.S.) students of different years of study. A pretested and validated self-administered questionnaire was used as survey instrument. Responses were recorded in “Yes,” “No,” and “Don't Know” tick box. Responses were scored, analyzed, and expressed in percentage, mean and standard deviation. One-way analysis of variance and Pearson's correlation were used according to necessity with α = 0.05. Results: Survey response rate was 91%. Seventy-four percent students had basic knowledge about HIV/AIDS. Correct knowledge about disease transmission was found in 66% students. Positive attitude was found in 51% students. Mean knowledge score of four groups of student according to year of the study was significantly (P < 0.05) different. There was no correlation (P > 0.05, insignificant r) between knowledge and attitude score. Conclusion: B.A.M.S students have basic knowledge about HIV/AIDS with relatively less knowledge about transmission of HIV. Knowledge increases with increase in year of the study. Increase in knowledge is not an indicator of positive attitude toward PLHIV.

Keywords: Ayurveda students, Bachelor of Ayurveda Medicine and Surgery, human immunodeficiency virus/acquired immunodeficiency syndrome, knowledge and attitude, people living with human immunodeficiency virus


How to cite this article:
Mondal H, Mondal S, Baidya C. Knowledge and attitude toward human immunodeficiency virus infection and acquired immunodeficiency syndrome among ayurveda medical students: A single institute experience. Med J DY Patil Univ 2017;10:548-54

How to cite this URL:
Mondal H, Mondal S, Baidya C. Knowledge and attitude toward human immunodeficiency virus infection and acquired immunodeficiency syndrome among ayurveda medical students: A single institute experience. Med J DY Patil Univ [serial online] 2017 [cited 2018 Jul 20];10:548-54. Available from: http://www.mjdrdypu.org/text.asp?2017/10/6/548/223367




  Introduction Top


Human immunodeficiency virus (HIV) targets the immune system of body and makes it weak to combat against infection. It also makes the individual susceptible to some types of cancer.[1] Acquired immunodeficiency syndrome (AIDS) is the third stage of HIV infection with one or more diagnosed opportunistic infections.[2] HIV infection and AIDS are global health issue with a burden of 36.7 million people living with HIV (PLHIV) in 2015.[3] In India, the prevalence is estimated 0.26% (0.22%–0.32%), and total number of PLHIV is estimated at 21.17 lakhs (17.11 lakhs to 26.49 lakhs) in 2015.[4] Among the infected population, only 54% know their infection status.[1]

At present, India has the National AIDS Control Program (NACP)– IV (2012–2017) with an aim to provide comprehensive service to PLHIV regarding antiretroviral therapy, psychological support, prevention and treatment of opportunistic infection, and facilitating home-based care.[5] Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) medical officer along with other staffs play significant roles in effective implementation of the National Health Programs by spreading awareness among population.[6] AYUSH doctors are posted in various health facilities, such as primary health centers, community health centers, district hospitals, especially in rural India where there is gross deficit in health workers.[7] Among AYUSH, Ayurveda has developed out of religious tradition with blend of natural medicine into an system that is grounded in clinical experience.[8] The syllabus of 3rd year Bachelor of Ayurveda Medcine and Surgery (B.A.M.S). includes AIDS and its control program. Fourth year B.A.M.S. syllabus includes care of HIV/AIDS infected patients.[9] In these 2 years of the study, students gain clinical knowledge which they utilize during their internship and in future practice.

Several previous studies were conducted in India and abroad which documented knowledge about and attitude toward HIV/AIDS among Medical, Paramedical, Dental and Nursing students.[10],[11],[12],[13],[14],[15],[16] In majority of the studies, knowledge about HIV/AIDS was good/high but attitude toward HIV/AIDS showed diverse result. As per our knowledge, no study has been conducted to assess the knowledge and attitude of B.A.M.S. students. Hence, we designed this study to find out the basic knowledge about HIV infection, mode of transmission of infective agent, and to find out attitude of budding Ayurveda doctors toward HIV-infected people or AIDS patients.


  Materials and Methods Top


A cross-sectional descriptive study was conducted among B.A.M.S. students of Jamini Bhushan Roy State Ayurvedic Medical College and Hospital, Kolkata, West Bengal, during the period of October to December 2016. Convenience samples from 1st year through 4th year B.A.M.S. students were taken. After a short briefing about the study, students willing to participate in the survey were included in the sample. Those students who participated in pilot study during validity test of the instrument were excluded from the study. Before participation, only verbal consent was taken considering the instrument type and study protocol. Although the 1st year and 2nd year B.A.M.S. syllabus does not include the theory of HIV/AIDS, we had included them with an aim to assess the difference in knowledge and attitude among students of different years of the study.

Survey instrument

After reviewing previous similar studies carried out in India,[10],[11],[12],[17],[18] a questionnaire was drafted in English according to the aim of the study. The questionnaire was divided into three sets:First set of statements was aimed to test the basic knowledge about the causative agent, diagnostic test, and available treatment for HIV infection/AIDS. Second set of statements was for determining knowledge level about the transmission of HIV. Third set of statements was for gathering information about the attitude of the students toward HIV-infected person/AIDS patients. Thus, a single page questionnaire was composed of 21 statements, seven statements in each group with tick box category. Tick box type survey is easily understood and quick to complete.[19] After initial draft of the questionnaire, content validity was tested by consulting six expert reviewer. Then, a pilot study with four students from each year was conducted with the questionnaire.[20] According to the recorded response, internal consistency was statistically tested by Cronbach's alpha.[21],[22] For calculation of alpha, recorded response was scored as: Correct response = 3, Don't Know (DK)/equivocal = 2, wrong response = 1. Calculated Cronbach's alpha was as follows:First set α= 0.79, Second set α= 0.84, and Third set α= 0.86. Among the three set of statements, first set was in “acceptable” and second and third set was in “good” level of internal consistency. According to the response of pilot study, the survey questionnaire was also found feasible to administer among the current batch of B.A.M.S. students. Personal identification data regarding name, age, sex, and roll numbers were not recorded in the questionnaire to avoid respondent's conscious reaction bias.[23]

Survey method

Participants were informed about the aim of the study but chances of hypothesis guessing were minimized. They were also given option to opt-out from the study in any stage without stating the reason. Questionnaire was distributed among 166 students. After collecting the filled up questionnaire, correct, wrong, and DK/equivocal responses were scored for survey statements individually (correct response = 3, DK/equivocal = 2, Wrong response = 1). Total correct response, wrong response, and DK/equivocal were also calculated. Data were stored for statistical analysis.

Statistical analysis

Stored data were analyzed in Microsoft Excel® 2010 Data Analysis Tools, and results were presented in percentage, mean and standard deviation (SD). One-way analysis of variance (ANOVA) was used to compare score of four groups of participants. Pearson's correlation was used to compare knowledge and attitude score, assuming knowledge as predictor variable and attitude as outcome variable. For all the statistical analysis, probability of type I error (α) was set at 0.05. Hence, P value <0.05 was considered statistically significant.


  Results Top


A total of 151 students returned the filled up questionnaire (survey response rate 91%). Among the participants, number of 1st year student was 37 (25%), 2nd year was 38 (25%), 3rd year was 30 (20%), and 4th year was 46 (30%). Percentage of students giving correct, wrong, and DK response for first set of statements showed 74% correct response, 12% wrong response, and 14% students marked DK (χ2 = 74.49, P < 0.0001). Percentage value of the response of first set statements is expressed in [Figure 1].
Figure 1: Correct, wrong and don't know response of students (n = 151) expressed in percentage value for first set of statements

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For the second set of statements, correct response was 66% followed by 22% wrong response and 12% DK response (χ2 = 49.52, P < 0.0001). This is shown in [Figure 2] in percentage value.
Figure 2: Correct, wrong and don't know response of students (n = 151) expressed in percentage value for second set of statements

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Positive response for third set of statements was 51%. Thirty-two percent students expressed negative response and 17% expressed equivocal response (χ2 = 17.42, P = 0.0002). [Figure 3] shows the percentage values of the recorded responses.
Figure 3: Correct, wrong and equivocal response of students (n = 151) expressed in percentage value for third set of statements

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Responses for individual statements of three set of statements are shown in percentage in [Table 1] ( first set), [Table 2] (second set), and [Table 3] (third set).
Table 1: Percentage of correct, wrong and donít know response for individual statements of first set of statements

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Table 2: Percentage of correct, wrong and donít know response for individual statements of second set of statements

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Table 3: Percentage of correct, wrong and donít know response for individual statements of third set of statements

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Score of individual student was calculated for each set of statement. Mean and SD of the score of four groups of students according to year of study is presented in [Table 4]. Group difference of scores for three set of statements were statistically significant (P< 0.05) when tested statistically by one-way ANOVA.
Table 4: Group (year) wise score of responses expressed in mean±standard deviation

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When the score of first and second set of statements were added together, it reflected the total knowledge score about both basic and transmission of HIV/AIDS. Difference in knowledge score of the four groups (1st year = 33.38 ± 3.27, 2nd year = 35.37 ± 3.77, 3rd year = 36.73 ± 3.12, 4th year = 37.09 ± 2.57) was statistically significant (F = 10.65, P < 0.0001). This knowledge score is expressed in [Figure 4].
Figure 4: Comparison of knowledge score of four groups of students

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The correlation between the knowledge score (Sum of set 1 and set 2) and attitude score (set 3) of students according to year of study is presented in [Table 5]. None of them was statistically significant (all P values were >0.05) correlation.
Table 5: Correlation between knowledge score and attitude score of four groups of students

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  Discussion Top


Result of this study showed that 74% of students had correct knowledge about the causative agent, current available treatment option, diagnostic tests, Coinfection with HIV and NACP [Figure 1]. Individual statements of set 1 [Table 1] indicated that knowledge about available treatment, NACP and availability of diagnostic test was lower than other statements.

Positive response for set 2 [Figure 2] revealed that 66% of students had correct knowledge about the transmission of HIV. Misconception about the transmission (22%) was higher than misconception about basic knowledge of HIV/AIDS (12%). Individual statements of set 2 statements [Table 2] showed that a major percentage of students (57%) have wrong knowledge about protective efficacy of condoms to prevent HIV transmission. HIV transmission during oral sex was another topic which received 31% wrong response. Oral sex is risky for transmission of HIV.[24] Remarkable 51% students responded that all HIV-positive mothers will surely deliver HIV-positive babies. This misconception may hamper counseling of HIV-positive pregnant woman.

Today's medical students are tomorrow's strength of health-care system. After being graduated from medical colleges, they are recruited in different posts and significant percentages are posted in rural area. Along with providing treatment, doctors play a major role in educating general population regarding communicable and noncommunicable diseases. Adequate knowledge about the current National Health Program is required for smooth implementation of those health programs. NACP-IV is being implemented after success of NACP-III. A knowledge regarding the causative agent, diagnostic test, available treatment option, and disease transmission mode of HIV/AIDS is essential for counseling and guidance to patients. However, this knowledge is also important for safety precautions to be taken during treatment of HIV/AIDS patients for self-protection.

A positive attitude toward PLHIV is desired not only to provide comprehensive service to patients but it also reinforces the information that doctors transmit to others. This study found that only 51% of students have positive attitude toward HIV/AIDS patients. Third set of statements [Table 3] suggests a huge negative attitude about the test for HIV during pregnancy. Eighty-two percent students, if posted with current attitude, may advise a mandatory HIV test for pregnant woman. However, it is an optional test to be encouraged. An advice for mandatory HIV test is violation of right to informed consent [25] and infringes on human rights.[1] Students are exposed to different clinical departments during rotatory internship, and they learn about management of various cases. Forty-four percent students think that HIV/AIDS patients should be treated in a separate word. This discriminatory attitude may be due to lack of proper knowledge about the mode of disease transmission. During internship, in many medical colleges, internees collect blood and send it to laboratory and invariably all internees insert intravenous (IV) cannula and inject IV drugs. These increase the risk of needle prick injuries. Forty-five percent students do not have any idea about postexposure prophylaxis (PEP). This can contribute to create unnecessary fear and negative attitude toward HIV patient during collection of blood or IV cannulation. Students should be aware about PEP along with precaution during handling blood and other body fluid.

Result of this study showed that knowledge level was increased concordantly with increment of year of study [Figure 4] but attitude level fluctuated discordantly. Positive attitude was highest among 2nd year students and least positive attitude was found among final year students. When Pearson's correlation was carried out between knowledge and attitude scores, it showed no statistically and quantitatively significant correlation [Table 5]. Hence, increase in knowledge level is not an indicator of development of positive attitude toward PLHIV, their treatment and safety measures.

Shankar et al. assessed knowledge and attitude of medical students in Nepal and found overall good knowledge but equivocal attitude.[13] Baytner-Zamir et al. studied the knowledge and attitude of preclinical medical students of Israel and found a gap in knowledge of HIV/AIDS, especially about transmission but the attitude was low.[14] Turhan et al. reported negative attitude of medical students in Turkey.[15] While Li et al. reported evaluating knowledge and attitude toward HIV/AIDS in dental students in China, they found good to excellent knowledge level but negative attitude.[16] Similar study by Farotimi et al. from Nigeria reported adequate knowledge but discriminatory attitude toward PLHIV.[26] All these studies found a low level of positive attitude in students toward PLHIV. Sample of these studies was taken from students of modern medicine, which was not same to our study. However, we can ignore the system of study because, in India, AYUSH doctors works together with modern medicine doctors and helps in implementation of national health programs. Hence, result of our study supports the finding of these studies carried out abroad.

Chauhan et al. assessed 1st year medical students in Bhubaneswar, India, and found low level of knowledge especially on disease transmission but found a high attitude.[10] However, poor knowledge base and high attitude may be disadvantageous during treatment and counseling of HIV/AIDS patients. Dharmalingam et al. studied undergraduate nursing student and found adequate knowledge and positive attitude.[11] Joshi et al. also found fair knowledge and positive attitude in 1st year medical students of Karnataka, India.[17] However, attitude level found in our study was not corroborative with the finding of these studies. Probable underlying reason behind it may be different sample sizes, geographical difference in place of study, and different levels of bias control.

Result of this study showed that increase in knowledge level is not an indicator of increase in attitude level among students. Patil et al. who studied dental students in Uttar Pradesh, India, found that level of knowledge is not a predictor for attitude toward PLHIV.[12] Result of their study is supported by the result of our study. However, finding of our study does not support the finding of Sharma et al.[18] who found that increase in knowledge increases the positive attitude.

From the findings in this study, it is obvious that the knowledge about HIV/AIDS in Ayurveda medical students should be reinforced along with a positive attitude promotion. In the survey, we also recorded the willingness to learn more about HIV/AIDS with an optional open question. Seventy-two percent of student answered the question. Among them, 76% of students answered with “YES” only and rest of students expressed their interest in seminar, workshop and extra lecture classes. Curricular teaching may be augmented to mop up the lacuna about knowledge of HIV/AIDS which are evident from our study. For acquiring knowledge and learning any topic, students prefer kinesthetic sensory modality.[27] Hence, for effective teaching about HIV/AIDS, a workshop may be better choice than lecture class. If it is not feasible, a symposium on HIV/AIDS including basic knowledge, diagnosis, treatment, prognosis, counseling methods, and safety measure may be presented specially for final year B.A.M.S. students who would join as internee doctor after their final examination. A training module for HIV/AIDS is available from the National AIDS Control Organization.[28] The resource can be used according to necessity.

Limitation

We took convenience sample from a single Ayurvedic medical college. Hence, result of this study may not be generalized for all students currently studying B.A.M.S.; rather this result encourages to carry out further studies with large sample size of B.A.M.S. students.


  Conclusion Top


BAMS students have adequate basic knowledge about the causative agent, diagnostic test and available treatment for HIV infection/AIDS with higher level of misconception about transmission of HIV. Knowledge level increases with increment of year of the study. Increase in knowledge is not an indicator for building positive attitude toward PLHIV including treatment, counseling and PEP.

Acknowledgment

We thank reviewers of the questionnaire; we thank participant students of J. B. Roy State Ayurvedic Medical College, Kolkata, for their active participation. We also thank Mr. Ashutosh Mondal and Mrs. Sarika Mondal for their help in tabulation of data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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