ORIGINAL PAPER

Attitude of healthcare students towards HIV/

AIDS and people living with HIV in selected
dental and nursing colleges at Chennai, India

Lathamangeswari Chinnasamy1, Akila Muthukrishnan2

Jothi College of Management Science & Technology, Bareilly, Uttar Pradesh, India
1

School of Nursing, College of Pharmacy and Nursing, University of Nizwa, Sultanate of Oman
2

Abstract
Introduction: The  healthcare personnel and people living with human immunodeficiency virus
(HIV)/acquired immunodeficiency syndrome (AIDS) need to understand each other for advancement
of healthcare delivery system. The attitude of healthcare people contributes a lot to achieve good practices
towards the same people who are in deliberate need of support for their living. The aim of this study was
to assess the attitude of 600 healthcare students in dental and nursing colleges towards HIV/AIDS and
people living with HIV infection (PLHIV), and associate the attitude with demographic data.
Material and methods: A quantitative study was carried out to obtain information from 600 health-
care students of six nursing and three dental colleges in Chennai, India to assess the level of attitude
regarding HIV and PLHIV. Non-probability convenient sampling technique with simple randomiza-
tion was used for the selection of samples. Reliability of tool was assessed by test-retest method, as
r = 0.7, and content validity was obtained from the experts. The collected data was analyzed by using
SPSS package version 22.0.
Results: Among 600 participants, 53% had negative attitude, 29% had moderately positive attitude,
and 18% had positive attitude towards taking care of HIV-infected people. The mean score was 18.91
(range, 0-60) with standard deviation of ±13.07. Their attitude level was significantly associated with
the source of information about HIV/AIDS, but not with the other demographic variable such as age,
gender, family income, and parents’ occupation.
Conclusions: Healthcare students are in need of  intense teaching program with various methods,
which can change their attitude to eliminate the fear and stigma towards HIV/AIDS and taking care
of people living with HIV/AIDS.

HIV AIDS Rev 2020; 19, 1: 43-48

DOI: https://doi.org/10.5114/hivar.2020.93234

Key words: AIDS, antiretroviral treatment, HIV prevention, healthcare society, stigma.

Introduction than one million Americans are infected with the virus [1].
African countries such as Ethiopia, Kenya, and Zimbabwe
Human immunodeficiency virus (HIV) infection and represent 30-60% of  their total health ministry budget on
acquired immunodeficiency syndrome (AIDS) remains HIV/AIDS [2]. In Asia and the  Pacific region, five million
a  leading cause of  ill-health and mortality. Today, more people are living with HIV, approximately 3.4 million people

Address for correspondence: Dr. Akila Muthukrishnan, Article history:

College of Pharmacy and Nursing, University of Nizwa, Received: 31.03.2019
Birkat al mouz, 616, Nizwa, Oman, e-mail: [email protected] Received in revised form: 27.05.2019
Accepted: 05.07.2019
Available online: 16.02.2020

HIV & AIDS Review 2020/Volume 19/Number 1

44 Lathamangeswari Chinnasamy, Akila Muthukrishnan

were reported with new HIV infections, and 240,000 peo- Material and methods
ple died of  AIDS-related causes in 2014 [3]. In Asia, 51%
of AIDS-related deaths occurred in 2013 and 8% of deaths This descriptive, quantitative study was conducted from
worldwide [4]. Also, between 2000 and 2014, the  num- January 2016 to April 2016 in six nursing colleges and three
ber of  AIDS-related deaths increased by 11%. However, dental colleges in Chennai, India. The prior consent was taken
the  treatment coverage is only for 36% of  all people living from a principal of each college. Through a simple random
with HIV in Asia and the  Pacific region [3]. On the  other sampling method, 651 students from the first year BDS and
hand, Indonesia and India account for 78% of new HIV in- Basic B.Sc. Nursing were recruited for the study. Among them,
fections. National AIDS Control Organization (NACO an- 34 students were not willing to participate and 17 had already
nounced that in India, HIV prevalence among gay men was attended the formal education program in HIV/AIDS, hence,
4% to 9% [5]. HIV/AIDS has major effect on the economic they were excluded from the study. Finally, 600 students par-
growth of a country, as the young age group (15-24) is get- ticipated. The  Meenakshi Institutional Ethical Committee
ting affected [6]. (MADC/IEC/003/2016) approved the study protocol.
The World Bank in a report from 2015 stated that by 2020, Verbal explanation about this study was given to the stu-
India will have to spend 7% of  its health budget on AIDS dents and written consent was obtained. Code numbers were
due to the  rising tide of  AIDS epidemic in North, North- given to maintain anonymity of the students. The demograph-
east, and South India, which would place a  further strain ic details of the students such as age, sex, parent’s occupation,
on a struggling health sector [7]. Ten years back, in South family income, and source of information about HIV/AIDS
Indian states such as Tamil Nadu, there was an alarmingly were recorded. The attitude level of the students was assessed
high incidence of HIV infection, which eventually dropped by using structured AIDS attitude assessment scale (AAAS)
down from third to fifth place among the  states [8]. HIV [13, 14]. It consisted of 15 questions from the HIV knowledge
infection is considered as one of the most deadly infection; attitude perception (KAP) questionnaire formulated by Mag-
once the virus enters the human body, it stays permanently. azine and Silas et al. [13, 14], which were selected and modi-
As per the current status, there is no cure to this infection, fied according to the sensitivity of the student group and cul-
but with a proper treatment and medical care, HIV infection tural value. Reliability of tool was tested by test-retest method,
can be controlled by keeping the  carrier individuals clini- as r = 0.7, and content validity was obtained from the experts.
cally healthy, thereby lowering their chances of transmitting The total score of AAAS ranges from 0 to 60 and has three
the  virus to others. It is estimated that a  20-year-old man subscale scores such as 0-20 negative attitude, 21-40 moder-
with HIV who begins treatment early can expect to live up to ately positive attitude, and 41-60 strongly positive attitude.
77 years, which is the average lifespan of an American. The students were asked whether they agree or disagree with
HIV-positive person with modern anti-retroviral thera- each question by using a  5-point Likert’s scale of  strongly
py can reduce the chances of transmitting the virus by 96%. agree, agree, disagree, or strongly disagree and undecided.
People living with HIV are very frequent visitors in health- Positive attitude statements were coded with strongly dis-
care sector, hence the World Health Organization (2015) [9] agree = 1 to strongly agree = 4 and negative attitude statements
announced as “any person enters the  healthcare system is were the reverse, with undecided = 0. The structured AAAS
potentially positive for HIV”. Aggarwal and Panat stated were distributed to all the students and asked to mark an an-
that an increasing number of HIV-infected individuals are swer. The  participants were given 20 minutes to complete
receiving oral dental care in India [10]. Guruprasad and the  questionnaires and the  data was collected. The  students
Chauhan reported that dental students who often use sharp were encouraged to clear any doubt in the AAAS with the in-
instruments and are handling blood of  HIV patients, are vestigator.
those who are the  most vulnerable to HIV exposure [11].
Taking care of HIV-infected persons have been a challeng- Statistical analysis
ing task in today’s scenario. Various healthcare profession-
als are involved in handling these individuals who often go Descriptive and inferential statistics were used for ana-
unnoticed. Moreover, the  attitude of  healthcare providers lyzing data with statistical package for social sciences (SPSS
remains with mixed feeling of doubts and queries. The fear version 22.0). The p-value of < 0.05 was considered to be sig-
of stigma attached to HIV/AIDS may prevent people from nificant.
having an HIV test, seeking treatment, and acknowledging
their own HIV status [12]. Ideally, these individuals should
Results
be able to come out openly with a positive thoughts to dis-
close HIV infection, but current attitudes of healthcare pro- Table 1 shows that all the  600 participants were with-
fessionals towards HIV/AIDS individuals make them re- in the  age group of  18-23 (mean, SD 19.25 ± 1.21) years,
luctant to reveal the problem. In view of the above, the aim out of  which 33% were male and 67% were female. Parents
of our study was to assess the attitude of 600 healthcare stu- of 38% and 25% of the students were doing business and daily
dents (HCS) from dental and nursing colleges towards HIV/ wages, respectively. With regards to the  family monthly in-
AIDS and people living with HIV (PLHIV), and associate come, 47% of participants parents had income of Rs > 30,000,
the attitude with demographic data. 41% had income of Rs 10,000-20,000 (mean, SD 24,050.56 ±

HIV & AIDS Review 2020/Volume 19/Number 1

Attitude of students towards HIV/AIDS 45

1,255.47). Around 56% of the students received information Table 1. Distribution of demographic variables among health­
regarding HIV/AIDS through web, media, and newspaper, care students (N = 600)
39% through friends, 3% through parents, and 2% through
Variables
the  teachers. Among the  healthcare students (Table 2),
65% of  them strongly agreed that homosexuality should be Age (in years), mean (SD); range 19.25 ± 1.21; 18-23
considered illegal. At the same time, 61% of them agreed that Gender, n (%)
a patient with AIDS has the right to obtain the same quality Male 196 (33)
of  care as any other patient, and 58% of  them agreed to do Female 404 (67)
something to make life easier for people with AIDS.
Sources of information, n (%)
Among 600 participants (Table 3), 53% had negative
attitude, 29% had moderately positive attitude, and 18% Web/Media/Newspaper/Books 336 (56)
had positive attitude for taking care of HIV-infected people. Teacher 12 (2)
The mean score was 18.91 (range, 0-60) with standard devi- Parents 18 (3)
ation of 13.07.
Friends 234 (39)
Healthcare student’s attitude level was significantly as-
sociated with source of  information about HIV/AIDS, but Parents’ occupation, n (%)
not with the other demographic variable such as age, gender, Daily wages 153 (25)
family income, and parents’ occupation (Table 4). Professionals (teaching, medical,
218 (36)
paramedical, engineering, etc.)
Discussion Business 229 (38)
24,050.56± 1,255.47;
All the 600 participants were within the  age group of Family income/month (in rs)
10,000 - > 30,000
18-23 years. This age group of people are very curious and

Table 2. Level of attitude of healthcare students about HIV/AIDS and PLHIV

Strongly Strongly
Criteria Agree Disagree Undecided
agree disagree
Patients who are only HIV-positive (without any other
– 30 (5%) 168 (28%) 270 (45%) 132 (22%)
diseases) can be treated in rooms with other patients
It is especially important to work with patients with AIDS
– 33 (6%) 306 (51%) 96 (16%) 165 (27%)
in a caring manner
If I am taking care of a HIV-infected patient, I am worried
168 (28%) 258 (43%) 54 (9%) 12 (2%) 108 (18%)
about the spread of the infection to my family and friends
HIV-negative children can live with their HIV-positive
60 (10%) 180 (30%) 234 (39%) – 126 (21%)
parents at home
I feel more sympathetic towards people who get AIDS from
156 (26%) 63 (11%) 96 (16%) 206 (34%) 79 (13%)
blood transfusion than those who get it by injected drugs
I think a patient with AIDS has the right to get the same
132 (22%) 366 (61%) 102 (17%) – –
quality of care as any other patient
A HIV-positive woman has got the right to become pregnant – 108 (18%) 186 (31%) – 210 (35%)
Most people who have AIDS deserve what they get 52 (9%) 80 (13%) 211 (35%) 165 (28%) 92 (15%)
Homosexuality should be considered illegal 390 (65%) 60 (10%) 72 (12%) – 78 (13%)
I think that people who are addicted to injected drugs
106 (18%) 83 (14%) 126 (21%) 149 (25%) 136 (23%)
deserve to be infected with AIDS
I would like to do something to make life easier for people
90 (15%) 348 (58%) 78 (13%) – 84 (14%)
with AIDS
Most people who have AIDS have to blame only
57 (10%) 52 (9%) 190 (32%) 181 (30%) 120 (20%)
themselves
I have a sympathy for people who get AIDS from sexual
60 (10%) 270 (45%) 120 (20%) – 132 (25%)
contact unknowingly
I have a strong fear about HIV-positive people 78 (13%) 330 (55%) 66 (11%)n – 126 (21%)n
Patients who are HIV-positive should be treated with
126 (21%) 234 (39%) 54 (9%) – 186 (31%)
the same respect as any other patients

HIV & AIDS Review 2020/Volume 19/Number 1

46 Lathamangeswari Chinnasamy, Akila Muthukrishnan

Table 3. Mean score of attitude of healthcare students about HIV/AIDS and PLHIV (N = 600)
Level of attitude No % Mean/SD (range) Overall mean/SD
Negative attitude 318 53 17.28 ± 1.52 (0-20) 18.91
Moderately positive attitude 174 29 27.14 ± 2.03 (21-40) 13.07
Positive attitude 108 18 43.62 ± 1.48 (41-60)

Table 4. Association of level of attitude of healthcare students towards patients living with HIV/AIDS with selected demogra­
phic variables
Variables No Level of attitude c2
Negative Moderately positive Positive p-value

Age (in years)

18-19 515 281 144 90 6.142
20-21 65 30 23 12 0.1887
22-23 20 8 10 2
Gender
Male 196 104 62 30 4.810
Female 404 242 94 68 0.090
Sources of information
Web/media/newspaper/books 336 172 109 55 35.626
Teacher 12 2 8 2 0.0001***
Parents 18 4 10 4
Friends 234 150 40 44
Parents’ occupation
Daily wages 153 82 47 24 2.871
Professionals (teaching, medical, paramedical,
218 120 55 43 0.057
engineering, etc.)
Business 229 118 72 39
Family income/month (in rs)
10,000-20,000 243 118 83 42 5.852
20,001-30,000 78 43 20 15 0.210
> 30,000 279 162 74 43
NS – not significant, ***p < 0.001

interested in sexual activities. So, it is suggested that this age the  600 participants, parents of  38% students were doing
group students are more prone to get HIV infection, which is business and 26% were daily wagers. However, the parent’s
supported by the Joint United Nations Programme on HIV/ occupation did not influence the  attitude level of  students
AIDS (UNAIDS Report, 2007) [15]. According to Hawkes and towards taking care of people infected with HIV.
Santhya, in India, 23% of the total population within the age In the present study, 56% of the students received infor-
group of 10-19 years fall under the risk of HIV infection [16]. mation regarding HIV/AIDS through web, media, news-
Out of  the  600 participants, 33% were male and 67% paper, and 39% by friends. This is in accordance with Goel
were female. The data suggested that the majority of students et al. who highlighted that 83% of the nursing students se-
opting a  healthcare profession such as dentistry and nurs- lected the main source of information as television (TV),
ing were female. This is in accordance with WD Square who newspaper/magazine, and 26% as peers [17]. Dharmalin-
stated that female are more vulnerable to get HIV infection gam et al. also revealed that nearly three-fourth (73.8%)
biologically and due to socio-cultural factors such as male of  the  nursing students received information about HIV/
domination, domestic violence, child labor, prostitution, AIDS through mass media, TV, newspaper, and magazines
and economic abuse. This is also supported by the Nation- [18]. It is suggested that mass media plays a major role in
al AIDS Control Organization Report (NACO) [5]. Among HIV awareness.

HIV & AIDS Review 2020/Volume 19/Number 1

Attitude of students towards HIV/AIDS 47

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HIV & AIDS Review 2020/Volume 19/Number 1