Abstract

Human immunodeficiency virus (HIV) infection has been linked to more than 35 million deaths globally, and the levels of infection are increasing; thus understanding people's knowledge, attitudes, and practice (KAP) concerning HIV/AIDS is a critical component of the battle against the disease. Objectives: measuring healthcare workers’ knowledge, attitude, and practice regarding HIV/AIDS, and people living with HIV (PLHIV). Methods: A quantitative cross-sectional study was conducted in the western area of the Kingdom of Saudi Arabia (KSA) from September 2022 to October 2022. Results: The study included 263 healthcare workers from eight hospitals. The level of knowledge was excellent among 46.4%, good among 17.1%, fair among 12.9%, and poor among 23.6%. Most respondents' overall attitude was positive, while the practice pattern was poor. Good KAP was significantly associated with physicians, nurses, and previous experience with HIV patients. Conclusion: The level of knowledge was high, the attitude was positive, and the practice was poor among most respondents regarding HIV/AIDS with a significant positive correlation with being a health care physician or nurse, and having previous experience with AIDS cases.

1. Introduction

Human immunodeficiency virus (HIV) infection has been linked to more than 35 million deaths globally as of 2017. At the end of 2017, 36.9 million people were living with HIV ¹. Ending 2015, there were 22,952 instances of acquired immunodeficiency syndrome (AIDS) cases in Saudi Arabia's Kingdom of Saudi Arabia (KSA). Of these, about 67% were found among non-Saudi ethnicities, while 1191 were newly discovered ². More than 8000 persons aged 15, and older were living with HIV in 2016; 72.5 percent of these people were males, and 27.5% were females ³.

Understanding people's knowledge, attitudes, and practice (KAP) concerning human immunodeficiency virus with acquired immune deficiency syndrome (HIV/AIDS) is a critical component of the battle against the disease. Many persons living with HIV/AIDS face prejudice because of a lack of understanding or misinformation about HIV/AIDS in the broader public ^{4, 5}. This precipitates issues with access to antiretroviral medication, psychological care, disclosure, and social isolation. People living with HIV also suffer regarding their health, well-being, and social support ⁶.

Furthermore, several variables are linked to one's level of HIV awareness, and have a significant effect on the degree of HIV stigma. Most of these characteristics may be attributed to people's knowledge of HIV, and their attitudes about it. There are several techniques for eliminating HIV stigma, two of the most successful of which include raising public education and understanding of the virus. Thus, as education levels rise, unfavorable views about PLWHIV diminish, and hence HIV stigma levels fall. Studies on the impact of educational, and awareness interventions on HIV stigma have been backed up by various quasi- studies ^{7, 8}.

Few research has focused on particular Saudi communities ⁹. In addition, a low level of knowledge was found among physicians regarding the routes of transmission ¹⁰. A lack of information about HIV transmission, prevention, and negative attitudes toward people living with HIV, were also found among the paramedical students ¹¹. This study aimed to measure health care workers’ knowledge, attitude, and practice regarding HIV/AIDS, and PLHIV. We believe our findings will aid in establishing a basis for further research in this field and help other health care workers modify their approach toward HIV/AIDS accordingly.

2. Methods

A quantitative cross-sectional study based on an online questionnaire sheet conducted in the western area of KSA, including Al Madinah Almnuwrah, and Makkah from September 2022 to October 2022 as four random hospitals were selected from each city, and included in the study.

The study included healthcare providers with various specialized services who were approved to take part in the survey after distributing the link for the questionnaire. The study sample included all healthcare workers in eight random hospitals.

To estimate the population prevalence with high precision, a suitable sample size is required. The sample size, and should be determined by the study setting, including the aims, and suggested analysis of the researcher. In this investigation, the needed sample size was calculated with the following formula:

(1)

If n is the sample size, Z is the confidence level statistic, P is the predicted prevalence, and d is the accuracy. The confidence level was 95%, and the sample size was 263 subjects.

An online questionnaire (Appendix) link was distributed among healthcare workers that included questions of different levels regarding HIV. A pilot study was done to evaluate the intelligibility, collect responses, and modifications needed for optimizing the questionnaire. The questionnaire was modified, and a part including the beliefs of the healthcare workers were added. The questionnaire has four parts about demographics, knowledge, attitude, and beliefs about HIV/AIDS.

The ethical committee of the faculty of medicine approved the study, and the questionnaire (IRB022-71). Online informed consent was provided by the participants included in the study.

Data were analyzed using IBM SPSS software package version 24.0. The qualitative data were described using numbers, and percentages. Comparison between different groups regarding categorical variables was tested using the Chi-square test. Significance test results are quoted as two-tailed probabilities. The significance of the obtained results was judged at the 5% level.

3. Results

Table 1 shows the distribution of the studied group in their demographics. More than half of the participants (58.6%) have worked for more than ten years. The majority of the participants were physicians (38.4%) followed, by nurses (25.1%), and pharmacists (19.4%). Also, 74.9% of the respondents didn’t have experience with HIV cases.

Table 2 represents the knowledge of the healthcare workers regarding AIDS causes, mode of transmission, and confidentiality. The majority of respondents correctly answered the question of whether the cause of AIDS is viral, and not bacterial (73.8%). About 74.1% knew that the risk of acquiring AIDS from needle stick injury is 0.3%. As for the mode of transmission, 77.6% answered the question correctly about the most common method of transmission. Also, most knew that Aids couldn’t be transmitted by shaking hands (68.1) or through the air (66.2%). Most participants (76.8%) admitted that confidentiality is essential with AIDS, and 71.5% identified the increased UNAIDS global report in 2012 as the total number globally of AIDS. The level of knowledge was excellent among 46.4%, good among 17.1%, fair among 12.9%, and poor among 23.6% (Table 3).

The overall attitude was positive among the majority of the respondents (Table 4 & Table 5). The attuited was negative among 63.5% as they tend to admit AIDS patients in air-borne isolation. Also, 70% has positive wrong attitude that AIDS is curable. On the other hand, most of the respondents tend to have positive attitude toward using Antiretroviral therapy to control AIDS, (71.5%), compulsory treating an AIDS patient (74.5%), and 63.9% support premarital HIV testing.

The practice of healthcare workers toward AIDS patients showed that about half of the participants (54.4%) avoid physical contact when providing care or services to a person living with HIV/AIDS, and 61.2% fear contracting HIV if you come in contact with the saliva of a person living with HIV/AIDS. The practice pattern among most of them was a little worried followed by worried, very worried, and the least were not worried regarding touching the clothing, dressing the wound or drawing blood from a person living with HIV/AIDS. The practice level was worried among 49.8% of participants followed by a little worried among 31.9% of healthcare workers (Table 7).

As shown in Table 8, Table 9, and Table 10 the highest level of knowledge, good attitude, and practice among respondents were significantly associated with being a healthcare practitioner as physicians, and nurses, and previous experience with HIV cases.

4. Discussion

Care providers were surveyed to determine their level of HIV-related KAP. A high degree of HIV-related information, a good attitude, and generally poor practices were all identified among HCWs towards PLHIV, except there were notable disparities amongst occupations.

In the exact accordance, a study conducted at Governmental Healthcare Facilities in Malaysia among healthcare workers observed that 68.8% of HCWs, despite their extensive education, still held the false belief that the HIV virus is resistant to disinfectants ¹².

It's consistent with the results of other studies that found a sizable percentage of HCWs worried about contracting HIV from their job ^{13, 14}.

Although this study found that most HCW overestimated their risk of HIV contacting HIV patients on the job, it does show that many people are willing to overestimate risks in order to avoid unpleasant consequences ¹². It is crucial to inform HCW that there is little evidence of HIV infection acquired on the job, especially compared to the spread of illnesses like hepatitis B ¹⁵.

In contrast to this study, health care workers in Abha, and Khamis Mushait, Saudi Arabia, were found to have an overall low level of expertise, negative attitudes, and unprofessional behavior ¹⁶. Twenty-five years ago, similar findings were revealed ¹⁷. Also, HCWs had insufficient information regarding how the illness spread ¹⁶. Medical, and dental professionals in four major Saudi Arabian cities (Jeddah, Riyadh, Dammam, and Jizan) showed similar levels of ignorance ^{10, 18}. Furthermore, the observed lack of knowledge, and misunderstanding had nothing to do with the gender, age, specialty, or length of employment of HCWs. Similar results have been found in previous research conducted in Saudi Arabia ^{10, 18}.

This shows that the HCWs may be affected less by their level of education than by the cultural preconception that HIV is typically the result of immoral sexual relationships such as those that occur outside of marriage, and homosexuality ^{10, 18, 19, 20}.

Poor attitudes, and stigma against HIV-positive patients were reported as a result of the examined HCWs' inadequate knowledge, and misunderstandings (PLWHA). One study conducted in Saudi Arabia found that doctors have a disproportionately high stigmatizing attitude toward HIV patients, which the researchers ascribed to their lack of understanding of the virus's transmission ^{10, 18}. Other research cited the psychological dread of HIV infection due to a lack of awareness ^{21, 22, 23, 24}.

The high KAP level was associated with being a doctor, nurse, or have previous experience with HIV cases; the same results were found in Oman as the highest level of knowledge was associated with physicians, and nurses more than pharmacists, and lab workers as well as the level of experience ²⁴.

This study was directed at the western part of KSA with a representative sample size that provides an expected result of the KAP of Saudi subjects. It includes health workers, and others to study the effect of occupation on KAP. However, the study was based on an online questionnaire thus results in the analysis may have been affected by response bias. Also, the study only evaluated the KAP level of HCWs at governmental hospitals, and didn’t include private hospitals which are numerous in KSA thus the results can’t be generalized allover KSA.

5. Conclusion

The level of knowledge was high, the attitude was positive, and the practice was poor among most of the respondents regarding HIV/AIDS with a positive significant correlation with being a health care physician or nurse and having previous experience with AIDS cases. However, the majority showed a high knowledge level, and the level of practice was poor among most of them, which recommends launching educational programs, and new health policies regarding the training of healthcare workers with HIV patients to enhance their commitment to provide medical help for HIV/AIDS patients with adhering to firm infection guiding principles to avert the spread of all infections.

Funding

The study was self-funded by the author.

Conflict of Interest

No conflict of interest.

Acknowledgements

All authors would like to thank ‘Mr. Nawaf Abdulrahman Madaddin’ for his efforts in facilitating the data collection process.

References