Correlates of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife,Nigeria

Objectives The study assessed physicians' perceptions of HIV/AIDS patients and identified the determinants of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria.

Methods A semi-structured questionnaire was used to elicit information from 110 physicians in a cross-sectional survey, while in-depth interviews were conducted with 10 people living with HIV/AIDS (PLWHA) who had been previously admitted under the care of the physicians. Univariate, bivariate and multivariate analyzes were conducted.

Results Although most physicians perceived PLWHA positively and 58% of them displayed a positive attitude toward communication with PLWHA under their care, the expectations of the patients concerning HIV/AIDS communication were not being met. Only 43% of physicians expressed any degree of comfort engaging PLWHA in lengthy discussions or communicating the diagnosis of HIV to patients. The strongest correlates of physicians' positive attitude were previous exposure to HIV/AIDS counseling, the number of HIV/AIDS patients treated per month, the number of years spent in the care of PLWHA, and the gender of the physicians (p < 0.05).

Conclusions Physicians in Ile-Ife, Nigeria are not adequately equipped by way of training to effectively meet the expectations of their patients concerning HIV/AIDS communication. The large number of PLWHA in the country calls for urgent attention to address this important aspect of care.     

Attitude of health-care workers to HIV/AIDS

The current 5% prevalence rate of HIV in Nigeria represents a significant population of people living with HIV/AIDS (PLWHA). Discrimination against PLWHA has profound impact on the care and support required for their optimal management particularly in resource-constrained settings. The study sought to assess the knowledge of health-care providers about HIV/AIDS, determine the potential for discrimination in the provision of services based on patients' HIV sero-status and review the factors that may contribute to such attitude. Self-administered semi-structured questionnaires were administered to respondents who were selected by multi-stage sampling technique. The questionnaires explored the respondents' knowledge about HIV and their attitude and practice regarding PLWHA. Three hundred and forty-five questionnaires were completed. Only 77.1% correctly identified breastfeeding as a source of HIV transmission; 5.2%and 2.6% respectively thought transmission was possible through mosquito bite and handshake. About 10% and 15% respectively among trained nurses and auxiliary nurses were unaware that HIV could be transmitted to the child during delivery. Some 13.9% and 12.7% of respondents respectively were unwilling to take vital signs and carry out physical examination on PLWHA. Compared to physicians, trained nurses and auxiliary nurses were more likely to deny services based on HIV sero-status. Negative attitude was more likely if the source of the HIV infection was from homosexual exposure or bisexual indiscretion. The health-care workers studied manifested certain attitudes that are potentially discriminatory of PLWHA. Well-coordinated continuing education of HIV/AIDS for all categories of health-care workers is recommended as a vital strategy in the crusade against the epidemic.     

Expanding access to the management of HIV/AIDS through physicians in private practice: an exploratory survey of knowledge and practices in two Nigerian states

Over the past few years, the cost of antiretroviral drugs has continued to decline. A significant proportion of people in Nigeria seek medical care primarily in the "for profit" private sector. The complexity of managing HIV and AIDS has led to debates on whether care should only be restricted to trained and accredited experts in HIV care. This research studied the knowledge and practices of physicians in private practice in two Nigerian states on the management of patients with HIV/AIDS using an anonymous self-administered questionnaire eliciting knowledge and attitudinal information. This is to ascertain their preparedness to manage HIV positive patients. The doctors were found to be poorly informed on practical issues in the management of HIV patients. These included the need to confirm their patient's HIV status, where to do the confirmation and where to refer such patients for counselling. Most of them referred to the mass media as their primary source of information. There is an urgent need for pro-active planning to prepare physicians in private practice for increasing demands in the management of HIV/AIDS in Nigeria. Organising a nation-wide training programme that would lead to ongoing accreditation programme is a way of achieving this. The formulation of guidelines for managing both clinical and non-clinical aspects of HIV/AIDS should be prioritised.     

Knowledge,attitude, and behavior of secondary (high) school students concerning HIV/AIDS in Enugu,Nigeria, in the year 2000

STUDY OBJECTIVE: To investigate the knowledge, attitude, and behavior of secondary (high) school students concerning HIV/AIDS as a way of assessing the need for inclusion of reproductive health education in the school curriculum.DESIGN: A questionnaire was constructed to expose depth of knowledge and attitude of respondents concerning HIV/AIDS.SETTING: This was a workshop venue, a civic center, outside a school compound.PARTICIPANTS: Three hundred and sixty students were randomly selected from 5 secondary (high) schools in Enugu, Nigeria.INTERVENTION: The questionnaire was administered just before the commencement of a workshop.MAIN OUTCOME MEASURE: All the students responded to the questionnaire but none responded to all the questions.RESULTS: The students had a defective knowledge of the disease. They were aware and afraid of the disease as being deadly but not sure of the cause, nature, or modes of transmission and prevention, except that illicit sexual activity should be avoided. Their attitude and behavior were consequently defective. Their main source of information was the media.CONCLUSION: There is need to provide students with correct, detailed, and broad-based information on reproductive health as part of the school curriculum to help them acquire adequate knowledge and develop appropriate attitude and behavior towards HIV/AIDS and other STDs.     

Assessing the level of preparedness of private health providers for clinical management of HIV/AIDS epidemic in Nassarawa State, Nigeria

Very little information is available on the extent to which the private health sector is involved in clinical management of HIV/AIDS in Nigeria. This study assessed the potentials and existing capacity of 15 private health facilities in Nassarawa state for clinical management of HIV/AIDS. Information was obtained from 25 staff (15 proprietors and 10 professionals) of the randomly selected health facilities in the state using structured questionnaire. Of the 15 health facilities, three provided voluntary counselling and testing (VCT), seven had never admitted persons living with HIV/AIDS (PLWHA), two provided laboratory services, none provided home-based care for PLWHAs, two had anti-retro-viral drugs in stock, two had rooms for counselling, three had full-time doctors, and six had registered nurses. Of the 25 health workers, 5 had skills/training in conducting VCT, 15 had skills in the treatment of opportunistic infections, 14 were aware of anti-retro-viral drugs and 13 did not feel comfortable attending to PLWHAs. The study recommended capacity building on HIV/AIDS related services for the private health-workers.     

Acceptability of prenatal HIV screening at the primary care level in Nigeria.

A survey of 333 pregnant women receiving antenatal care at the primary healthcare centres in Sagamu Local Government Area of Ogun State, southwest Nigeria was conducted between January and March 2005 to assess the acceptability of prenatal HIV screening among them. A total of 325 (97.8%) of the respondents were aware of HIV/AIDS but only 181 (54.3%) of them believed it is a problem in Nigeria. A total of 257 (77.2%) respondents agreed to undergo voluntary counselling and HIV testing (VCT). Multivariate logistic regression analysis of associated factors indicated that being married, self-perception of no risk of HIV infection, awareness of benefits of prenatal HIV testing and Christianity are independent predictors of acceptance of prenatal HIV testing in this population. Most of the respondents (78.9%) who were unwilling to take the test cited fear of being infected with its consequences of stigma and discrimination as the reason for their attitude. The survey suggests that a successful integration of VCT programme into the existing primary healthcare services for prevention of vertical HIV transmission is feasible in this part of Nigeria.     

Journalists' knowledge of AIDS and attitude to persons living with HIV in Ibadan, Nigeria

This study surveyed 254 journalists from the seven media organisations in Ibadan, Nigeria, to assess their knowledge of acquired immune deficiency syndrome (AIDS), attitude to persons living with HIV/AIDS (PLWA) and reports of AIDS-related issues. The journalists' overall mean AIDS knowledge score was 10.6 out of 14 points. About one third (29%) believed that the bite of a mosquito could transmit HIV and 28% thought that AIDS could be cured if detected early. Although 75.2% agreed that the rights of PLWAs to employment should be protected, 49.6% believed AIDS patients should be detained in hospital to prevent the spread of HIV. About a quarter (25.2%) had received training about HIV/AIDS, while 74.8% had not. The majority (65.4%) had never written any report on HIV/AIDS-related issues, while 35.6% had done so. Journalists in Ibadan do not have adequate knowledge of AIDS, and many of them show negative attitude to PLWAs, thus undermining their potential ability to educate the public about AIDS. Advocacy and training workshops are recommended to address this problem.     

Analysis of women's reproductive health situation in Bida Emirate of Niger State,Nigeria

This study examined the reproductive health situation in Bida Emirate of Nigeria, with a view to advancing frontiers in communication support for reproductive health education. Multi-stage sampling technique was used to randomly select 1,200 women respondents that participated in the study. Data was obtained on reproductive health and rights, reproductive health history, and personal and social characteristics of respondents. Data analyses showed that majority (68.1%) of respondents were aware of existing methods of birth control, while 31.9% were not. On the use of methods, abstinence, breastfeeding and use of condoms recorded 42.8%, 22% and 40.3% respectively. Respondents rarely used traditional methods of birth control. Forty five per cent blamed their husbands for not using family planning methods. Surprisingly, 84.8% of respondents had no idea of what HIV/AIDS is all about; only 13% and 3.1% could describe gonorrhoea and AIDS respectively. Results further revealed that there is no significant relationship between personal and social characteristics of respondents (religion, marital status and position, etc) and their attitude towards family planning. However, rural and urban women significantly differed in their health status (t = 0.2729; p < 0.001). Similar trend was observed for attitude towards family decision-making (t = 40; p < 0.001), sexuality and STD prevention (t = 90; p < 0.001), and maternity/childcare (t = 0.001; p < 0.001). In conclusion, the study reveals that there is a wide gap between social expectations of women's reproductive health and cultural realities in Nupeland of Nigeria. The study thus recommends, among others, the need for sustainable safe motherhood campaign in culture bound societies.     

Assessment of awareness of HIV/AIDS among selected target groups in and around Addis Ababa,Ethiopia

A total of 2278 individuals were interviewed using a pre-tested questionnaire with key indicators such as mode of transmission, attitude towards HIV/AIDS patients, information sources, sex, educational and marital status. Findings indicate that most of the respondents (93.2%) were aware of the reality of HIV/AIDS and considered it as a killer disease (89.2%). A significant number of them had negative attitude towards HIV/AIDS patients. Some 30.4% believed HIV/AIDS patients can be identified through symptoms rather than clinical diagnosis. There is significant association between knowledge of HIV/AIDS and target group (p < 0.001), age (p < 0.05), sex (p < 0.05), marital status (p < 0.05) and educational level (p < 0.001). There is also a remarkable knowledge difference among respondents on means of prolonging life of individuals with HIV/AIDS. Some have never heard about how to prolong the life of such patients (10.2%). Farmers (42.5%) indicated that there is no means of prolonging the life of such patients. Respondents' knowledge on combating HIV/AIDS related diseases as a means of prolonging the life of succumbed individuals was rather low (5.5%). Low level awareness, therefore, may deter HIV/AIDS patients from seeking necessary medical attention.     

Physician knowledge and attitudes of Minnesota laws concerning adolescent health care

STUDY OBJECTIVE: To determine physicians' knowledge and attitudes of medico-legal issues affecting adolescent health care. DESIGN, SETTING, PARTICIPANTS: A cross-sectional, mailed survey was distributed to 900 randomly selected primary care physicians in Minnesota, and all eligible physicians in Olmsted County. INTERVENTIONS: Physicians were mailed a survey with questions concerning Minnesota consent and confidentiality laws. MAIN OUTCOME MEASURES: Physician knowledge and attitudes of consent and confidentiality laws. RESULTS: A total of 317 (26%) surveys were returned. Olmsted county physicians achieved a median score of 37.5% and non-Olmsted physicians achieved a median score of 50% correct on a test of knowledge. Using a scoring scale where -1 signified "a bad law," 0 signified "neither a good nor bad law," and +1 signified "a good law," attitude regarding the laws was a median of +0.5 for both groups. In all, 41.1% of Olmsted physicians and 51.7% of non-Olmsted physicians felt that the laws had affected them or their practice. Olmsted physicians were compared to a cohort of Olmsted parents previously reported, with statistically significant differences noted. CONCLUSIONS: Results suggest that primary care physicians are not knowledgeable of Minnesota laws affecting adolescent health care. Opinion of these laws was positive, with notable exceptions. Physicians lack a sense of impact of laws affecting adolescent health care. Physicians were more knowledgeable and felt more positively about the laws than did parents of adolescents. Lack of knowledge and the presence of certain attitudes identify areas where physicians could benefit from greater understanding.     

Results from a Secondary Data Analysis Regarding Satisfaction with Health Care among African American Women Living with HIV/AIDS

ObjectiveTo analyze satisfaction with health care among African American women living with HIV/AIDS.DesignSecondary analysis of baseline data of African American women who participated in Protect and Respect, a sexual risk reduction program for women living with HIV/AIDSSettingHIV Care Clinic in an urban city in the northeast United States.ParticipantsOne hundred fifty‐seven (157) African American women living with HIV/AIDS.MethodsRegression analyses were used to examine the relationships between demographic variables, self‐reported health characteristics, communication with health care providers, and satisfaction with health care provider.ResultsA majority of women reported satisfaction with medical services (88%, n = 140). Communication with health care providers, detectable viral load, education, income, self‐reported health status, and sexual orientation were significantly bivariately associated with satisfaction with healthcare (all ps < .05). In the multivariate models, no variables significantly predicted satisfaction with healthcare.ConclusionBecause satisfaction with health care can influence the quality of care received, health outcomes, and adherence to provider recommendations among patients living with HIV/AIDS, health care providers’ ability to elicit satisfaction from their patients is just as important as the services they provide. This project is one of the first studies to find high rates of satisfaction with health care among African American women living with HIV/AIDS. Further examination of satisfaction with health care among African American women living HIV/AIDS may help in narrowing health care disparities and negative treatment outcomes.     

Knowledge,attitude and practice of emergency contraception among health care providers in Ismailia,Egypt

ObjectiveTo explore the knowledge, attitude and practice of health care providers in Ismailia, Egypt regarding emergency contraception.Participants and methodA structured questionnaire was distributed to a total of 270 health care providers (obstetrics and gynecology specialists and general practitioners or family physicians). The questionnaire contained four main domains: demographic characteristics; knowledge about EC; attitude toward EC; and practice of EC.ResultsKnowledge of specialists was significantly higher than general practitioners/family physicians regarding the three most commonly used methods of EC, viz; combined oral contraceptive (Yuzpe) method, progesterone only pills (plan B) method and IUCD. Only 39.5% of specialists and 24.0% of GPs/family physicians had good knowledge of EC (p = 0.01). 45.7% of specialists and 42.6% of GPs/family physicians had favorable attitude toward EC with no significant difference. 39.5% of specialists and 26.6% of GPs/family physicians reported ever prescribing EC. Yuzpe method was the most commonly prescribed method by specialists (31.5%) and GPs/family physicians (27.0%) with no significant difference. Knowledge and favorable attitude were significantly associated in both groups. Age and years of experience significantly affected the three outcome measures.ConclusionA deficit in knowledge and a negative attitude shown by health care providers lead to an insufficient use of EC methods.     

Persistence of risky sexual behaviours and HIV/AIDS: evidence from qualitative data in three Nigerian communities

The behavioural factors that are driving HIV/AIDS remain largely elusive despite vast number of quantitative studies. It is widely acknowledged that sensitive issues like sexual mores are better studied, using the qualitative methods. An ethnographic semi-longitudinal study was conducted in three of Nigeria's communities with high and/or low HIV/AIDS prevalence rates in order to ascertain the risky behavioural factors that are still driving the epidemic despite colossal investment in preventative programmes. The focus group discussion, in-depth interview and key informant methods were utilized to gather data from members of the communities, opinion leaders, policymakers, healthcare practitioners and religious leaders. The nine factors that appear to be driving the infection are: transactional sex, age of sexual debut and lack of parental care, misconceptions about HIV and AIDS, sexual partnership beyond spouses and primary partners, mismatched sexual desire, fatalism, syndrome of denial, condom use, and alcohol. The outcomes of the study have implications for the prevention of the HIV/AIDS epidemic in the country.     

HIV prevention for rural youth in Nigeria: background overview

The negative impact of the HIV/AIDS epidemic has been a major challenge to sub-Saharan Africa. Although the rate of new HIV infections in sub-continent has decreased, the total number of people living with HIV continues to rise. Most of the people infected with HIV/AIDS in sub-Saharan Africa are within the age bracket of 15 to 35 years. It has been estimated that about 80% of the infected group are aged 20-29 years. It is against the background of the challenges posed by HIV/AIDS to young people that the Canadian-Nigerian partnership Action Research on HIV Prevention for Rural Youth was conceived. This paper provides the background to the outcomes reported in this special edition of this journal by reviewing the HIV/AIDS situation in sub-Saharan Africa and the nature of the associated response; discussing the rationale for the Action Research which focuses on Nigeria; and outlining the key components of the research.     

Perceived sufficiency and usefulness of IEC materials and methods related to HIV/AIDS among high school youth in Addis Ababa, Ethiopia

This study was conducted to assess the perceived sufficiency and usefulness of HIV/AIDS information, education and communication (IEC) messages and materials as well as to identify preferences for IEC sources and methods. Data were collected using a self-administered questionnaire and focus group discussions. A total of 901 students in Addis Ababa, Ethiopia, participated in the study. Over three quarters of the respondents believed in the usefulness of IEC. IEC materials were perceived to be useful in increasing knowledge about HIV/AIDS by 456 (51%), to influence attitude by 357 (40%) and to acquire safer sexual practices by 382 (42%) of the respondents. None of the information sources and messages available for high school students highly satisfied the sufficiency indicators. Even though no single information source was highly preferred, radio and television ranked top. Life skills training was the most desired intervention by the students. IEC on HIV/AIDS was able to acquaint students with the disease rather than equipping them with knowledge and skill needed in their daily life. Therefore, appropriate and mutually reinforcing IEC messages with emphasis on life skill training are recommended.     

Sex and reproduction among HIV-infected people in Maiduguri, Nigeria.

For HIV-infected people, prevention of transmission of the virus to their spouses and other sexual partners can only be achieved through abstinence and safer sex practices using condoms. New drugs and technologies are now available that can prevent vertical transmission of the virus. A total of 262 people living with HIV/AIDS (PLWHA) were interviewed to explore their sexual and reproductive desires and practices. About 75.6% of them were sexually active and 62.2% never used condoms. Although only 26.3% had no living child, the majority of these (71.4%) wanted to have children. Their knowledge of mother-to-child transmission of HIV and how to prevent it was good. PLWHA engage in unprotected sexual intercourse with the desire to have more children. It is expected that more paediatric HIV infections will be seen in the future in a poor-resource setting like ours.     

Perception and use of complementary and alternative medicine among gynecologic oncology care providers

Objective

To determine general attitudes and approaches to complementary and alternative medicine (CAM) among physicians who care for gynecologic oncology patients.

Methods

Surveys were mailed to members of the Society of Gynecologic Oncologists and the Michigan Oncology Group. Physicians were asked to rate their general attitude toward CAM.

Results

Surveys were obtained from 462 physicians. Gynecologic oncologists and female physicians were more likely to have positive attitudes toward CAM, and to believe that clinical care should integrate conventional and CAM practices, compared with other oncologists and male physicians.

Conclusion

Discrepancies exist among oncologists regarding attitude and use of CAM in their practice. Education of physicians regarding the safety and efficacy of CAM modalities may ultimately improve patient care.