HIV Knowledge and Awareness Status of the Medical Students in Romania: An Awareness Study

Objective: We aimed to evaluate the status of knowledge and attitudes of medical students about HIV/ AIDS. Material and methods: In this descriptive, cross-sectional survey study, the status of knowledge and attitudes of medical students of Grigore T. Popa University of Medicine and Pharmacy about HIV/AIDS in June 2017 were evaluated. Results: A total of 85 medical students answered all of our 19 survey questions. The mean age was 21.80 ± 1.37 years (Range: 19-24 years). In the second question, six out of the 15 choices were correct and the mean of correct answers was 4.41 ± 1.49. There was a significant relationship between the grade of the students and the level of knowledge in the responses to the seventh question (p: 0.024). Conclusion: It is obvious that there are needed more healthinformative organizations targeting the young population especially at schools and universities about sexually transmitted diseases, especially HIV/AIDS – transmission routes, misconceptions about HIV, preventive measures, and the life expectancy after HIV acquirement. Those programs may raise the HIV awareness and be useful to change the behaviour against HIV patients eliminating stigma. *Corresponding author: Gedik H, Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey, Tel: +90 212 414 53 09; E-mail: habipgedik@yahoo.com Received: August 03, 2017; Accepted: August 07, 2017; Published: August 14, 2017 Citation: Parcaoglu F, Gedik H (2017) HIV Knowledge and Awareness Status of the Medical Faculty Students in Romania: An Awareness Study. J Infect Dis Med 2: 111. doi: 10.4172/2576-1420.1000111 Copyright: © 2017 Parcaoglu F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. awareness of HIV/AIDS among college students, have reported that students had insufficient knowledge about HIV prevention, the protection against HIV, and transmission routes of HIV [8-11]. Throughout the world, young people are the highest risk group. Their awareness and knowledge on the transmission routes and prevention of HIV/AIDS is very important. It was reported that the HIV awareness programs had a significant impact on the community [12]. Medical students are also trained about all HIV during their education, so their knowledge about HIV should be at the top level to inform their circles and the community. For that reason, we aimed to evaluate the level of knowledge and attitudes of medical students about HIV and AIDS. Material and Methods The purpose of this descriptive, cross-sectional survey was to evaluate the knowledge and perceptions of the medical students of Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania about HIV and AIDS. The samples were not selected for the survey study, and the survey was applied to students that agreed to participate in June 2017 at Grigore T. Popa University of Medicine. The characteristics of the students included gender, age, and grade in the faculty. The duration of training is six years in the medical faculty, so students were categorized into six grades. There was no question about the identity of the participant. J o u r n a l o f I nf ec tiou s ases nd M e d i c i n e ISSN: 2576-1420 Journal of Infectious Diseases and Medicine Citation: Parcaoglu F, Gedik H (2017) HIV Knowledge and Awareness Status of the Medical Faculty Students in Romania: An Awareness Study. J Infect Dis Med 2: 111. doi: 10.4172/2576-1420.1000111


Introduction
Human immunodeficiency virus (HIV) has been causing one of the devastating pandemics and has a great impact on society due to its history of evolution.Acquired immunodeficiency syndrome (AIDS) was publicly reported in 1981 by the Centres for Disease Control (CDC) in the USA.Doctors reported the unexpected clusters of extremely rare diseases, such as Pneumocytis carinii pneumonia and Kaposi's sarcoma.Those conditions manifested in a defined risk group, such as young homosexual men.After a short time, the disease had been recognized in other groups, including hemophiliacs, blood transfusion recipients, and intravenous drug users.By 1982, cases were being seen among the partners and infants of those infected with HIV [1,2].HIV is transmitted by contact with an infected persons' certain body fluids, such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, breast milk and by sharing needles/syringes (primarily for drug injection), and rarely through the transfusions of infected blood [3].
The World Health Organization (WHO) and the Joint United Nations Program on HIV and AIDS (UNAIDS) reported that 36.7 million people were living with HIV globally; 2.1 million people became newly infected, and 1.1 million people died of HIV related causes at the end of 201 [4].The first HIV case was reported in Romania in 1985.Of 18,797 HIV/AIDS cases registered between 1985 and 2013, 55% were male [5].The rates of new cases with HIV increased 17.9%; 47.3% between 2009 and 2010; and 20.3% between 2011 and 2012 [6,7].According to the report of Romanian Ministry of Health, National Institute for Infectious Diseases "Prof.Dr. Matei Bals" Compartment for Monitoring and Evaluation of HIV/AIDS Data 2012, the number of HIV cases was 416 in the age group 1-19 years, while it was 4813 in the age group 20-24 years [7].The age group 20-24 years is generally the college students at high risk for the sexually transmitted diseases due to the risky attitudes in their sexually active lives.
The studies, which were conducted in different countries regarding awareness of HIV/AIDS among college students, have reported that students had insufficient knowledge about HIV prevention, the protection against HIV, and transmission routes of HIV [8][9][10][11].Throughout the world, young people are the highest risk group.Their awareness and knowledge on the transmission routes and prevention of HIV/AIDS is very important.It was reported that the HIV awareness programs had a significant impact on the community [12].Medical students are also trained about all HIV during their education, so their knowledge about HIV should be at the top level to inform their circles and the community.For that reason, we aimed to evaluate the level of knowledge and attitudes of medical students about HIV and AIDS.

Material and Methods
The purpose of this descriptive, cross-sectional survey was to evaluate the knowledge and perceptions of the medical students of Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania about HIV and AIDS.The samples were not selected for the survey study, and the survey was applied to students that agreed to participate in June 2017 at Grigore T. Popa University of Medicine.The characteristics of the students included gender, age, and grade in the faculty.The duration of training is six years in the medical faculty, so students were categorized into six grades.There was no question about the identity of the participant.

Journal of Infectious Diseases and Medicine
The questionnaire was written in English.The structured questionnaire included 19 questions.Students were asked to choose single answer, multiple answers, or yes/no in the questionnaire.The questions were about HIV definition, early sign and symptoms, modes of transmission, attitudes, and perceptions towards HIV positive patients, prevention measures, detection of disease, and counselling choices.

Statistics
Data are analysed using SPSS 23.0 (Chicago, IL, USA).Continuous variables were described as mean ± standard deviation and range.Percentile values were described with decimals.Dichotomous variables were compared by Fisher's exact test for two by two comparisons or Pearson χ 2 for greater than two responses.P-value < 0.05 was considered as significant.The P 1 indicates the statistical comparison of the responses between men and women.The P 2 indicates the statistical comparison of the responses by the grades of the students.
The questions and responses of the students have been revealed in Table 1.On the second question, six out of the 15 choices were correct and the mean of correct answers was 4.41 ± 1.49 (Range: 1-6).There was a significant relationship between the grade of the students and the level of knowledge in the responses to the seventh question (p: 0.024).Since the fourth and fifth graders had more knowledge about HIV than those in other grades.There was found a significant relationship between choosing the correct answer and the grades of the students in the eighth question about the protection of the contraceptive pill against HIV (p: 0.0005).The high rates of wrong answers (26%) of fifth graders caused that significant relationship.There was found a significant relationship between the correct response and the grade of the students in the 17 th question about HIV prevention (p: 0.001).The numbers of wrong answers were higher in the first and second graders, and the fact that nearly half of the students in third grade responded false caused a significant difference.

Discussion
College students are one of the groups at higher risk of HIV infection, and some of them due to the lack of proper knowledge regarding the disease due to lack of knowledge and training at educational institutes [13].HIV awareness should be kept at a higher level, as they may instruct people about HIV during their social contact.In this study, the majority of students demonstrated a sufficient knowledge about HIV transmission routes, risky behaviours, and HIV prevention.However, there are still some misconceptions needed to be corrected among students [13].
Our study findings indicated that medical doctors and medical centers are commonly preferred to receive information about HIV/ AIDS, followed by the Internet.Preparing brochures and the training programs about HIV and other sexually transmitted diseases are performed at hospitals and community health centers may be useful to instruct students and people.Since people commonly hesitate to ask Note: P 1 indicates the value obtained as a result of the statistical comparison of the responses between men and women.P 2 indicates the value obtained as a result of the statistical comparison of the responses by the grades of students in the faculty.
Table 1: Survey questions and response rates.
questions and to receive information about HIV.The Internet, which was the second preferred information source in our study, may be an important tool to inform the people and to increase their awareness about HIV/AIDS.The projects, including a direct counselling by an interview on the Internet or a communication with HIV related associations or non-governmental organizations as well as the websites to provide correct information about HIV/AIDS [14].Since people frequently use the Internet to obtain information.Although all the students have revealed that they have information about HIV/AIDS, 30% of them did not know the difference between HIV and AIDS and several students did not know the all transmission routes of HIV exactly.The misconceptions about the transmission of HIV, such as hugging and kissing, sharing glasses with an infected person, mosquito bites, and sharing toilet seat, cause stigma against HIV positive people.Our findings were consistent with the findings of the other published studies in China, Turkey, India, and the USA [15][16][17][18][19]. Therefore, it is essential to introduce and provide the accurate information about the transmission routes of HIV to decrease the misconceptions, prejudice, and stigmatization [20].
Almost all of the students revealed that their attitudes towards people living with HIV/ AIDS were positive.However, approximately 20% of the students responded that they would not share an apartment, not use items of an infected person, and not kiss in related to the misconception of transmission routes, in.It should be emphasized in the seminaries about HIV/AIDS that HIV is not transmitted during a social relationship with HIV-positive people.There could be a social problem when HIV positive people are stigmatized in the society [21].HIV related associations, foundations, and non-governmental organizations should organize informative meetings for the community to prevent the stigma.
There was a sufficient knowledge among the students about using condom as a way of prevention of sexually transmitted diseases, but some of the students revealed that they use condom depend on their feelings or partners.The rates of condom use are not at the desired level yet.The cognitive and emotional variables as well as the cultural aspects of perceptions were reported to be factors hampering the condom use [22,23].Condom use should be encouraged by the advertisements and projects [24].Only 76% of the students knew the ineffectiveness of birth control pills against HIV protection.That shows the gap in the knowledge about protection against HIV.
Even though most of the students responded that they would receive HIV counselling from an HIV specialist and try to start antiretroviral treatment as soon as possible, some students might either commit suicide or get isolated from the community, if they were diagnosed with HIV.HIV-related stigma, discrimination, prejudice, negative attitudes, and abuse were reported to be in 35% of countries and over 50% of people as the main reasons related to suicide and isolation from community [25].Stigma, which causes poor treatment, detergency in educational and work settings, erosion of HIV-positive patients' rights, and psychological damage, is still a big problem through the world for HIV-positive patients.At this point, it should be pointed out that HIV is a chronic disease and it is possible to live a healthy and quality life for many years with antiretroviral therapy.
We found a significant difference between the knowledge level of the pre-clinical graders (grade 1 and 2) and the medical graders (grade from 3 to 6).It was reported that informative activities should be started in the early years of study to increase the knowledge [26,27].Superficiality and insufficiency of information about HIV/AIDS in the curriculum of pre-clinical years in the medical schools can be related to our findings [28].
The limitation of this study was the insufficient number of students from each grade, as the distribution of students by grades was not similar.The study could have propounded more accurate results about the knowledge status of medical students, if the study was conducted with the sufficient number of students from each grade.The curriculum.The curriculum of the medical faculty and the presence of informative organizations about HIV were not evaluated to assess the effectiveness of them among the students in our study as well.
As a result, it is obvious that there are needed more healthinformative organizations targeting the young population especially at schools and universities about sexually transmitted diseases, especially HIV/AIDS -transmission routes, misconceptions about HIV, prevention measures, and the life expectancy after HIV acquirement.Those programs may raise the HIV awareness and be useful to change the behaviour change against HIV patients eliminating stigma.The dissemination and integration of HIV modules in the pre-medical faculties are needed to raise the information level about HIV and the social responsibility projects should be encouraged to raise the awareness of targeted social groups.