Medical students’ attitudes towards treating patients with HIV: A 12-year follow-up study

Dear Sir

Undergraduate medical trainees are likely to encounter patients infected with human immunodeficiency virus (HIV) during their careers. The identification of attitudes associated with unwillingness to treat HIV-infected patients is important in devising relevant curricula to prepare medical trainees for such encounters. While several studies have been performed to measure such attitudes, the vast majority is outdated, as medical and societal stigmas surrounding HIV have evolved considerably over time.

We performed a cross-sectional survey of pre-clerkship medical students at an urban Canadian university using a published, standardized survey instrument administered to a different cohort 12 years prior (Carter et al. 1996). The goal of the survey was to measure the willingness of medical trainees to treat patients with HIV and HIV-associated attitudes. Linear regression was used to identify correlations between attitudes and the Student's t-test and Fisher's exact test were used to identify significant associations between desired outcomes.

A total of 201 students (81.4%) completed the survey. Willingness to treat patients with HIV was rated as 6.16 ± 0.74 out of maximum value of 7 and compared with results from 12 years prior, students were significantly more willing to treat patients with HIV (p < 0.01). Factors most strongly correlated with unwillingness to treat HIV-infected patients were fear of infection and homophobia (R = −0.50 and −0.49, respectively), while a stronger sense of professional obligation was weakly associated with willingness to treat (R = 0.37). Interestingly, neither fear of infection nor homophobia scores showed a significant change over the 12-year interval and sense of professional obligation actually decreased (p < 0.01).

Stratified by age, younger students were less willing to treat patients with HIV, more fearful of infection and scored higher on homophobia scales (p < 0.05). Compared to first-year students, second-year students were more willing to treat HIV-infected patients, felt a stronger sense of professional obligation, and scored lower on homophobia scales (p < 0.05). This is cause for optimism as previous studies showed no changes in attitudes or a declining willingness to treat HIV patients as students advanced through their training (Weyant et al. 1993)

Medical school provides a unique opportunity to educate future physicians about vulnerable populations such as HIV-infected patients who continue to face social stigma and challenges in access to healthcare. While medical trainees are now more willing to treat patients with HIV than their successors, fear of infection and homophobia remain barriers to patient care that should be addressed in medical curricula.

Shawn Hoffart, Department of Kinesiology, Alberta Health Services, Calgary, AB, Canada, George M. Ibrahim, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada, Russell A. Lam, Department of Pediatrics, Queen's University, Kingston, ON, Canada, Evan P. Minty, Department of Medicine, University of Calgary, Calgary, AB, Canada, Michelle Theam, Department of Anesthesia, University of Alberta, Alberta, Canada, Jeffrey P. Schaefer, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, AB T2N 2T9, Canada. E-mail: [email protected]