Assessing the levels of HIV-related knowledge and attitudes toward HIV-infected patients among undergraduate dental students: a cross-sectional study

Figures & data

Table 1 Knowledge regarding HIV status in Egypt and infection/AIDS disease characteristics

Statement	Correct responses (%) (95% confidence interval)			Total (%) (95% CI)	P-value
	Third year	Fourth year	Fifth year
Percentage of HIV-infected individuals in Egypt is above 1% of the total population	16 (8, 24)	7 (1.6, 12.4)	15.2 (7.3, 23.1)	12.6 (8.7, 16.7)	0.148
Medical treatment is available in Egypt for HIV- infected individuals*	47.5 (36.6, 58.4)	11.9 (5.1, 18.7)	32.9 (22.6, 43.2)	30.5 (24.8, 36.2)	<0.001
HIV can survive up to 1 hour outside human tissues*	17.5 (9.2, 25.8)	41 (30.6, 51.4)	40.5 (29.7, 51.3)	33.1 (27.2, 39)	0.001
Every HIV-infected individual develops AIDS	38.5 (28, 49.1)	55.4 (44.9, 66)	49.4 (38.4, 60.4)	47.9 (41.7, 54.1)	0.094
The average time interval between contracting HIV and producing antibodies is 6–12 weeks**	31.6 (21.5, 41.7)	51.8 (41.2, 62.4)	50.6 (39.6, 61.6)	44.9 (38.7, 51.1)	0.016
For most HIV-infected individuals, clinical incubation period can extend to 8 years*	32.5 (22.3, 42.7)	38.8 (28.5, 49.1)	61 (50.3, 71.7)	43.8 (37.6, 50)	0.001

Note:

* Significant at level 1%;

** significant at level 5%.

Table 2 Knowledge of HIV modes of transmission

Statement	Correct responses (CI)			Total (%) (CI)	P-value
	Third year (%)	Fourth year (%)	Fifth year (%)
Dentists are among the high-risk groups to contract HIV infection	8.8 (2.6, 14.9)	1.2 (–1.1, 3.5)	8.8 (2.5, 15)	6.1 (3.1, 9.1)	0.065
Infection control measures to prevent hepatitis C infection can also prevent the transmission of HIV in the dental setting*	70.4 (60.5, 80.3)	100 (100, 100)	82.3 (73.9, 90.7)	84.3 (79.8, 88.8)	<0.001
AIDS is a contagious disease; it can be transmitted through sharing public toilets and swimming pools*	48.1 (37.5, 59)	81.2 (72.9, 89.5)	55.7 (44.8, 66.6)	62 (55.9, 68.1)	<0.001
HIV can spread by touching, kissing, coughing, sharing food or drink*	50.6 (39.7, 61.5)	79.5 (71, 88)	53.8 (42.9, 64.7)	61.5 (55.4, 67.6)	<0.001
HIV can be transmitted from the infected mother to her newborn infant during breastfeeding	42.5 (31.7, 53.3)	41 (30.6, 51.4)	29.1 (19.1, 39.1)	37.6 (31.6, 34.6)	0.162
Body fluids that contain high concentrations of HIV and have been linked to transmission of the virus are blood, semen, vaginal secretions, breast milk**	70 (60, 80)	86.7 (79.5, 93.9)	73.1 (63.4, 82.8)	76.8 (71.5, 82.1)	0.026
The risk for HIV infection after needle stick injury or after exposure of non-intact skin to HIV contaminated blood is <0.5%*	20 (11.3, 28.7)	34 (23, 44)	52.6 (41.7, 63.5)	35.4 (29.4, 41.4)	<0.001
Occupational exposure to saliva in the dental setting can readily transmit HIV to the dentist*	44.4 (33.6, 55.2)	70.6 (61, 80)	44.3 (33.4, 55.2)	53.5 (47.3, 59.7)	<0.001

Note:

* Significant at level 1%;

** significant at level 5%.

Table 3 Dental students’ knowledge of HIV-associated oral manifestations

Oral manifestation	Yes (%) (95% CI)			Total (%) (CI)	P-value
	Third year (%)	Fourth year (%)	Fifth year (%)
Oral candidiasis	45.7	62.1	60.8	56.3	0.063
	(34.9, 56.5)	(51.8, 72.4)	(50.1, 71.5)	(50.1, 62.5)
Recurrent aphthous ulcer**	21	23.3	38	27.2	0.032
	(12.1, 29.9)	(14.4, 32.2)	(27.4, 48.6)	(21.7, 32.7)
Kaposi’s sarcoma*	20	36.8	54.4	37	<0.001
	(11.3, 28.7)	(26.6, 47)	(43.5, 65.3)	(40, 43)
Necrotizing ulcerative periodontitis	13.6	19.8	28.8	20.6	0.057
	(6.1, 21.1)	(11.4, 28.2)	(18.9, 38.7)	(15.6, 25.6)
Non-Hodgkin’s lymphoma*	8.8	25.3	41.8	25.2	<0.001
	(2.6, 15)	(16.1, 34.5)	(31, 52.6)	(19.8, 30.6)
Cytomegalovirus ulcers**	18.5	28.7	37.5	28.2	0.028
	(10, 27)	(19.1, 38.3)	(26.9, 48.1)	(22.6, 33.8)
Linear gingival erythema**	8.6	7	20	11.7	0.019
	(2.5, 14.7)	(1.6, 12.4)	(11.2, 28.8)	(7.7, 15.7)
Xerostomia	44.4	34.5	40.5	39.7	0.412
	(33.6, 55.2)	(24.5, 44.5)	(29.7, 51.3)	(33.6, 45.8)
Oral hairy leukoplakia*	17.3	51.2	57.5	42.1	<0.001
	(9.1, 25.5)	(40.6, 61.8)	(46.7, 68.3)	(35.9, 48.3)
Salivary gland enlargement**	30.9	16.1	17.5	21.4	0.039
	(20.8, 41)	(8.3, 23.9)	(9.2, 25.8)	(16.3, 26.5)
Herpes zoster	23.8	26.7	35.4	28.6	0.237
	(14.5, 33.1)	(17.3, 36.1)	(24.9, 45.9)	(22.9, 34.2)
Herpes simplex**	29.6	32.6	47.5	36.4	0.041
	(19.7, 39.5)	(22.7, 42.5)	(36.6, 58.4)	(30.4, 42.4)
Lichen planus	39.5	36	28.8	34.8	0.343
	(28.9, 50.1)	(25.9, 46.1)	(18.9, 38.7)	(28.9, 40.7)
Immune thrombocytopenic purpura*	9.9	29.1	22.8	20.7	0.008
	(3.4, 16.4)	(19.5, 38.7)	(13.6, 32)	(15.6, 25.8)
Human papilloma virus lesions*	14.8	39.1	38.8	31	0.001
	(7.1, 22.5)	(28.8, 49.4)	(28.1, 49.5)	(25.2, 36.8)

Note:

* Significant at level 1%;

** significant at level 5%.

Table 4 Dental students’ attitudes toward PLHIV

Attitude statement	Mean ± SD	Chi square	P-value
Every dentist in Egypt should be legally bound to provide routine dental care to HIV-infected individuals*	3.32±0.93	283.19	<0.001
Right now you perceive yourself capable of detecting HIV-related oral lesions and properly manage HIV-infected individuals*	1.88±1.06	151.57	<0.001
Providing dental care to HIV-infected individuals can discourage others from seeking care in a dental setting*	1.83±1.23	49.15	<0.001
Dentists should be willing to perform mouth-to-mouth resuscitation on an AIDS patient in case of respiratory arrest*	1.67±1.21	34.44	<0.001
HIV-infected individuals are obliged to reveal their HIV status to their dentists*	0.53±0.93	412.44	<0.001
Infection control measures for management of HIV-infected individuals could raise the costs for dental practice?*	1.97±1.28	49.48	<0.001
Dental health care professionals are morally bound to provide routine dental care to PLHIV*	3.15±0.87	225.71	<0.001
In your dental practice, you will deliver emergency dental care to HIV/AIDS patient if the need arises*	2.91±0.92	144.40	<0.001

Note:

* Significant at level 1%.

Abbreviation: PLHIV, people living with HIV.

Table 5 Comparison of the mean knowledge and attitude scores among dental students of 3 academic years

Year of study	Knowledge index, mean ± SD	Attitude index, mean ± SD
Third	10.37±4.8	16.05±3.1
Fourth	13.79±3.8	16.31±2.7
Fifth	14.09±4.3	13.92±3.4
Total	12.71±4.6	15.48±3.2
ANOVA	16.82* (P<0.001)	13.57* (P<0.001)
Post hoc comparisons	Fifth year, fourth year > third year	Fourth year, third year > fifth year

Note:

* Significant at level 1%.

Table 6 Determinants of knowledge score and attitude score

Independent variables	Dependent variables
	Model (1) knowledge	Model (2) attitudes	Model (3) attitudes
	Coefficients (95% CI)	Coefficients (95% CI)	Coefficients (95% CI)
Age	−0.02 (−1.1, 1.1)	0.27 (−0.51, 1.05)	0.26 (−0.53, 1.04)
Year of study
Third year (reference)
Fourth year	3.41* (1.75, 5.07)	−0.48 (−1.7, 0.8)	−0.70 (−1.98, 0.6)
Fifth year	4.13* (1.74, 6.53)	−2.95* (−4.7, −1.2)	−3.01* (−4.8, −1.2)
Place of origin
Urban governorates (reference)
Lower Egypt	0.17 (−1.9, 2.2)	0.73 (−0.8, 2.2)	0.66 (−0.8, 2.1)
Upper Egypt	1.29 (−1.4, 3.9)	1.14 (−0.9, 3.2)	1.32 (−0.79, 3.4)
Frontiers region	−1.98 (−10.7, 6.7)	1.23 (−1, 3.8)	1.37 (−1.1, 3.9)
Not Egyptian	2.24 (−2.6, 7.04)	1.90 (−1.5, 5.3)	1.56 (−1.9, 5)
Father’s education
Illiterate (reference)
Less than high school	0.51 (−4.3, 5.3)	−4.04 (−12.5, 4.4)	−4.09 (−12.5, 4.3)
High school	−0.49 (−4.5, 3.5)	−5.43 (−13.5, 2.6)	−4.96 (−13, 3.09)
Two years academy	−1.94 (−4.6, 0.7)	−5.51 (−13.4, 2.4)	−5.09 (−13.03, 2.8)
University and above	−2.32 (−9.2, 4.1)	−4.09 (−11.7, 3.5)	−3.99 (−11.6, 3.6)
Mother’s education
Illiterate (reference)
Less than high school	−4.45 (−13.3, 4.4)	1.68 (−2.4, 5.8)	1.61 (−2.5, 5.7)
High school	−1.97 (−9.4, 5.5)	−0.17 (−2.1, 1.7)	−0.20 (−2.1, 1.7)
Two years academy	−4.98 (−12.3, 2.4)	0.76 (−1.1, 2.6)	0.83 (−1.01, 2.7)
University and above	−2.57 (−9.7, 4.6)	1.71 (−2.5, 5.9)	1.85 (−2.8, 6.1)
Gender
Female (reference)
Male	0.61 (−0.68, 1.9)	−0.31 (−1.3, 0.65)	−0.25 (−1.2, 0.71)
Knowledge on HIV characteristics	–	–	0.19 (−0.21, 0.59)
Knowledge on modes of HIV transmission	–	–	0.38 (0.04, 0.7)
Knowledge on HIV treatment	–	–	0.04 (−0.5, 0.6)
Knowledge on oral manifestations associated with HIV	–	–	0.03 (−0.13, 0.2)
Knowledge	–	0.13 (0.02, 0.23)	–
Constant	13.281 (−9.7, 36.2)	13.3 (−5, 31.5)	12.8 (−5.6, 31.2)
R^2	0.20	0.16	0.18
ANOVA	F=3.34*	F=2.37*	F=2.19*

Note:

* Significant at level 1%.