Family Practice Vol. 19, No. 6, 682-684
© Oxford University Press 2002
Survey of HIV/AIDS knowledge and attitudes of Kuwaiti family physicians
Department of Psychiatry, Faculty of Medicine, Kuwait University.
Dr Abdullahi Fido, Chairman, Department of Psychiatry, Faculty of Medicine, Kuwait University, P.O. Box 24923 Safat, Kuwait 13110; E-mail: fido{at}hsc.kuniv.edu.kw
Fido A and Al Kazemi R. Survey of HIV/AIDS knowledge and attitudes of Kuwaiti family physicians. Family Practice 2002; 19: 682–684.
Received 2 February 2001; Revised 29 April 2002; Accepted 16 July 2002.
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Abstract |
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Objectives. This study aimed to explore Kuwaiti family physicians’ attitudes and knowledge about HIV/AIDS.
Methods. One hundred and sixty-two Kuwaiti family physicians (95 females and 67 males) from all four health catchment areas have completed a 30-item self-administered questionnaire to measure HIV/AIDS-related attitudes and knowledge.
Results. Knowledge was lacking in areas dealing with HIV-related neuropsychiatric complications and other issues concerning HIV/AIDS, special populations and range of normal sexuality. The majority of physicians expressed negative attitudes toward homosexuality and about AIDS patients in general. Eighty-three per cent of Kuwaiti family physicians would opt out of treating AIDS patients. More than half of the physicians would avoid coming into social contact with HIV-seropositive persons. No significant difference was found for the total knowledge and attitude scores for gender.
Conclusion. The results of this survey revealed that even in the second decade of the AIDS epidemic, some Kuwaiti family physicians continue to have a lack of proper knowledge about HIV and harbour negative attitudes toward AIDS patients. There is a need to promote an AIDS education early in the medical internship training years which addresses many underlying socio-cultural factors.
Keywords. Attitudes and knowledge, HIV/AIDS, Kuwaiti family physicians.
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Introduction |
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The HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) epidemic has resulted in a tremendous health care burden with an increasing need for primary health services. Hence, physicians have both a unique opportunity and a professional obligation to provide care to HIV-affected persons in a competent and compassionate manner.1 Targeted family physician education about HIV/AIDS is essential to ensure that physicians have appropriate knowledge to understand the predominantly behavioural mechanisms underlying viral transmission, the myriad neuropsychiatric complications linked to HIV/AIDS, and the substantial psychosocial ramifications of living with HIV. However, 20 years into the HIV/AIDS epidemic, little research has examined the HIV-related educational needs of family physicians, particularly those in the Third World. A number of investigators have examined knowledge and attitudes about AIDS among various student populations.2 Two studies offer limited information about family physicians and HIV/AIDS attitudes. The first of these in the USA revealed that 24% of the physicians surveyed expressed negative attitudes toward AIDS patients.3 Chaimowitz found that 26% of Canadian family physicians endorsed prejudice against homosexuals.4 When asked whether they thought homosexuals with AIDS "got what they deserved", 7% of family physicians answered yes.
These limited studies suggest likely gaps in knowledge and attitudes that are apt to adversely influence the provision of HIV-related health care. As HIV and AIDS incidence rates continue to rise, concern that negative attitudes about AIDS among physicians adversely affect patient care has been growing.
Although Kuwait has achieved remarkable success in the effective control of some of the indigenous infectious diseases commonly prevalent in this part of the world, it does have its share of some of the life-threatening diseases such as HIV, which continue to pose the biggest challenge.5
Kuwait’s health infrastructure consists of 14 hospitals, supported by a network of polyclinics for its population of about 2 million people. Unfortunately, there is little information available concerning the level of AIDS morbidity in Kuwait. The current situation indicated that the number of AIDS sufferers is probably increasing, and as there is no specialized AIDS clinic in Kuwait, the burden of caring for patients with AIDS falls largely on family physicians. To date, Kuwaiti family physicians’ attitudes, knowledge and fears of patients with AIDS have not been evaluated.
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Methods |
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A 30-item questionnaire to measure AIDS-related attitudes and knowledge was administered to 162 Kuwaiti family physicians (95 females and 67 males) aged 28–54 years (mean age 38.2 SD ± 6.3) from all four health catchment areas of Kuwait. The instrument was adopted from an earlier similar study survey of medical students.2 To establish face and content validity for the survey, an initial draft of the instrument was distributed to an experienced multidisciplinary team of health professionals working in a general hospital. Their critical appraisal allowed revision for clarity and reliability. The first 15 items of the survey assessed general knowledge about transmission, contagion, epidemiology, and medical treatment of HIV and AIDS. Responses to these items were true, false or don’t know. The remaining 15 items were attitudinal statements scored on a 5-point Likert-type scale, ranging from strongly disagree (1) to strongly agree (5). For descriptive purposes, all 15 attitudinal items were collapsed into 3-point scales (agree/no opinion/ disagree). We then determined frequencies for each of the 25 items. In addition, we computed an overall knowledge score by giving each respondent 1 point for each of the knowledge items that was answered correctly, counting don’t know as an incorrect response. The possible range for the knowledge scale score was from 0 to 10. We used simple regressions to determine whether the overall knowledge score was significantly correlated with any of the 15 attitude items.
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Results |
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The mean knowledge score was 8.57 (SD = 2.3), with a range from 2 to 14 and a median of 10. Internal consistency reliability for both coefficients were in acceptable ranges (r = 0.75 and r = 0.78, respectively). Table 1
summarizes the percentage of correct, incorrect, and uncertain responses for each knowledge item. Sixty per cent of all items were answered correctly by at least half of the respondents. Excluding ‘Don’t know’ responses, four items were incorrectly endorsed by a majority of the respondents: ‘Dementia due to HIV disease is rare in asymptomatic HIV patients’ (70% incorrect) and ‘The only bodily fluids known to transmit HIV are blood and semen’ (53% incorrect). Two more knowledge items ‘persons infected with HIV will likely develop antibodies within six months’ and ‘HIV positive newborns sometimes revert to HIV negative status’ attracted 55% and 51% incorrect answers respectively. The most intriguing findings regarding the knowledge items were among five neuropsychiatry items. For each of these, although from 38% to 49% of the respondents answered correctly, those who did not do so tended to endorse ‘Don’t know’ as opposed to the incorrect answer. Generally, attitudes were not extreme. However, some important attitudinal items deserve comment. For example, 80% of the respondents felt uncomfortable coming into social contact with HIV-positive persons, 61% would feel different about patients with HIV infection than patients with any other disease, 84% would quarantine HIV patients to stop the spread of infection, 70% believed homosexuality to be a psychiatric illness, and 83% would choose to opt out of treating HIV patients in family practice, and 90% disapproved the condom use for protection from HIV sexual transmission. Simple regression analysis showed that knowledge was not significantly correlated with any of the 15 attitudes.
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Discussion |
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We found that a significant portion of the family physicians in our sample had attitudes that might have an adverse impact on the care of AIDS patients. The additional finding that these same physicians expressed discomfort in treating patients with AIDS poses a significant obstacle to the delivery of comprehensive health care. Our finding that a subgroup of physicians appeared to feel uncomfortable with homosexual patients and HIV-seropositive patients is consistent with the findings in an earlier survey which found that 40% of physicians in North Carolina reported having refused to provide care for or had referred new HIV-infected patients to another physician.6 Our survey showed that a majority of Kuwaiti family physicians appeared to hold social distance from AIDS patients. The explanation for this might be that in traditional Arabic Islamic culture, patients with serious illnesses such as AIDS, cancer and mental disorders are regarded as deviants with little strength and character.7 Personal feelings, failures, and weaknesses are either discussed among family members or not at all. Causes for disorders that are still an enigma are attributed to be as a result of Witchcraft/Punishment from God or Satan’s Work. Patients on the other hand, tend to adopt a fatalistic attitude and accept their illness at face value considering their ordeal as God’s test of their patience.8 Our findings were similar to results of previous surveys about attitudes toward mental illness in China,9 and Africa.10 The results of this study reveal that, even in the second decade of the AIDS pandemic, some family physicians in Kuwait continue to have poor knowledge about HIV and to harbour pervasive negative attitudes about AIDS patients. Caution must be exercised in drawing conclusions due to the relatively small sample size. With increasing evidence that concentrated AIDS education workshops may significantly affect both attitudes and knowledge,11 we feel that it is critical that family physicians in Kuwait maintain up-to-date HIV knowledge and appropriate attitudes to enable them to discuss sensitive key components of HIV-related mental health care. Further, HIV/AIDS education and clinical experience early in the course of residency training may be important for increasing these physicians’ comfort in managing AIDS patients.
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References |
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1 Centers for disease control and prevention. HIV/AIDS Surveillance Report. 1993 (No. 4); 1–19.
2 McDaniel JS, Carson LM, Thompson NJ et al. Knowledge and attitudes about HIV and AIDS among medical students. J Am Coll Health 1995; 44: 11–14.[ISI][Medline]
3 Bernstein CA, Rabkin, JG, Wolland H. Medical and dental students’ attitudes about the AIDS epidemic. Acad Med 1990; 65: 458–460.[ISI][Medline]
4 Chaimowitz GA. Homophobia among psychiatric residents, family practice residents and psychiatric faculty. Can J Psychiatry 1991; 36: 206–209.[ISI][Medline]
5 Awaish K. Proceedings of international conference on AIDS in Kuwait. (1997), 113–123.
6 Weinberger M, Conover CJ, Samsa GP, Greenberg SM. Physicians’ attitudes and practices regarding treatment of HIV-infected patients. South Med J 1992; 85: 683–686.[ISI][Medline]
7 Fakhr El-Islam MF. Cultural aspects of morbid fears in Qatari women. Soc Psych Epidemiol 1994; 29: 137–140.
8 Fido A, Omar Y, Al-Fayez G. Affective reaction to breast cancer, Diagnosis among Arab women. Med Prin Pract 1992; 93: 72–76.
9 Shokoohi Yekla M, Retish P. Attitudes of Chinese and American students to ward mental illness. Inter J Soc Psych 1991; 37: 192–200.
10 Ofozi Atta A, Linden W. The effect of social change on causal beliefs of mental disorders and treatment preference in Ghana. Soc Med 1995; 40: 1231–1242.
11 Johnson J, Campbell A. Knowledge and attitudes about AIDS among first and second-year medical students. AIDS Educ Prevent 1990; 2: 48–57.[Medline]
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