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Occupational Medicine Advance Access originally published online on April 20, 2006
Occupational Medicine 2006 56(4):275-278; doi:10.1093/occmed/kql019
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

SHORT REPORT

Risk perception and attitudes towards HIV in Serbian health care workers

Aleksandra Jovic-Vranes1, Slavenka Jankovic1, Dejana Vukovic1, Boris Vranes2 and Dragan Miljus3

1 Medical School of the University of Belgrade, Institute of Social Medicine, Dr Subotica 8, Belgrade 11000, Serbia
2 Royal Hospital for Women, Gynaecological Cancer Centre, Barker Street, Randwick, NSW, Australia
3 Institute of Public Health of Serbia, Dr Subotica 5, 11000 Beograd, Serbia and Montenegro

Correspondence to: Aleksandra Jovic-Vranes. Medical School of the University of Belgrade, Institute of Social Medicine, Dr Subotica 8, Belgrade 11000, Serbia. Tel: +381 63 8702 634; fax: +381 11 659 533; e-mail: aljvranes{at}yahoo.co.uk


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV).

Aim To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia.

Methods Cross-sectional study of 1559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied.

Results Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4–14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5–4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0–3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2–3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1–2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients.

Conclusions HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.

Keywords      Attitude; health care workers; HIV infection; knowledge; practice; professional risk; Serbia


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Approximately 3 million health care workers (HCWs) are exposed to bloodborne viruses each year. More than 90% of acquired infections occur in low-income countries, and most could be prevented. Blood has been implicated as the source of the exposure in nearly all occupationally acquired infections. Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient's blood or through contact of the eye, nose or mouth with the patient's blood [1,2]. Developed countries have recognized the importance of knowledge, attitudes and safe practice among HCWs. There are number of studies addressing the professional risk, knowledge, attitude and practice among HCWs but such studies are lacking in Eastern European countries. The aim of our study was to investigate the perception of professional risk from human immunodeficiency virus (HIV) and the knowledge, attitudes and practice of HCWs in Serbia.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
 References
 
The study was part of the project ‘Controlling HIV/AIDS in Serbia: A comprehensive Country Strategy and Emergency Action Plan’ and was conducted among Serbian HCWs. Ethical approval was obtained by the government coordinating body, when enrolling into the project. Data collection was carried out in October 2003. A total of 1600 HCWs were included in the study, which represents 2% of the total number of HCWs in Serbia. The sample was stratified according to occupation (doctors, dentists, nurses, laboratory technicians and others). HCWs were from four clinical medical centres, five primary health care centres and four dental clinics. The data were collected by an anonymous self-completed questionnaire containing 36 questions and distributed by trained interviewers. A multi-disciplinary team consisting of epidemiologists, public health practitioners, biostatisticians and HCWs developed the questionnaire which was pre-tested among 96 HCWs.

The chi-square test was applied for assessing the significance of differences by occupation and perception of risk for acquiring HIV infection. A multiple logistic regression was performed in order to calculate odds ratio (OR) of the risk perception for acquiring HIV infection and their corresponding 95% confidence intervals (CIs). The probability P < 0.05 was taken as the minimum level of significance.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
Out of 1600 HCWs, 1559 completed the questionnaire giving a response rate of 97%. Of which, 1249 (80%) were female and 310 (20%) were male. A total of 1003 (64%) were nurses, 402 (26%) doctors, 65 (4%) dentists, 67 (4%) laboratory technicians and 22 (2%) other HCWs. The mean age of the respondents was 39.3 ± 9.4 years. Duration of employment in the current job was 12.2 ± 9.2 years. Thirty per cent of HCWs (465) were practicing surgery and 90% (1410) carried out some form of intervention with a risk of HIV infection (contact with blood or other body fluids). Eighty-nine per cent (1392) perceived there to be high professional risk of acquiring HIV infection. Dentists were more concerned about this risk than other professionals ({chi}2 = 32.8; P < 0.001).

Within the last year, 59% (921) of HCWs had skin contact with patient's blood, followed by needlestick injuries in 51% (791), cuts from sharp instruments in 38% (599) and contact of eye and other mucosa with patient's blood in 34% (536). Exposures occurred most frequently in dentists, but the cuts from sharps occurred mainly in laboratory technicians (Table 1).


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  		Table 1. Knowledge, attitudes and practice of HCWs regarding occupational differences

 
Respondents had deficient knowledge about the modes of HIV transmission. Misconceptions were found relating to HIV transmission by saliva/tears, sweat, stool and urine. Doctors and other medical staff had generally better knowledge than the others (Table 1).

The majority of HCWs agreed that all inpatients should be tested for HIV, but attitudes towards the HIV-positive patient differed with respect to their profession ({chi}2 = 37.9; P < 0.001). In particular, doctors disagreed with restricting HIV-positive HCWs from practicing medicine ({chi}2 = 37.8; P < 0.001). Seventy-seven per cent (1199) of HCWs felt that their personal protection was more important than the confidentiality of patient's HIV/AIDS status. Ten per cent (157) agreed that HCWs should be offered the option to be excused from care for an HIV/AIDS patient and 8% (125) of HCWs thought that HIV-positive status was the individual's own fault (Table 1).

Seventy per cent (1088) of HCWs protected themselves regularly, using appropriate barriers (gloves, glasses and mask) there being no significant difference by profession. If the HIV status of a patient was known, 84% (911) of respondents would use additional protection. Nurses used additional personal protection more frequently then others ({chi}2 = 25.2; P < 0.001) (Table 1). Nearly 80% of respondents had not been informed about guidelines for protection against HIV, and protocols of post exposition prophylaxis or such protocols did not exist in their work environment.

Twelve per cent (191) of HCWs had received education about HIV/AIDS in the last year and 37% (579) within the last 5 years. Dentists were educated more frequently than the others ({chi}2 = 389; P < 0.001). The majority of HCWs (76%) expressed a need to be further educated about HIV/AIDS. Thirty-five per cent (552) of respondents had previously been tested for HIV status, with no significant difference by occupation.

Using logistic regression, we found that perception of professional risk of acquiring HIV infection was associated with everyday practice, and was higher among HCWs who were exposed to patients blood and other body fluids, those who used additional protection if the HIV status of the patient was known, those who had received cuts from sharp instruments within the last year, those who had been tested for HIV, as well as among HCWs who had previously treated HIV-positive patients (Table 2).


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  		Table 2. Perception of professional risk of acquiring HIV infection among HCWs—multiple logistic regression analysis

 

   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
Our study found that knowledge of HCWs about HIV transmission was generally deficient and this did not differ according to their education. Insufficient professional education about HIV/AIDS has been previously reported in two local studies [3,4], as well as worldwide [5,6]. We also found that a high proportion (89%) of Serbian HCWs, like their colleagues from other countries, recognize the professional risk of acquiring HIV infection [7]. Dentists were more likely to perceive this risk perhaps due to their everyday use of sharp instruments.

We found that risk perception of acquiring HIV infection was associated with type of clinical practice (where this involved treating HIV-positive patients), the use of protective measures, experience of sharp injuries and those previously tested for HIV. Despite this, 30% of HCWs did not use adequate protection and this did not differ by profession. This might be explained by the fact that nearly 80% of respondents said they had not been informed about guidelines and protocols or these were reported not to exist. Doctors have generally failed to report sharp injuries, and a number of studies have pointed this out. Nurses appear to have higher reporting rates but also more frequent exposures [8,9]. In our study, the most common accidental injury was a skin contact with patient's blood, followed by needlestick injuries and cuts by sharp instruments. Dentists and nurses were more exposed to needlestick injuries and laboratory technicians to cuts by sharps.

Attitudes towards HIV-positive patients are a persistent moral and ethical dilemma among HCWs in Serbia. More than half of them think that every hospitalized patient should be tested for HIV, and that protection of HCWs is more important than confidentiality of the patient's HIV/AIDS status. This attitude has been reported in other studies [6,7]. Insufficient knowledge might cause negative attitudes towards HIV-positive patients.

Our study has several strengths and limitations. Our data are based on the self-reports and perceptions of HCWs. Perception, compared with facts, can be very time sensitive. Also, the cross-sectional study design does not allow us to establish causal relationships among variables. We must not forget that these data provide a window into perception of profession risk to HIV/AIDS, knowledge, attitudes and practice of HCWs during a period of dramatic changes in Serbia. The data were gathered through anonymous questionnaire distributed by trained interviewers. We can speculate that their active participation in collecting data resulted in the high response rate of 97%.

Our results may stimulate further research and provide a valuable reference point for future studies of this issue.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared.


   Acknowledgements
 
This work was supported by The Global Fund to Fight Aids, Tuberculosis and Malaria (Grant No. SER-102-G01-H-00) and by the Ministry of Science and Ecology of Serbia, contract No. 101460, 2002–2005.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

  1. Kermode M, Jolley D, Langkham B, Tomas MS, Crofts N. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. Am J Infect Control 2005;33:34–41.[Medline]

  2. NIOSH Alert. Preventing Needlestick Injuries in Health Care Settings. Cincinnati, OH: DHSS (NIOSH), Publication No. 2000-108, 1999.

  3. Savun K. Public Reaction of Professionals. AIDS and Public Reaction. Beograd: ITGP Prometej, 1992; 20–65 [in Serbian].

  4. Zakula N, Garotic Ilic L, Rakic M. Attitudes and knowledge about HIV infection and transmission risk in medical institutions among HCWs. In: Proceedings of the 9th Meeting of Serbian HCWs. June 20–24 1998, Tara, Serbia. Belgrade: Serbian Medical Association, 1998 (in Serbian).

  5. Abedbamowo AC, Ezeome RE, Ajuwon AJ, Ogundiran OT. Survey of the knowledge, attitude and practice of Nigerian Surgery trainees to HIV infected persons and AIDS patients. BMC Surg 2002;2:7.[CrossRef][Medline]

  6. Scoular A, Watt AD, Watson M, Kellz B. Knowledge and attitudes of hospital staff to occupational exposure to bloodborne viruses. Commun Dis Public Health 2000;3:247–249.[Medline]

  7. Maupome G, Acosta-Gio E, Borger-Yanes SA, Diez-de-Bonilla FJ. Survey on attitudes toward HIV-infected individuals an infection control practices among dentists in Mexico City. Am J Infect Control 2000;28:21–24.[Medline]

  8. Dement JM, Epling C, Ostbye T, Pompeii LA, Hunt DL. Blood and body fluid exposure risks among health care workers: results from the Duke Health and Safety Surveillance System. Am J Ind Med 2004;46:637–648.[CrossRef][Web of Science][Medline]

  9. Hentgen V, Jaureguiberry S, Ramiliariosa A, Andrianantoandro V. Knowledge, attitude and practices of health personnel with HIV/AIDS in Tamatave (Madagascar). Bull Soc Pathol Exot 2002;95:103–108.[Medline]


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This Article
Right arrow Abstract Freely available
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