|Year : 2013 | Volume
| Issue : 3 | Page : 146-150
A survey of HIV knowledge and attitudes of pharmacy students in Canada and Qatar
Emily Black1, Kyle Wilby1, Jason Perepelkin2
1 Clinical Pharmacy Practice Section, College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar
2 College of Pharmacy and Nutrition, Room 116 Thorvaldson Building, 110 Science Place, University of Saskatchowan, Saskatoon, Saskatchewan, Canada
|Date of Web Publication||14-Feb-2014|
Qatar University, College of Pharmacy, PO Box 2713, Doha
Source of Support: None, Conflict of Interest: None
Background: Little is known about knowledge and attitudes of pharmacy students regarding human immunodeficiency virus (HIV) or how knowledge and attitudes compare internationally. Aims: The primary objective of this study was to compare pharmacy students' knowledge and attitudes of HIV between students in Doha, Qatar, and Saskatchewan, Canada. Materials and Methods: A cross-sectional survey was administered to pharmacy students enrolled at Qatar University and at the University of Saskatchewan. Results: Overall response rate was 36.1%, with 51% and 32% completing the survey in Qatar and Canada, respectively. While most students at both institutions were knowledgeable about HIV, students from Qatar had a significantly greater number of misconceptions. Attitudes and beliefs differed significantly between students in Canada and Qatar. Conclusions: Findings suggest that students are generally knowledgeable and have positive attitudes; however, several misconceptions and negative beliefs remain. Current educational strategies should further emphasize modes of HIV transmission and prevention.
Keywords: Acquired immunodeficiency syndrome, attitudes, human immunodeficiency virus, knowledge, pharmacy students
|How to cite this article:|
Black E, Wilby K, Perepelkin J. A survey of HIV knowledge and attitudes of pharmacy students in Canada and Qatar. Saudi J Health Sci 2013;2:146-50
| Introduction|| |
Human immunodeficiency virus (HIV) is a worldwide pandemic. The World Health Organization (WHO) reports a steady increase in the number of infected individuals living with HIV. In 2010, this number increased to 34 million worldwide.  However, the reported number of individuals living with HIV in Qatar is low. A country progress report from 2008 reported 78 HIV-infected individuals were living in Qatar with 5-10 new cases diagnosed each year. 
Conversely, recent statistics from the province of Saskatchewan in Canada show this region having rates that more accurately reflect worldwide trends; rates of new infection are reported to be twice the national average in Saskatchewan compared to the rest of Canada (20.8 vs. 9.3 cases/100,000, respectively).  It is speculated that increases in injection drug use combined with emerging high-risk populations (Aboriginal females) have accounted for these findings.
Despite the increasing incidence of HIV infection worldwide, a lack of knowledge and negative attitudes from general university students in the Middle Eastern region has been reported. ,,, Female university students in particular were noted to be significantly less knowledgeable about HIV as compared to male students. , While data on knowledge and attitudes of students completing degrees in various health professions in the Middle East have not been reported, several studies evaluating these outcomes in healthcare professionals internationally have identified gaps in knowledge and negative attitudes. , Two studies report findings from American medical students, Nigerian medical students, and Australian nursing students demonstrated discordant knowledge and attitudes were also present. , These findings indicate that training of healthcare professionals internationally may lack necessary emphasis on HIV education.
Pharmacists, as frontline healthcare providers, are increasingly relied upon as drug therapy experts in caring for patients with HIV. Furthermore, pharmacists must be prepared to provide care to patients with HIV in a positive manner. Little is known about pharmacists' or pharmacy students' knowledge and attitudes of HIV internationally or the preferred sources of information students utilize to learn about HIV and to care for HIV-positive patients. It is also unknown how knowledge and attitudes of Middle Eastern students compared to pharmacy students in North American universities, where reported HIV incidence is higher.
| Objectives|| |
The objectives of this study were to compare students' knowledge and attitudes of HIV between pharmacy students in Doha, Qatar, and Saskatoon, Canada. The College of Pharmacy at Qatar University is a Canadian Accredited pharmacy program which follows a North American curriculum. As a result, we chose to compare students in Qatar to those in Canada. A secondary objective aimed to evaluate students' preferred sources of information about HIV.
| Materials and Methods|| |
This study was designed as a cross-sectional survey. The study was conducted at Qatar University in Doha, Qatar, and the University of Saskatchewan in Saskatoon, Canada. This project was completed in accordance with the Declaration of Helsinki and ethics approval was obtained for completion of this study through the Institutional Review Board at Qatar University (XX IRB 92/11) and the Behavioural Research Ethics Board (BEH# 12-08) at the University of Saskatchewan. The survey was self-administered and as a result, consent was considered implied upon submission as per institutional review board policies at both universities.
A literature search was completed that identified previously administered questionnaires assessing similar objectives to this study. ,,,,, The results of this search were used to create a questionnaire, using validated questions identified from these studies in combination with other questions to match our specific objectives. Response set bias was avoided by incorporating both negatively and positively worded statements. After initial questionnaire development, a sample of pharmacy students was invited to independently complete the questionnaire online and provide written comments on each question. Five students completed the pilot questionnaire. Based on comments from the piloting phase, the questionnaire was updated and disseminated to undergraduate and graduate pharmacy students at Qatar University and University of Saskatchewan using Survey Monkey≥ , an online survey tool.
All students enrolled in the full-time pharmacy program at Qatar University or the University of Saskatchewan were eligible to participate. Few males were included in this study as students in the full-time pharmacy program at Qatar University are entirely female and approximately 75% of students at the University of Saskatchewan are female. Students enrolled in the part-time Doctor of Pharmacy program in Qatar are primarily practicing pharmacists who completed their entry-to-practice pharmacy degree outside of Qatar. Due to the heterogeneous nature of this population, these students were excluded from the survey.
Data were collected using survey monkey and analyzed using SPSS, version 20.0. Data were summarized descriptively using frequencies, means, standard deviations, medians, and ranges. Comparisons for nonparametric data were analyzed using the Chi-squared test or Fisher's exact test and the Mann-Whitney U test.
| Results|| |
The overall response rate for both universities was 36.1% (161/446). The response rate at Qatar University was 51% (49/96), while the response rate at the University of Saskatchewan was 32.0% (112/350). Baseline characteristics of students from both universities are summarized in [Table 1].
The majority of students from both Canada and Qatar demonstrated a high level of knowledge about HIV and AIDS. Students from Canada were significantly more knowledgeable about HIV and AIDS in most domains compared to students in Qatar. Significantly more Canadian students were aware that use of condoms could decrease the risk of HIV transmission as compared to students from Qatar (98.2% vs. 81.2%, P < 0.001). No statistically significant differences between students in Canada and Qatar were observed in relation to possible routes of HIV transmission through sexual contact (100% vs. 100%), blood transfusions (92.0% vs 95.9%), and from mother to fetus (98.2% vs. 95.9%). Students from Qatar, however, had a number of misconceptions relating to transmission of HIV or acquired immunodeficiency syndrome (AIDS) through other routes including transmission via toilet seats and through mosquito bites. Findings are summarized in [Table 2].
Attitudes and beliefs relating to HIV and AIDS differed significantly between students from Canada and Qatar. The greatest discordance in attitudes related to agreement with the statement that children with HIV or AIDS should be permitted to attend school with noninfected children (77.7% vs. 38.8%, P < 0.001) followed by agreement that women who are HIV positive should not be prevented from having children (50.0% vs. 14.3%, P < 0.001). Students from both Canada and Qatar showed positive attitudes toward agreeing that HIV patients should have the same rights to medical care as other patients (97.3 vs. 87.7, P = 0.758). Complete findings of comparisons between Canadian and Qatari students are outlined in [Table 3].
Current sources of information students use to obtain information about HIV and AIDS are outlined in [Table 4]. The most commonly used resources for information on HIV and AIDS by Canadian students were textbooks, journal articles, and guidelines (96.4%); healthcare workers (89.3%); and posters or pamphlets (80.4%). The most commonly used resources for information on HIV and AIDS by students in Qatar were television (87.7%), textbooks, journal articles, and guidelines (83.7%), and healthcare workers (67.3%). Significantly more students from Canada as compared to Qatar learned about HIV and AIDS through healthcare workers, posters and pamphlets, and textbooks, journal articles, or guidelines; while significantly more students from Qatar learned about HIV and AIDS from religious leaders and social gatherings as compared to Canadian students.
Preferred sources of information for students to obtain information about HIV and AIDS are outlined in [Table 5]. Students from Canada and Qatar both preferred to learn about HIV and AIDS primarily from textbooks, journal articles, and guidelines (91.1% vs. 85.7%, P = 0.403) and from healthcare workers (74.1% vs. 63.3%, P = 0.189). While significant differences in other preferred resources exist, the majority of students did not prefer to learn about HIV and AIDS from other resources.
| Discussion|| |
To the best of our knowledge, this questionnaire is the first to compare the knowledge, attitudes, and preferred learning resources of pharmacy students internationally with respect to HIV and AIDS. A previously published international comparison of medical students demonstrated a significantly higher level of knowledge and positive attitudes relating to HIV and AIDS in American students compared to Nigerian students.  Although the majority of students in Canada and Qatar are knowledgeable about HIV, several misconceptions about modes of transmission, strategies for prevention, and negative attitudes were prevalent. Misconceptions and negative attitudes among students occurred despite a reported wide variety of learning resources available in both countries.
While students attending the Canadian University were generally more knowledgeable than those at Qatar University, students at Qatar University had knowledge that was consistent or better than previously reported studies from the region. Similar gaps in knowledge have also been reported in the Middle East among studies of university students and the general population. , Al-Serouri and colleagues completed a survey of young people between the ages of 15-24 years of age in Yemen and found that only 29% of students were aware condoms were an effective preventative measure in reducing the risk of HIV transmission. Knowledge of transmission was also lacking with 92% of students reporting HIV could be transmitted through donating blood, 67% reported HIV could be transmitted through mosquito bites, and 40% of students stating HIV was transmitted through contact with bathroom items.  A survey comparing female university students in Bahrain, Kuwait, and Jordan similarly demonstrated a lack of knowledge with only 17-22% of students correctly identifying that condoms reduced the risk of HIV transmission.  While direct head-to-head comparisons cannot be made, pharmacy students in Qatar appeared to have a lower frequency of the same misconceptions as compared to other university students in the region.
Negative attitudes of students in Qatar with respect to HIV were evident in this study. One of the most prominent negative attitudes related to HIV-positive women bearing children, with only 14.3% of students in Qatar agreeing that this population should not be prevented from having children. A recent study conducted in Qatar among women in the general University population demonstrated consistent findings with 78% of students stating women with HIV should not have children and 56% of students commenting that women who are HIV positive should be sterilized to prevent pregnancy.  These findings suggest an enhanced focus on prevention strategies to decrease mother-to-child transmission as part of educational strategies for the female population in Qatar is needed.
Canadian students demonstrated positive attitudes overall toward patients with HIV however, some negative attitudes persisted. In particular, 18.8% of students identified they would not share food with a person who was infected with HIV. A previous finding of medical students from the United States demonstrated that only 4.6% of the study population believed that HIV could be transmitted through eating food prepared by a cook infected with HIV.  These findings suggest that some Canadian students may have misconceptions about HIV and further education to Canadian students may be necessary.
Despite the students' report of a wide range of current resources about HIV and AIDS, gaps in knowledge of pharmacy students in Canada and Qatar remain. Educators and healthcare providers must recognize the importance of appropriately educating pharmacy students about HIV and AIDS, as lack of knowledge about HIV and AIDS correlates negative attitudes.  Negative attitudes and stigmatization from healthcare workers have resulted in avoidance of seeking care and use of alternative medicines in the management of HIV.  Upon graduation, the majority of pharmacy students will be working as frontline care givers who are likely to encounter HIV-positive patients and must be prepared to adequately care for these patients without contributing to stigmatization.
Although students in Qatar report discomfort in learning about HIV from their schoolteachers, comprehensive education in the pharmacy curriculum should not be compromised. A lack of training of healthcare workers has been significantly associated with negative attitudes.  Peer-based HIV-related educational strategies in the Middle East have demonstrated a significant improvement in knowledge and attitudes of students.  The current undergraduate pharmacy curriculums in Canada and Qatar should continue to educate pharmacy students about HIV and AIDS and should increase focus on discussing modes of transmission (including myths) and strategies for prevention. Furthermore, instructors should have an open discussion with student-to-student interaction about attitudes and beliefs relating to HIV infection. Finally, educational programs for pharmacy students can further supplement lectures on HIV and AIDS through provision of reputable resources for student self-learning.
Several limitations to this study should be considered. Due to small class sizes in both universities, sample size was limited. A greater proportion of first year pharmacy students at Qatar University participated in the survey as compared to University of Saskatchewan resulting in a higher percentage of students in Canada who had received formal HIV training in the undergraduate pharmacy curriculum. Furthermore, a university-wide HIV awareness campaign was launched at Qatar University in the final week of data collection, which may have influenced students' responses. We feel the campaign likely had minimal impact on student responses as the majority of questionnaires had been collected before the awareness campaign was launched. Despite these limitations, our study offers valuable insight into knowledge and attitudes of pharmacy students in Canada and in Qatar.
In conclusion, this study characterized the knowledge and attitudes of pharmacy students at the University of Saskatchewan and Qatar University with respect to HIV and AIDS. The majority of pharmacy students in both countries are knowledgeable about HIV and most have positive attitudes; however, several misconceptions and negative beliefs remain. Current educational strategies within the pharmacy curriculum should further emphasize modes of HIV transmission and prevention and efforts should also be considered toward continued reduction of stigma.
| References|| |
|1.||World Health Organization. Global HIV/AIDS Response - Epidemic update and health sector progress towards universal access - Progress Report Summary 2011. http://www.who.int/hiv/pub/progress_report2011/en/. |
|2.||Alkhal A. State of Qatar: Report on the Country Progress Indicators towards Implementing the Declaration of Commitment on HIV 2008. Available from: http://data.unaids.org/pub/Report/2008/qatar_2008_country_progress_report_en.pdf. Last accessed on 2013 Apr 3]. |
|3.||Saskatchewan Ministry of Health. Saskatchewan′s HIV strategy 2010-2014. Available from: http://www.health.gov.sk.ca/hiv-strategy-2010-2014 [Last accessed on 2012 Oct 15]. |
|4.||Badahdah AM, Foote CE. Role of shame in the stigmatization of people with human immunodeficiency virus: A survey of female college students in 3 Arab countries. East Mediterr Health J 2010;16:982-7. |
|5.||Ganczak M, Barss P, Alfaresi F, Almazrouei S, Muraddad A, Al-Maskari F. Break the Silence: HIV/AIDS Knowledge, Attitudes, and Educational Needs among Arab University Students in United Arab Emirates. J Adolesc Health 2007;40:572.e1-8. |
|6.||Badahdah AM, Sayem N. HIV-related knowledge and AIDS stigma among college students in Yemen. East Mediterr Health J 2010;16:901-6. |
|7.||Al-Serouri AW, Anaam M, Al-Iryani B, Al Deram A, Ramaroson S. AIDS awareness and attitudes among Yemeni young people living in high-risk areas. East Mediterr Health J 2010;16:242-50. |
|8.||Askarian M, Hashemi Z, Jaafari P, Assadian O. Knowledge about HIV Infection and Attitude of Nursing Staff Toward Patients with AIDS in Iran. Infect Control Hosp Epidemiol 2006;2:48-53. |
|9.||Fido A, Al Kazemi R. Survey of HIV/AIDS knowledge and attitudes of Kuwaiti family physicians. Fam Pract 2002;19:682-4. |
|10.||Najem GR, Okuzu EI. International comparison of medical students′ perceptions of HIV infection and AIDS. J Natl Med Assoc 1998;90:765-74. |
|11.||Pickles D, King L, Belan I. Undergraduate nursing student′s attitudes towards caring for people with HIV/AIDS. Nurse Educ Today 2012;32:15-20. |
|12.||Hayyawi AH, Al-Marayaty AY, Salman WS, Hamed W. HIV/AIDS knowledge, attitudes and beliefs among a group of Iraqis. East Mediterr Health J 2010;16:18-23. |
|13.||Thomson C, Currie C, Todd J, Elton R. Changes in HIV/AIDS education, knowledge, and Attitudes among Scottish 15-16 year olds, 1990-1994: Findings from the WHO: Health Behaviour in School-aged Children (HBSC). Health Educ Res 1999;14:357-70. |
|14.||Mahklouf OC, Bott S, Carrieri P, Parsons M, Pulerwitz J, Rutenburg N, et al. HIV testing, treatment, and prevention: Generic tools for operational research. Geneva: World Health Organization; 2009. |
|15.||Davis C, Sloan M, MacMaster S, Hughes L. The International AIDS Questionnaire - English Version (IAQ-E). J HIV AIDS Prev Child Youth 2008;7:29-42. |
|16.||Bahdahdah AM, Al-Kubaisi F. Stigmatization of HIV-Positive Women among Qatari Students. In proceedings of the Qatar Foundation Annual Research Forum Proceedings 2011. Doha, Qatar: Qatar Foundation; 2011. |
|17.||Rahmati-Najarkolaei F, Niknami S, Aminshokravi F, Bazargan M, Ahmadi F, Hadjizadeh E, et al. Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran. J Int AIDS Soc 2012;13:27. |
|18.||Knussen C, Niven C. HIV/AIDS and Healthcare Workers: Contact with patients and attitudes towards them. Psychol Health 1999;14:367-78. |
|19.||Barss P, Grivna M, Ganczak M, Bernsen R, Al-Maskari F, El Agab H, et al. Effects of a rapid peer-based HIV/AIDS educational intervention on knowledge and attitudes of high school students in a high-income Arab country. J Acquir Immune Defic Syndr 2009;52:86-98. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]