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ATTITUDE AND PRACTICE OF HEALTH CARE PROFESSIONALS, REGARDING HIV AND AIDS

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CHAPTER ONE

Introduction

Background of the Study

The twenty-first century has witnessed the global health problem of HIV and AIDS, that has produced the greatest challenge to mankind. The epidemic is a global crisis, an unprecedented threat and a formidable challenge to human development and social progress. It poses a very great challenge to Health Care Professionals (HCPs) who are practitioners of disease prevention, treatment, rehabilitation and preservation of health. They are very important group in the prevention and management of blood-borne infections (HIV and AIDS, Hepatitis B). Reports have shown that HCPs are at risk of contacting the infection because of their close contact with the patients. Scully and Greenspan (2006) reported that a health care professional has been found to be HIV positive and subsequent investigations had revealed no other identified risk of exposure other than occupational exposure. Centres for Disease Control-CDC (2002) reported that there had been 57 occupational HIV infections among HCPs in the United States of America. In addition, 139 other cases of HIV infections or AIDS have been recorded among HCPs who reported a history of occupational exposure to HIV infected blood, body fluids or laboratory materials. A further 14 cases of occupational transmission of HIV in health care professionals have been diagnosed in United Kingdom (Heptonstall, Gill, Porter, Black & Gilbert, 1993). From the foregoing, one stands to reason that acquisition of appropriate knowledge, attitude and practice is important for health care professionals in the management of HIV and AIDS patients and for the reduction of risk of occupational transmission.

Attitude is concerned with ones feeling towards an object, person or thing (Okafor, 1991). Eyo (1995) defined attitude as a mental and neutral state of readiness organized through experience, exerting a directive or dynamic influence upon the individual’s responses to all objects and situations, which it relates. Attitude serves a primary function of bringing together the diverse experiences to which an individual is exposed and forming them into a cohesive, organized whole (Effa-Heap, 1997). Attitude, according to Odunukwe (2002), is evaluating feelings towards particular targets. He further stated that attitude represents an organization of positive and negative emotions. Park (2007) explained that attitude is a relatively enduring organization of beliefs around an object, subject or concept, which predispose one to respond in some preferential manner. He maintained that attitudes are acquired by social interaction. Attitude is a reaction to an object or something due to one’s belief against that object which makes him to behave in that particular way. In this study, attitude refers to favourable or unfavourable disposition health care professionals have towards people living with HIV and AIDS (PLWHA). One’s attitude can influence one’s practices of health matters such as those concerned with taking adequate precautionary measures against contacting HIV and AIDS.

Practice is a process or procedure of doing things. Knowledge and action are related. No wonder World Health Organisation WHO (1996) stated that knowledge is a prerequisite for any health action. HCPs may engage in positive (correct) or negative (incorrect) practice. Positive practices are those practices that will enhance adherence to universal precautions, that is, those practices that will be adopted to prevent transmission of HIV in the hospitals or reduce risk of occupational exposure to HIV and AIDS. Negative practice are those practices that will expose HCPs towards contacting the virus. Negative practices will negatively impact on HCPs as they are constantly in close contact with blood and body fluids in the management of HIV positive patients. In this study, practice refers to ways or actions adopted by health care professionals to maintain safety in the care and treatment of HIV positive patients. These include those precautionary measures HCPs adopt to prevent them from contacting HIV and AIDS.

Health care involves a multitude of services rendered to individuals, families, communities by health professionals for the purpose of promoting, maintaining, monitoring or restoring health (Park, 2007). Health care is concerned with all the activities rendered by the health care workers to ensure adequate well-being of individuals. These activities include preventive, for example immunization services; curative, treatment, care and support services, rehabilitative services; and keeping the public informed on health matters that is health education. These activities are usually carried out by HCPs.

HCPs are persons in the preventive and treatment care. They are a group of practitioners who share common health goals and common objectives. They include doctors, nurses, laboratory scientists, dentists, and physiotherapists (www.+xcancer.org/ impact/ glossary.html). Many at times they take health risks such as exposure to HIV and other blood-borne infections or associated opportunistic infections.

World Health Organization-WHO (2004) explained that HIV means Human Immuno Deficiency Virus and AIDS stands for Acquired Immune Deficiency Syndrome. This is a serious infection. Lewis (1996) described it as the scourge of our time. The primary mode of acquiring HIV infection is associated with sexual behaviour or hetro-sexual relationship (WHO, 2004). A number of factors help to spread the infection in Nigeria but the core causative factors are poverty and a wide-range of deep-rooted harmful traditional practices (United Nation Development Programme-UNDP, 2004).

HCPs, in providing care can be at risk of transmission, especially where basic rules of occupational safety and precautions are not implemented. Today, there is still no cure for HIV and AIDS or vaccine to prevent it. Treatment relies on antiretroviral drug (ARD) and prevention approaches by public awareness campaigns, individual behaviour change, screening of blood and blood products and strict adherence to universal precautions (WHO, 2004).

Universal precautions are set of practices designed to protect health care workers and patients from exposure to blood borne pathogens (WHO, 2004). These practices are washing hands before and after direct contact with patients, disinfecting during invasive procedures, use of protective equipment such as using gloves when in contact with body fluids, non-intact skin, or mucus membranes; using masks, eye protection, and gowns when blood or other body fluids could splash or applying water proof dressing to cover all cuts and abrasions, promptly and carefully cleaning spills involving blood and other body fluids and proper disposal of contaminated materials.

The prevalence of HIV and AIDS is rising in Nigeria since it was first discovered in 1986. According to Lambo (2005), the epidemic may be as high as 75 per cent. About 22.4 million people in Sub-Sahara Africa, both adult and children are living with HIV and AIDS and a total of 33.4 million people world wide are living with the virus (World Wide HIV/AIDS Statistics, 2008). It further recorded that 2.0 million people died from AIDS, in 2007. In response to the increasing prevalence of HIV and AIDS in Nigeria, the Federal Government established a multi-sectorial national co-ordinating body called National Action Committee on AIDS (NACA), State Action Committee on AIDS (SACA) and Local Action Committee on AIDS (LACA) in 2000. Since then a lot of activities have been carried out to mitigate the epidemic by various stakeholders. The Federal and State Governments have demonstrated various levels of commitment to the National response in addition to our development partners such as WHO, World Bank, USAID, and UNICEF. The response to the scourge of the disease in Nigeria has been over-whelming.

Over 50 per cent of hospital beds in the countries of Sub-Sahara Africa are occupied by people with HIV related illnesses (ILO & WHO, 2005). Many countries of the world, especially the poorest ones such as Uganda, Kenya and Nigeria are the most affected in terms of number of infections and scale of the epidemic impact. The effect of the disease on children, families, communities and wider society are multifaceted and far-reaching. It poses a threat to the security and well-being of millions of people (WHO, 2004). It has increased the number of children orphaned. Jonna (2004) stated that more than 15 million children under the age of 15 years have already lost one or both parents to HIV and AIDS. This has resulted to a rise in the number of child-headed household, with orphaned siblings living together with limited adult protection or support, leaving them highly vulnerable to exploitation and abuse. The Federal Ministry of Health-FMOH (2005) stated that 3.6 million Nigerians are living with HIV and AIDS and the prevalence rate in the states range from 1.2% in Osun State to 12% in Cross River State.

Ministry of Labour, Industrial Relations, Employment, Local Government, Urban Development and Housing (2008) stated that HIV and AIDS have affected workplaces in many ways. They further stated that a number of these consequences include stigma and discrimination in the workplaces, slow economic growth and increased labour cost for employers and reduced productively.

Caring for HIV and AIDS patients requires special skills. They include the identification and management of specific clinical problems, counseling technique and the ability to communicate effectively with individuals, families and communities. HCPs need to possess positive attitude and correct practice regarding HIV and AIDS as it will prevent transmission of HIV in the hospitals. That is why the study is focused on determining the attitude and practice of HCPs regarding HIV and AIDS in Abia State Hospitals.

There are some socio-demographic factors that affects attitude and practice of HCPs. This study is concerned with socio-demographic factors of gender, and jobtype. Adedigba, Ogunbodebe, Fajewonyomi, Ojo and Naidoo (2006) conducted a study to determine the gender differentiation on the attitude and practice of HCPs in Osun State, Nigeria. The study revealed that there was significant gender difference in attitude, behaviour and practices of HCPs with males having position attitude towards PLWHA and also complied more to universal precautions than females. A study carried out by Alekanda, Slavenka and Boris (2006) on Serbian HCWs (doctors, dentists and nurses) to investigate their safety practices. The result revealed that doctors had high compliance to safety practices than dentists and nurses because of their knowledge on hospital guidelines for safety practices.

Abia State, was created in August, 27, 1991 with its capital at Umuahia. The size of the state is 5,582.20 sq km (Ministry of Information-MOI, Abia State, 2008). It is bounded in the north by Enugu and Ebonyi State, on the South by River State, on the east by Cross Rivers and Akwa Ibom States, on the West by Imo State. It is made up of 17 local governments. The economy is based on agriculture, petroleum resources and commerce. It has a total of eight hundred and eighty two health facilities (both private and public). There is a state owned teaching hospital, one federal medical centre, ten general hospitals, two dental centers, a civil service clinic and one leprosarium (Ministry of Information-MOI, Abia State, 2008). Two of these hospitals are designated for HIV and AIDS treatment. These hospitals are Abia State University Teaching Hospital at Aba and Federal Medical Centre, at Umuahia.

 

Statement of Problem

HCPs are expected to have very high level of knowledge regarding HIV and AIDS and its precautionary measures by virtue of their training. Following from this, they should demonstrate positive attitude towards people affected by the epidemic. This implies that they should care for PLWHA without discrimination and stigmatization since they are not likely to contact HIV and AIDS knowing the precautionary measures.

Regrettably, evidence by Action AID International for Africa (2008) revealed that stigma and discrimination is still a major problem for people living with HIV and AIDS. This is supported by the Ministry of Labour, Industrial Relations, Employment, Local Government, Urban Development and Housing (2008), which stated that they are being discriminated against in the work places. Research conducted by Aisien and Shobowals (2004) at University of Benin Teaching Hosptial, Benin City, showed that over 40 per cent of health workers exhibited discriminating attitude to people affected by this epidemic.

This situation is very worrisome and hence the researcher is uncertain whether HCPs working in Abia State hospitals particularly Abia State University Teaching Hopsital, Aba are also demonstrating stigmatizing and discriminating attitude in view of the fact that they are expected to fully adhere to universal precautions. Conducting an investigation into this, therefore becomes necessary.

 

Purpose of the Study

The purpose of the study is to determine the attitude and practice of HCPs regarding HIV and AIDS in Abia State hospitals. Specifically, the objectives of the study are to determine the:

  1. attitude of HCPs regarding causative agent of AIDS;
  2. attitude of HCPs regarding mode of transmission of HIV;
  3. attitude of HCPs regarding preventive measures of HIV and AIDS;
  4. attitude of HCPs regarding HIV and AIDS treatment;
  5. attitude of HCPs towards people living with HIV and AIDS;
  6. difference in the attitude of male and female HCPs regarding of HIV and AIDS;
  7. difference in the attitude of different categories of HCPs (doctors, nurses, medical

laboratory scientists) regarding HIV and AIDS;

  1. practice of HCPs regarding adherence to universal precautions;
  2. difference in practice of male and female HCPs regarding adherence to

universal precautions, and

  1. difference in practice of different categories of HCPs (doctors, nurses, medical

labouratory scientists) regarding adherence to universal precautions.

 

Research Questions

  1. What is the attitude of HCPs regarding causative agent of AIDS?
  2. What is the attitude of HCPs regarding mode of transmission of HIV?
  3. What is the attitude of HCPs regarding preventive measures of HIV and AIDS?
  4. What is the attitude of HCPs regarding HIV and AIDS treatment?
  5. What is the attitude of HCPs towards people living with HIV and AIDS?
  6. What is the difference in attitude of male and female HCPs regarding HIV and AIDS?
  7. What is the different in attitude of different categories of HCPs (doctors nurses, medical laboratory scientists) regarding HIV and AIDS?
  8. What is the practice of HCPs regarding adherence to universal precautions?
  9. What is the difference in practice of male and female HCPs regarding adherence to universal precautions?
  10. What is the difference in practice of different categories of HCPs (doctors, nurses, medical labouratory scientists) regarding adherence to universal precautions?

 

 

Hypotheses

The following hypotheses are formulated and each will be tested at .05 level of significance.

  1. There is no significant difference in the attitude of male and female HCPs

regarding HIV and AIDS.

  1. There is no significant difference in the attitude of different categories of

HCPs regarding HIV and AIDS.

  1. There is no significant difference in the practice of adherence to universal

precautions by male and female HCPs regarding HIV and AIDS.

  1. There is no significant difference in the practice of adherence to universal

precautions by different categories of HCPs regarding HIV and AIDS.

 

Significance of the Study

The information to be generated from the study will determine whether the HCPs are doing the right thing or not. This will be of immense benefit to hospital administrator who may need to encourage or enforce adherence to the practice of universal precaution. The findings may also be beneficial to the HCPs, people living with HIV and AIDS (PLWHA) and the general public.

The result on the attitude of HCPs regarding HIV and AIDS: causative agent, mode of transmission, preventive measures, treatment of HIV and AIDS, may reveal positive or negative attitude. This will be of benefit to PLWHA and the general public, in that positive attitude would be encouraged as it may help to reduce stigma and discrimination to the general public. By implication, many people may be willing to go for voluntary confidential counseling and testing (VCCT), thereby reducing the spread. It may give PLWHA a sense of acceptance, care and support and help them to live positive life. On the other hand, negative attitude will be corrected through education.

The result on the practice of HCPs regarding adherence to universal precautions, may reveal whether the HCPs are adhering to those practices or not. The result will be beneficial to HCPs, PLWHAS and the general public. Appropriate practice will create a safe work environment for HCPs. It will enable them to deliver effective patient care without compromising personal safety, because they know the precautionary measures and can adequately handle these patients. This would further reduce the spread of the epidemic to the general public. Findings that may indicate non-adherence to universal precautions implies that HCPs are at risk of exposure to occupational HIV infection and should be made to understand the impending danger they are inflicting on themselves.

The result on the difference in attitude and practice of male and female HCPs regarding HIV and AIDS may reveal positive or negative attitude, appropriate practice or inappropriate practice. The result will be useful to both male and female HCPs. Positive attitude and appropriate practice will be encouraged and motivated. Negatives attitude and non adherence to safety practices will be discouraged and strategies put in place to encourage compliance.

The result on the attitude and practice of different categories of HCPs may reveal positive or negative attitude, safety practices or inappropriate practice. The result will be useful to the different categories of HCPs. Positive attitude and safety practices will be encouraged and motivated. Negative attitude and inappropriate practice should be corrected through education.

 

Scope of the Study

The study will be delimited to Abia State University Teaching Hospital Aba which is one of the health facilities designated for care and treatment of people living with HIV and AIDS. It is further delimited to attitude regarding the following areas of HIV and AIDS: causative agent, mode of transmission, preventive measures, treatment and care of people living with HIV and AIDS, risk of occupational transmission as well as practice or adherence to universal precautions by health care professional. The study will also explore the difference in the attitude and practice of HCPs regarding HIV and AIDS according to such variables as gender

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