KNOWLEDGE, ATTITUDES AND PRACTICES REGARDING HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNE DEFICIENCY SYNDROME AND SEXUALLY TRANSMITTED INFECTIONS AMONG HEALTH CARE PROVIDERS IN LAHORE, PAKISTAN
AbstractBackground: Human Immunodeficiency Virus (HIV) infection is a global problem of extraordinarydimensions and has so far resulted in nearly 25 million deaths worldwide. Health care providers (HCPs)are considered to play a pivotal role in the provision of preventive and curative services to individualssuffering from HIV/AIDS and sexually transmitted infections. Pakistan, which was previouslycategorised as having a low-prevalence, high-risk HIV epidemic, is now facing a concentrated HIVepidemic among its most at-risk populations such as injecting drug users. The objective of this studywas to assess the knowledge, attitudes and reported practices relating to HIV/AIDS and STIs amongprivate and public sector health care providers providing clinical services in areas where women sellsex. Methods: This was an exploratory quantitative study, where a structured questionnaire wasadministered in face-to-face interviews with 200 HCPs from the public and private sectors. Knowledgeabout AIDS and correct diagnosis of STIs were defined as according to the national guidelines ofNACP. Pearson’s chi-square analysis was performed to test associations between predictors and levelof knowledge of STIs in each group separately. Multivariate logistic regression analysis was employedto indicate predicting factors for correct management of STIs. Results: Forty-five percent of the HCPshad correct knowledge about the transmission and prevention of HIV, whereas 21% had seen a patientwith advanced HIV infection, only two HCPs had been trained to manage such cases and 82% were notaware of syndromic management of STIs. Only 10% could cite the ‘correct treatment’ of gonorrhoea,syphilis and vaginal discharge. The odds of having the ‘correct knowledge’ of diagnosing gonorrhoeaand syphilis were 2.1 (CI 95%, 1.2–3.8) if the HCP was a female medical doctor working in publicsector. Conclusion: Further intensive training is needed to improve the ability of relevant HCPs tocorrectly diagnose and effectively treat patients infected with HIV and STIs.Keywords: HIV/AIDS, Sexually transmitted infections (STI), health care providers (HCP), knowledgeattitudes and practices (KAP), Pakistan
UNAIDS. 2008 Report on the global AIDS epidemic 2008.
available at: http://www.unaids.org/en/KnowledgeCentre/
Khan AA, Awan AB, Qureshi SU, Razaque A, Zafar ST.
Large sharing networks and unusual injection practices
explain the rapid rise in HIV among IDUs in Sargodha,
Pakistan. Harm Reduct J 2009;6:13.
Platt L, Vickerman P, Collumbien M, Hasan S, Lalji N,
Mayhew S, et al. Prevalence of HIV, HCV and sexually
transmitted infections among injecting drug users in
Rawalpindi and Abbottabad, Pakistan: evidence for an
emerging injection-related HIV epidemic. Sex Transm Infect
Mir AM, Wajid A, Reichenbach L, Khan M. STI prevalence
and associated factors among urban men in Pakistan. Sex
Transm Infect 2009;85(3):199–200.
Hawkes S, Collumbien M, Platt L, Lalji N, Rizvi N,
Andreasen A, et al. HIV and other sexually transmitted
infections among men, transgenders and women selling sex
in two cities in Pakistan: a cross-sectional prevalence survey.
Sex Transm Infect 2009;85(Suppl 2):ii8–16.
Khan AA, Rehan N, Qayyum K, Khan A. Correlates and
prevalence of HIV and sexually transmitted infections among
Hijras (male transgenders) in Pakistan. Int J STD AIDS
Siddiqi S, Hamid S, Rafique G, Chaudhry SA, Ali N, Shahab
S, et al. Prescription practices of public and private health
care providers in Attock District of Pakistan. Int J Health
Plann Manage 2002;17(1):23–40.
Khan MS, Unemo M, Zaman S, Lundborg CS. Poverty of
opportunity forcing women into prostitution–a qualitative
study in Pakistan. Health Care Women Int (In press).
Kirkwood BR, Stern JAC. Essential Medical Statistics, 2nd
Edition. Massachusetts: Blackwell Science; 2003.
J Ayub Med Coll Abbottabad 2009;21(4)
NACP. The National Guidelines for the Management of
Sexually Transmitted Infections. Islamabad: National AIDS
Control Program 2007.
Abrams EJ, El-Sadr WM. Lessons from Harlem: Relevance
to a global epidemic. J Acquir Immune Defic Syndr
Yu D, Souteyrand Y, Banda MA, Kaufman J, Perriens JH.
Investment in HIV/AIDS programs: Does it help strengthen
health systems in developing countries? Global Health
Lehmann U, Van Damme W, Barten F, Sanders D. Task
shifting: the answer to the human resources crisis in Africa?
Hum Resour Health 2009;7:49–52.
Sihavong A, Lundborg CS, Syhakhang L, Vernby A,
Panyanouvong A, Marions L, et al. Health providers'
competence in the management of reproductive tract
infections in Vientiane, Lao People's Democratic Republic.
Int J STD AIDS 2007;18:774–81.
Baig LA, Akram DS, Ali SK. Development of the
Community-Oriented Medical Education curriculum of
Pakistan: a case report on the national initiative on
curriculum development. Educ Health (Abingdon)
Quach L, Mayer K, McGarvey ST, Lurie MN, Do P.
Knowledge, attitudes, and practices among physicians on
HIV/AIDS in Quang Ninh, Vietnam. AIDS Patient Care
Markham WA, Bullock AD, Matthews P, Firmstone VR,
Kelly S, Field SJ. Sexual health care training needs of
general practitioner trainers: a regional survey. J Fam Plann
Reprod Health Care 2005;31:213–8.
NIPS. Pakistan Demographic and Health Survey 2006–07.
Islamabad: National Institute of Population Studies,
Islamabad Pakistan and Macro International Inc.2008.
Saeed F. Taboo! The Hidden Culture of a Red Light Area. 1st
ed. Oxford: Oxford University Press; 2002.
Brown L. The Dancing Girls of Lahore: selling love and
saving dreams in Pakistan's ancient pleasure district. New
York: HarperCollins Publishers; 2005.
Reis C, Heisler M, Amowitz LL, Moreland RS, Mafeni JO,
Anyamele C, et al. Discriminatory attitudes and practices by
health workers toward patients with HIV/AIDS in Nigeria.
PLoS Med 2005;2(8):e246.
Sheikh NS, Sheikh AS, Sheikh AA. Knowledge, attitude and
practices regarding Crimean–Congo Hemorrhagic Fever
among healthcare workers in Balochistan. J Ayub Med Coll
Guidelines for Management of Sexually Transmitted
Infections. Geneva, Switzerland: World Health Organization
Available at: http://whqlibdoc.who.int/publications/
Ray K, Muralidhar S, Bala M, Kumari M, Salhan S, Gupta
SM, et al. Comparative study of syndromic and etiological
diagnosis of reproductive tract infections/sexually transmitted
infections in women in Delhi. Int J Infect Dis
Yin YP, Wu Z, Lin C, Guan J, Wen Y, Li L, et al. Syndromic
and laboratory diagnosis of sexually transmitted infection: a
comparative study in China. Int J STD AIDS 2008;19:381–4.
Hylton-Kong T, Brathwaite AR, Rosario GRD, Kristensen S,
Kamara P, Jolly PE, et al. Marginal validity of syndromic
management for reproductive tract infections among
pregnant women in Jamaica. Int J STD AIDS 2004;15:371–5.
Lan PT, Lundborg CS, Phuc HD, Sihavong A, Unemo M,
Chuc NT, et al. Reproductive tract infections including
sexually transmitted infections: a population-based study of
women of reproductive age in a rural district of Vietnam. Sex
Transm Infect 2008;84:126–32.
Sihavong A, Phouthavane T, Lundborg CS,
Sayabounthavong K, Syhakhang L, Wahlstrom R.
Reproductive tract infections among women attending a
gynecology outpatient department in Vientiane, Lao PDR.
Sex Transm Dis 2007;34:791–5.
Lewis DA, Scott L, Slabbert M, Mhlongo S, van Zijl A, Sello
M, et al. Escalation in the relative prevalence of
ciprofloxacin-resistant gonorrhoea among men with urethral
discharge in two South African cities: association with HIV
seropositivity. Sex Transm Infect 2008;84:352–5.
Le Lin B, Pastore R, Liassine N, Aramburu C, Sudre P. A
new sexually transmitted infection (STI) in Geneva?
Ciprofloxacin-resistant Neisseria gonorrhoeae, 2002–2005.
Swiss Med Wkly 2008;138(15-16):243–6.
Tapsall JW, Ndowa F, Lewis DA, Unemo M. Meeting the
public health challenge of multidrug- and extensively drugresistant Neisseria gonorrhoeae. Expert Rev Anti Infect Ther
Khandwalla HE, Luby S, Rahman S. Knowledge, attitudes,
and practices regarding sexually transmitted infections
among general practitioners and medical specialists in
Karachi, Pakistan. Sex Transm Infect 2000;76:383–5.
Lan PT, Mogren I, Phuc HD, Stalsby Lundborg C.
Knowledge and practice among healthcare providers in rural
Vietnam regarding sexually transmitted infections. Sex
Transm Dis 2009;36:452–8.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.