KNOWLEDGE, ATTITUDES AND PRACTICES REGARDING HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNE DEFICIENCY SYNDROME AND SEXUALLY TRANSMITTED INFECTIONS AMONG HEALTH CARE PROVIDERS IN LAHORE, PAKISTAN

Authors

  • Mohsin Saeed Khan
  • Magnus Unemo
  • Shakila Zaman
  • Cecilia Stålsby Lundborg

Abstract

Background: 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

References

UNAIDS. 2008 Report on the global AIDS epidemic 2008.

available at: http://www.unaids.org/en/KnowledgeCentre/

HIVData/GlobalReport/2008/2008_Global_report.asp

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

;85(Suppl 2):ii17–22.

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

;19:817–20.

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)

http://www.ayubmed.edu.pk/JAMC/PAST/21-4/Mohsin.pdf

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

;52(Suppl 1):S24–6.

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

;4:8.

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)

;19:223–8.

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

STDS 2005;19:335–46.

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

Abbottabad 2004;16:39–42.

Guidelines for Management of Sexually Transmitted

Infections. Geneva, Switzerland: World Health Organization

Available at: http://whqlibdoc.who.int/publications/

/9241546263.pdf

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

;136:1432–40.

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

;7:821–34.

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.

Published

2009-12-01