AIDS Attitude in First-Year Students with History of Sexual Behaviors: A Cross-Sectional Study

AUTHORS

Meisam Akhlaghdoust ORCID 1 , Shahla Chaichian ORCID 2 , * , Poorya Davoodi 3 , Mahin Ahmadi Pishkuhi 4 , Ali Azarpey 5 , Mahshid Imankhan 5 , Atoosa Hashemi 3 , Fatemeh Afroughi 5 , Nesa Zarbati 6 , Shadi Erfanian Asl 7

1 Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Minimally Invasive Techniques Research Center in Women, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran

3 Young Researchers and Elite Club, Yadegar-e-Imam Khomeini (RAH) Shahr-e-Rey Branch, Islamic Azad University, Tehran, Iran

4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

5 Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran

6 Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

7 Universal Scientific Education and Research Network (USERN), Tehran, Iran

How to Cite: Akhlaghdoust M, Chaichian S, Davoodi P , Ahmadi Pishkuhi M, Azarpey A , et al. AIDS Attitude in First-Year Students with History of Sexual Behaviors: A Cross-Sectional Study, Int J High Risk Behav Addict. 2019 ; 8(3):e94612. doi: 10.5812/ijhrba.94612.

ARTICLE INFORMATION

International Journal of High Risk Behaviors and Addiction: 8 (3); e94612
Published Online: September 15, 2019
Article Type: Brief Report
Received: May 29, 2019
Revised: August 26, 2019
Accepted: August 28, 2019
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Abstract

The aim of this study was to investigate the attitudes of the students of Medical Sciences and Technical Sciences Universities toward HIV/AIDS. This cross-sectional study was performed on 950 first-year Medical Sciences students and first-year Technical Sciences students between May 2017 and June 2018 in Tehran, Iran. The students were selected using the census-sampling method to fill out the International AIDS Questionnaire-Persian version (IAQ-P). SPSS version 21 was used to analyze data by the chi-square test and nonparametric tests. There was a significant difference in the mean score of AIDS attitude between the two groups (P < 0.001). Confounding factors including age, gender, and marital status had a significant effect on students’ AIDS attitude between the different groups using regression models (P < 0.001). There is an increasing trend in sexual activity among students and young people while it is not true about its attitude and awareness. Therefore, we need to improve attitude toward AIDS in developing countries.

Keywords

Attitude HIV AIDS Students Sex

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Since its inception in 1981, the Acquired Immune Deficiency Syndrome (AIDS) has been undoubtedly one of the most important challenges for developed and developing countries (1-4). Based on the World Health Organization (WHO) estimates, there were about 37 million people in 2016 in the world suffering from AIDS and Human Immunodeficiency Virus (HIV) (2-4). Moreover, according to the latest WHO report in 2016, 1.8 million people across the world were infected with HIV and more than one million patients died of AIDS-related disease (4-8).

In recent years, concerns about sexual health have increased throughout the world (9). In most countries, the increasing prevalence of Sexually Transmitted Diseases (STDs), especially HIV infection, in young people is alarming (10, 11). According to the report of the Ministry of Health and Medical Education in Iran, 36,571 people were living with HIV in 2018, while this number was 5,086 in 2003 (5). Studies have shown that new HIV-infected people in Iran were drug users, but there is a rapidly rising trend in the number of people infected sexually (8). Reports published by the WHO over the past 10 years show that the pattern of HIV transmission through sexual relationships has changed (4). Teens and young people are more at risk of AIDS than adults (3). The WHO estimates that 50% of individuals newly diagnosed with HIV are young, between the ages of 15 and 24; additionally, 53% of new patients infected with HIV in Iran are in the age group of 21 to 35-years-old (8-11). Young people and university students are a major group involved in sexual activity and the first sexual experience like intercourse can occur during the university period (12-16). In Iran, there is no sexual relationship/STD education provided by the national media and the Ministry of Education that causes unreliable education to young people.

2. Objectives

The aim of this study was to investigate the AIDS attitude in first-year students with prior sexual behavior experience.

3. Methods

This cross-sectional study was performed on first-year Medical Sciences students (Islamic Azad University, Tehran Medical Sciences Branch) and first-year Technical Sciences students (Islamic Azad University, Shahr-e-Rey Branch) between May 2017 and June 2018. The sample was recruited by the census-sampling method and 2,643 first-year students in the first or second semesters were included to complete the questionnaires (n ≥ 1,300 students from each university). The inclusion criteria included first-year students from the selected universities, an age of at least 18 years, and a prior sexual behavior experience. The exclusion criteria included incomplete questionnaires and a history of participating in AIDS educational courses.

In this study, we used the International AIDS Questionnaire-Persian Version (IAQ-P) for data collection (14). The IAQ was developed by Davis et al. (1999) (17). This questionnaire includes 18 questions for assessing the four dimensions of HIV/AIDS attitude, including myths, facts, personal risk, and attitudes. Every question was scored on a five-point Likert scale. Finally, higher scores indicated positive and accurate attitudes toward AIDS. Alipour et al. (2016) confirmed the validity and reliability of the Persian version of this questionnaire (13). The data were analyzed using SPSS version 21 using the chi-square test and nonparametric tests. P values of less than 0.05 were considered significant.

4. Results and Discussion

Overall, 950 first-year students entered the study. Approximately, 36% of the students (n = 2643) had a prior sexual behavior experience (Medical sciences group = 33.1% and Technical Sciences group = 38.8% (Table 1). The total mean score of the questionnaire was 31.93 ± 5.67 (technical sciences group = 32.36 ± 5.53 and medical sciences group = 30.75 ± 4.17) (P value < 0.001). The mean scores of myth, personal risk, and attitude dimensions were significantly different between the two groups (P value < 0.001). The finding of the study showed that technical sciences students had more sexual experiences than medical sciences students and they had a higher attitude level (Table 2). The study by Alipour et al. (2016) showed the following mean scores for various dimensions: myth (28.34 ± 4.73), attitude (19.75 ± 3.72), personal risk (10.19 ± 2.28), facts (12 ± 3.41), and total (70.04 ± 8.77) (13). Therefore, the AIDS attitude of Iranian students has decreased over time. It seems that this difference may be due to the greater involvement of technical students with electronic media, making them contact more with Western culture. in addition, the pride of medical students might be a driving force for back-out of having sex.

Table 1. Demographic Characteristics of Medical and Technical Sciences Students
Technical Sciences Group (N = 513)Medical Sciences Group (N = 437)P
Age, mean ± SD21.66 ± 1.1420.57 ± 1.000.591
Gender, No. (%)0.024
Female387 (75.5)297 (68)
Male126 (24.5)140 (32)
Marital status, No. (%)0.558
Single453 (88.3)396 (90.6)
Married60 (11.7)41 (9.4)
Table 2. Comparison of HIV/AIDS Attitude Scores Between Technical (A) and Medical (B) Sciences University Students
International AIDS Questionnaire-Persian VersionABP ValueTotal
Mean ± SD aAgreement, % bMean ± SDAgreement, %Mean ± SDAgreement, %
Transmission myths (possible range: 7 - 35)9.82 ± 2.8125.38.90 ± 2.1615.91< 0.0019.31 ± 2.5223.60
1. HIV can be spread through coughing and sneezing 1.12 ± 0.467.61.04 ± 0.193.500.0041.09 ± 0.406.41
2. AIDS can be contracted through sharing cigarettes 1.43 ± 0.8224.21.16 ± 0.4115.20< 0.0011.31 ± 0.6921.54
3. HIV/AIDS can be spread through hugging an infected person 1.11 ± 0.4181.04 ± 0.302.920.0021.09 ± 0.396.57
4. HIV can be transmitted through the air 1.08 ± 0.3771.02 ± 0.241.160.0011.01 ± 0.145.26
5. HIV can be spread through swimming pools 1.50 ± 0.8213.51.42 ± 0.6336.250.1581.47 ± 0.7319.90
6. HIV can be contracted through toilet seats 1.39 ± 0.7037.51.48 ± 0.779.700.2901.45 ± 0.7536.51
7. Mosquitoes can transmit HIV 1.98 ± 1.1179.61.75 ± 0.9942.69< 0.0011.91 ± 1.0769.07
Facts (possible range: 3 - 15)5.00 ± 1.90735.12 ± 1.1891.030.2735.07 ± 1.5536.34
8. Condoms will decrease the risk of HIV transmission 2.95 ± 0.98743.51 ± 0.7294.15< 0.0013.19 ± 0.8435.03
9. HIV can be transmitted from mother to baby 2.50 ± 0.96833.20 ± 1.0187.130.0922.59 ± 1.1328.28
10. HIV is spread through infected semen 3.57 ± 0.82623.39 ± 0.9791.81< 0.0013.43 ± 0.9345.72
Personal risk (possible range: 3 - 15)4.20 ± 1.72183.62 ± 1.0430.60< 0.0013.88 ± 1.4220.55
11. Iranians are less susceptible to contracting AIDS than other nationalities 1.33 ± 0.47171.33 ± 0.6722.80< 0.0011.56 ± 0.8715.62
12. AIDS only affects intravenous drug users, prostitutes, and homosexuals 2.53 ± 1.81241.84 ± 0.0151.46< 0.0011.95 ± 0.8828.28
13. You can protect yourself against AIDS by being vaccinated for it 2 ± 1.20131.27 ± 0.7217.54< 0.0011.72 ± 1.0917.76
Attitudes (possible range: 5 - 25)14.1 ± 2.7716.4813.21 ± 2.3723.27< 0.00113.62 ± 2.5934.25
14. People with HIV should be kept out of school 1.41 ± 0.9319.41.09 ± 0.298.18< 0.0011.28 ± 0.787.73
15. I would end my friendship if my friend had AIDS 1.13 ± 0.33181.23 ± 0.6115.78< 0.0011.20 ± 0.3063.98
16. I am willing to do volunteer work with AIDS patients 2.69 ± 1.26122.81 ± 1.1676.02< 0.0012.28 ± 1.0765.68
17. If a family member contracts HIV he/she should move out 1.46 ± 1.005.31.07 ± 0.374.090.4581.28 ± 0.8213.32
18. People with HIV should stay home or in hospital 1.43 ± 0.8927.71.22 ± 0.6612.280.0101.33 ± 0.8020.55
Total score (possible range: 18 - 90)32.36 ± 5.5333.1930.75 ± 4.1740.20< 0.00131.93 ± 5.6728.68

aItems were scored on a five-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree).

bAgreement percentage calculated by points 1 and 2 of the Likert scale.

The results showed that after adjustment for the confounding effects of age, gender, and marital status (Table 3), the university had a significant effect on students’ attitude toward HIV/AIDS (β = -0.154, P value < 0.001). The study by Davis et al. (2007) in Chinese adolescents showed similar results although the average scores in our study were lower in all four dimensions (17). The AIDS attitude was more in female students than in male students but there was no significant relationship between gender and AIDS attitude. However, male students had more sexual behaviors. Some studies have shown that new HIV-infected patients in the world are mostly young females (18). In the study by Mulu et al. (2014), the attitude of men was more than that of women (19). In addition, Alipour et al. (2016) showed females had more AIDS attitude than males (P < 0.0001); however, in our study, there was no significant difference between males and females.

Table 3. Predicting Factors of the Total Score of HIV/AIDS Attitude Using Linear Regression Models
GroupsMean ± SDP ValueCI for Mean DifferenceStandardized β CoefficientP ValueCI for Standardized β Coefficient
LowerUpperLowerUpper
Age0.059-0.0492.570-0.0220.504-1.7940.882
< 2032.69 ± 6.31
≥ 2031.43 ± 4.69
Gender0.036-1.410-0.0470.0590.066-0.0431.318
Female31.29 ± 4.53
Male32.02 ± 5.43
University type< 0.0010.9922.204-0.154< 0.001-2.110-0.853
Technical32.36 ± 5.53
Medical30.75 ± 4.17
Marital status0.359-0.5441.498-0.0320.320-1.5290.500
Single31.55 ± 4.81
Married31.07 ± 4.81

The level of students’ attitude toward AIDS/HIV was not desirable that may be due to the limited educational resources for HIV and sexual activity targeting Iranian students (8-11). In some developing countries including Iran, society and culture create stigma around discussing sexual activity and related issues and there are misconceptions and myths about sexual activity, sexual health, and STDs (8-11, 14).

The limitations of our study were the small sample size, the stigma around the subject, unwillingness of some students to participate in the study and report on their prior sexual behaviors like intercourse. This finding showed that Iranian students’ attitude was poor toward AIDS and HIV, especially in Medical Sciences students. There is an increasing trend in sexual activity among students and young people while it is not true about its attitude and awareness. Therefore, we need to increase attitude toward AIDS in developing countries.

Footnotes

References

  • 1.

    Turhan O, Senol Y, Baykul T, Saba R, Yalcin AN. Knowledge, attitudes and behaviour of students from a medicine faculty, dentistry faculty, and medical technology vocational training school toward HIV/AIDS. Int J Occup Med Environ Health. 2010;23(2):153-60. doi: 10.2478/v10001-010-0008-5. [PubMed: 20630832].

  • 2.

    World Health Organization. Summary report on the WHO/UNAIDS/UNFPA/UNICEF joint regional meeting on the global accelerated action for the health of adolescents: Guidance to support country implementation, Cairo, Egypt, 20-21 March 2017. World Health Organization. Regional Office for the Eastern Mediterranean; 2017.

  • 3.

    Singh VP, Osman IS, Rahmat NA, Bakar NAA, Razak N, Nettem S. Knowledge and attitude of dental students towards HIV/AIDS patients in Melaka, Malaysia. Malays J Med Sci. 2017;24(3):73-82. doi: 10.21315/mjms2017.24.3.9. [PubMed: 28814935]. [PubMed Central: PMC5545620].

  • 4.

    Gisslen M, Svedhem V, Lindborg L, Flamholc L, Norrgren H, Wendahl S, et al. Sweden, the first country to achieve the joint united nations programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90-90-90 continuum of HIV care targets. HIV Med. 2017;18(4):305-7. doi: 10.1111/hiv.12431. [PubMed: 27535540]. [PubMed Central: PMC5347969].

  • 5.

    National AIDS Committee Secretariat. Islamic Republic of Iran AIDS progress report on monitoring of the united nations general assembly special session on HIV and AIDS. Tehran: Ministry of Health and Medical Education; 2015.

  • 6.

    Atav AS, Sendir M, Darling R, Acaroglu R. Turkish and American undergraduate students' attitudes toward HIV/AIDS patients: A comparative study. Nurs Forum. 2015;50(2):116-24. doi: 10.1111/nuf.12059. [PubMed: 24387272].

  • 7.

    Ozakgul AA, Sendir M, Atav AS, Kiziltan B. Attitudes towards HIV/AIDS patients and empathic tendencies: A study of Turkish undergraduate nursing students. Nurse Educ Today. 2014;34(6):929-33. doi: 10.1016/j.nedt.2013.10.018. [PubMed: 24268638].

  • 8.

    Hosseini Hooshyar S, Shahesmaeili A, Safari Faramani R, Khajehkazemi R, Nasirian M, Sharifi H, et al. 85: Knowledge, attitude and practice of hiv/aids: A systematic review among key populations at risk for hiv infection in Iran. BMJ open. 2017;7(Suppl 1):bmjopen-2016-015415.85.

  • 9.

    Yazdi-Ravandi S, Taslimi Z, Ghaleiha A, Azhdarloo M, Shamsaei F. Knowledge and attitude in Hamadan University of Medical Sciences students toward AIDS: A cross-sectional study from west of Iran. Int Clin Neurosci J. 2017;4(3):103-6.

  • 10.

    Tavakolpour S, Mirsafaei HS, Elkaei Behjati S, Ghasemiadl M, Akhlaghdoust M, Sali S. Toward cure chronic hepatitis B infection and hepatocellular carcinoma prevention: Lessons learned from nucleos(t)ide analogues therapy. Immunol Lett. 2017;190:206-12. doi: 10.1016/j.imlet.2017.08.003. [PubMed: 28827021].

  • 11.

    Khani Jeihooni A, Arameshfard S, Hatami M, Mansourian M, Kashfi SH, Rastegarimehr B, et al. The effect of educational program based on health belief model about HIV/AIDS among high school students. Int J Pediatr. 2018;6(3):7285-96.

  • 12.

    Petros B, Belayneh S, Mekonnen Y. AIDS and college students in Addis Ababa: A study of knowledge, attitude and behavior. Ethiopian J Health Dev. 1997;11(2).

  • 13.

    Alipour Z, Eskandari N, Mokhah S. Evaluation of knowledge and attitude of non-medical students about AIDS. J Holistic Nurs Midwifery. 2016;26(1):10-20.

  • 14.

    Pourmarzi D, Taromian S, Razi M, Esmaeilie-Hesari A. Validity and reliability of a Persian version of a questionnaire on knowledge of health care providers about sexually transmitted infections. East Mediterr Health J. 2016;22(8):596-602. [PubMed: 27834441].

  • 15.

    Chen M, Liao Y, Liu J, Fang W, Hong N, Ye X, et al. Comparison of sexual knowledge, attitude, and behavior between female Chinese college students from urban areas and rural areas: A hidden challenge for HIV/AIDS control in China. Biomed Res Int. 2016;2016:8175921. doi: 10.1155/2016/8175921. [PubMed: 28101513]. [PubMed Central: PMC5215479].

  • 16.

    Farotimi AA, Nwozichi CU, Ojediran TD. Knowledge, attitude, and practice of HIV/AIDS-related stigma and discrimination reduction among nursing students in southwest Nigeria. Iran J Nurs Midwifery Res. 2015;20(6):705-11. doi: 10.4103/1735-9066.170011. [PubMed: 26793257]. [PubMed Central: PMC4700691].

  • 17.

    Davis C, Sloan M, Macmaster S, Hughes L. The international AIDS questionnaire—English version (IAQ-E) assessing the validity and reliability. J HIV/AIDS Prev Child Youth. 2007;7(2):29-42.

  • 18.

    Thanavanh B, Harun-Or-Rashid M, Kasuya H, Sakamoto J. Knowledge, attitudes and practices regarding HIV/AIDS among male high school students in Lao People's Democratic Republic. J Int AIDS Soc. 2013;16:17387. doi: 10.7448/IAS.16.1.17387. [PubMed: 23481130]. [PubMed Central: PMC3595419].

  • 19.

    Mulu W, Abera B, Yimer M. Knowledge, attitude and practices on HIV/AIDS among students of Bahir Dar University. Sci J Public Health. 2014;2(2):78-86.

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