Abstract
Background
Despite the fact that the possible modes of transmission of Human Immunodeficiency Virus (HIV) are well established, there still abound many misconceptions, which contribute to the persistence of social stigmatization of those living with the virus.
Aim: To assess the perception of some dental patients on the possible modes of transmission of HIV in order to identify areas of misconceptions.
Design of the study
A prospective study
Setting
A dental centre located within a teaching hospital in Nigeria.
Materials & Methods
A prospective study of 212 dental patients was undertaken using a structured questionnaire to assess the perception of respondents on possible mode of transmission of HIV.
Results
Majority of the respondents agreed that HIV could be transmitted through sexual means (96.2%), blood transfusion (96.7%) and sharing of sharp objects (92.5%). A few of the respondents believed that HIV can be transmitted through sharing of drinking cups (9.4%) and mosquito bites (13.6%). A greater percentage of those with higher educational qualifications agreed that the use of unsterilized dental instruments may transmit the virus, which was statistically significant (p< .002) and a lower percentage of the more educated respondents agreed that sharing of drinking cup can transmit the virus (p<.000).
Conclusion
Despite the generally good knowledge of the possible modes of transmission of HIV, there are still some misconceptions, which may encourage stigmatization of those living with HIV, which could lead to people unwilling to consent and go for voluntary counseling and testing.
Keywords: HIV, Transmission mode, Misconceptions, Dental patients
Introduction
Since the discovery of Human Immunodeficiency Virus (HIV) about 34 years ago, it has become a serious public health issue and many screening centers had been established in order to ease the counseling and testing of people for the virus. HIV infection is considered pandemic by the World Health Organisation (WHO). From its discovery in 1981 to 2006, AIDS had reportedly killed more than 25 million people, while HIV had infected about 0.6% of the world’s population1. The discussion has since shifted from the number of people dying from AIDS to people living with HIV/AIDS (PLWHA), which to a large extent had been made possible by early diagnosis and prompt treatment of the condition. Accurate knowledge of HIV/AIDS is a necessary precondition for consistent adoption of protective behaviors and good relationship with people living with HIV. Lack of correct information about possible modes of HIV transmission may hinder people’s willingness to receive voluntary counseling and testing, and increased likelihood of stigmatization and isolation of people living with HIV, among other adverse psychosocial influences2.
Previous studies have reported the presence of some misconceptions concerning possible mode of transmission of HIV among different study populations3-5. Bassey et al3 reported that about 15% of the antenatal women that were studied believed that mosquito bite could transmit HIV/AIDS and 13.7% stated that HIV/AIDS could be transmitted by sharing a meal with an infected person. In another study among Nigerian students, there was the misconception that once somebody is infected with HIV, he or she already has AIDS4 while another study among army personnel reported that 9.1% of the participants believed that HIV could be contracted through mosquito bite and 2.1% stated that it could be contracted through body contact such as hugging5. The purpose of this study was to assess the knowledge of dental patients on HIV/AIDS in a Nigerian teaching hospital setting in order to identify areas of misconception concerning the mode of transmission of the virus. This will help in the appropriate channeling of resources towards correcting the misconceptions associated with the mode of transmission of the virus and may enhance the acceptance of voluntary counseling and testing for HIV by the populace, which can help in curtailing further spread of the disease.
Patients & Methods
A cross-sectional study of 212 respondents was carried out at the dental clinic of the University College Hospital, Ibadan, Nigeria. Respondents were selected by convenient sampling of willing patients that presented at the dental clinic from June to December, 2014. A structured questionnaire was used in the collection of information on the knowledge of human immunodeficiency virus (HIV) transmission and the readiness of respondents to undergo screening for the condition. The questionnaire was pretested among 10 respondents that were not eventually included in the study and the result of the pretest was used to modify the questionnaire accordingly. Some of the routes that the respondents were requested to assess as a possible means of transmission for HIV include sexual means, blood transfusion, human bites, sharing of plates, spoons or cups. The views of the respondents on the possibility of contracting HIV through sharing of barber’s clippers and toothbrush with others were also sought. Information on how the respondents will feel in case a medical practitioner should request that they have HIV screening done without properly informing them was also sought. Data obtained from the questionnaires was analyzed using Statistical Package for Social Sciences version 16 (SPSS inc., Chicago, IL, USA). Analysis included calculation of mean, frequency. Statistical significance was inferred at p < 0.005.
Results
Two hundred and twelve completely filled questionnaires were returned, out of which 95 (44.8%) of the respondents were males and the remaining 117 (55.2%) were females. Age of respondents ranged from 14 to 80 years (36.6 ± 15.7 years). Seventy-four (34.9%) of the respondents were in the age range 21–30 years, 33/212 (15.6%) were in the age range of 41–50 years, while 40/212 (18.9%) were older than 51 years and 23/212 (10.8%) were younger than 20 years of age. The remaining 42(19.8%) were in the age range of 31–40 years. Majority, 111/212 (52.4%), of the respondents had first degree as highest academic qualification, while about 20% had only secondary school leaving certificate and 41(19.3%) had postgraduate qualifications.
Table 1 shows the knowledge of respondents concerning possible mode of transmission of HIV, majority of the respondents agreed that the virus can be transmitted through sexual means (96.2%), blood transfusion (96.7%) and sharing of sharp objects (92.5%). Also, high percentage (86.8%) agreed as to the possibility of transmission of the virus through barber’s clippers, and use of non-sterile dental instruments (74.6%). Only a few of the respondents agreed that the virus may be transmitted through mosquito bites (13.7%) and sharing of cups, spoons or plates with others (9.4%) (Table 1).
Table 1. Knowledge of respondents concerning mode of transmission of HIV .
| Possible mode of transmission | Yes (%) | No (%) | Not sure (%) | Total (%) |
| Sexual means | 204 (96.2) | 3 (1.4) | 5 (2.3) | 212 (100) |
| Blood transfusion | 205 (96.7) | 4 (1.9) | 3 (1.4) | 212 (100) |
| Human bite | 79 (37.3) | 77 (36.3) | 56 (26.4) | 212 (100) |
| Sharing of sharp object | 196 (92.5) | 6 (2.8) | 10 (4.7) | 212 (100) |
| Sharing of plates and spoons | 13 (6.1) | 169 (79.7) | 30 (14.2) | 212 (100) |
| Sharing drinking cups with infected person | 20 (9.4) | 156 (73.6) | 36 (17.0) | 212 (100) |
| Sharing toothbrush with others | 145 (68.4) | 29 (13.7) | 38 (17.9) | 212 (100) |
| Sharing barber’s clippers with others | 184 (86.8) | 16 (7.5) | 12 (5.7) | 212 (100) |
| Mosquito bites | 29 (13.7) | 144 (67.9) | 39 (18.4) | 212 (100) |
| Through Handshake/hugging | 11 (5.2) | 179 (84.4) | 22 (10.4) | 212 (100) |
| Through mother-child during birth | 170 (80.2) | 19 (9.0) | 23 (10.8) | 212 (100) |
| Through mother-child during breastfeeding | 132 (62.3) | 33 (15.6) | 47 (22.1) | 212 (100) |
| Through kissing | 68 (32.1) | 87 (41.0) | 57 (26.9) | 212 (100) |
| Use of non-sterile dental instrument | 158 (74.5) | 3 (1.4) | 51 (24.1) | 212 (100) |
When the level of the academic status of the respondents was compared with their knowledge of possible routes of transmission of HIV, it was discovered that the higher the level of their academic qualification, the higher the percentage that agreed that the use of non-sterile dental instruments is a possible means of transmitting HIV, which was statistically significant (p< .002), the same trend was observed in the case of sharing of drinking cup in which lower percentage of those with postgraduate qualifications agreed that sharing of cup can transmit HIV (p<.000). A higher percentage of those with lower educational status agreed that human bites is a possible means of transmitting the virus compared with those of higher academic status, which was statistically significant (Table 2). Comparing the gender of respondents with their knowledge of possible means of transmission of HIV shows that all the female respondents agreed that HIV can be transmitted through blood transfusion, while a few of the male respondents disagreed with the fact (p<.022). A higher percentage of the female respondents agreed that sharing of toothbrush may transmit the virus (p>.005) and that the virus may be transmitted through mosquito bites (p<.009). A greater percentage of the female respondents also agreed that HIV can be transmitted when an infected woman breastfeeds her baby (p<.026) (Table 3).
Table 2. Comparison of the level of academic status of respondents with their views on the possible route of transmission of HIV .
| Highest Academic qualification (%) | p-value | ||||||
| Primary school | Secondary school | First degree | Postgraduate qualification | ||||
| Possible Route of transmission | Use of non-sterile dental instrument | Yes | 7 (41.2) | 29 (67.4) | 87 (78.4) | 35 (85.4) | .002 |
| No | 0 (0) | 2 (4.7) | 0 (0) | 1 (2.4) | |||
| Not sure | 10 (58.8) | 12 (27.9) | 24 (21.6) | 5 (12.2) | |||
| Sharing of drinking cups | Yes | 7 (41.2) | 4 (9.3) | 7 (6.3) | 1 (2.4) | .000 | |
| No | 6 (35.3) | 32 (74.4) | 88 (79.3) | 31 (75.6) | |||
| Not sure | 4 (23.5) | 7 (16.3) | 16 (14.4) | 9 (22.0) | |||
| Sharing of toothbrush | Yes | 13 (76.5) | 25 (58.1) | 76 (68.5) | 32 (78.0) | .192 | |
| No | 3 (17.6) | 10 (23.3) | 14 (12.6) | 2 (4.9) | |||
| Not sure | 1 (5.9) | 8 (18.6) | 21 (18.9) | 7 (17.1) | |||
| Sharing of sharp objects | Yes | 13 (76.5) | 37 (86.0) | 108 (97.3) | 38 (92.7) | .032 | |
| No | 1 (5.9) | 2 (4.7) | 2 (1.8) | 1 (2.4) | |||
| Not sure | 3 (17.6) | 4 (9.3) | 1 (0.9) | 2 (4.9) | |||
| Through Human bite | Yes | 12 (70.6) | 13 (30.2) | 38 (34.2) | 15 (36.6) | .022 | |
| No | 3 (17.6) | 15 (34.9) | 48 (43.2) | 11 (26.8) | |||
| Not sure | 2 (11.8) | 15 (34.9) | 25 (22.5) | 15 (36.6) | |||
| Total | 17 (100) | 43 (100) | 111 (100) | 41 (100) | |||
Table 3. Comparison of the views of respondents concerning possible routes of transmission of HIV with their gender .
| Gender (%) | p-value | ||||
| Male | Female | ||||
| Possible Route of transmission | Blood transfusion | Yes | 89 (93.7) | 117 (100) | .022 |
| No | 3 (3.2) | 0 (0) | |||
| Not sure | 3 (3.2) | 0 (0) | |||
| Sharing of plates/spoons | Yes | 5 (5.3) | 8 (6.8) | .034 | |
| No | 70 (73.7) | 99 (84.6) | |||
| Not sure | 20 (21.1) | 10 (8.5) | |||
| Sharing of toothbrush | Yes | 58 (61.1) | 88 (75.2) | .061 | |
| No | 15 (15.8) | 14 (12.0) | |||
| Not sure | 22 (23.2) | 15 (12.8) | |||
| Through mosquito bites | Yes | 10 (10.5) | 18 (15.4) | .009 | |
| No | 59 (62.1) | 86 (73.5) | |||
| Not sure | 26 (27.4) | 13 (11.1) | |||
| Through breastfeeding | Yes | 50 (52.6) | 82 (70.1) | .026 | |
| No | 17 (17.9) | 16 (13.7) | |||
| Not sure | 28 (29.5) | 19 (16.2) | |||
| Total | 95 (100) | 117 (100) | |||
Over 60% of the respondents will not mind to have HIV screening done, though some of them will prefer not to know the outcome of the investigation. Majority 167/212 (78.4%) of the respondents will like to know the type of investigation being requested for by the physician before they are sent for HIV screening. Respondents had diverse opinions as to their reactions if they get to know that they have been requested to go for HIV screening without receiving pre-text counseling by the requesting medical personnel. Some were of the opinion that they will feel betrayed (81/213) and 52/213 will prefer to be indifferent as to whether or not they were previously properly informed or counseled about the nature of the screening (figure 1).
Figure 1. How respondent would feel if not previously informed of the nature of screening done .
Discussion
There was a good knowledge as to the possibility of transmission of HIV through means such as blood transfusion, sexual transmission and sharing of sharp objects with others, which could have been as a result of widespread campaign about the possible means of transmission of the virus. According to Ogbuji, HIV could be transmitted through unprotected sexual intercourse (93.5%), blood transfussion (98.2%) and use of blade at a saloon (93.5%)6. This agrees with our results in Table 1 that shows that 96.2% agreed that HIV could be transmitted through sexual means, blood transfusion 96.7% and sharing of sharps 92.5%.
Only a few of the respondents (37.1%) agreed that HIV may be transmitted through human bite. Though the issue is controversial, there are several documented reports of cases of possible transmission of the virus through human bites 7-12. There are also contrary reports climing that there is no evidence that HIV can be transmitted through human bite 13-14. Transmission of the virus through human bite is considered to be rare and requiring that there be blood in the saliva of the person that is biting and a break in the skin of the person that is bitten, transmission of HIV through human bites is however, considered to be biologically plausible 7. Despite the seemingly insignificant nature of this route of transmission of the virus, there is the need for public enlightenment as to its possibility, such that people will avoid being bitten and anyone that falls victim of human bite, can seek for prompt medical attention. It is also worthy of note that a few of the respondents still consider that the virus may be transmitted through means such as sharing of cups and plates with infected people. The proportion (6.1%) that agreed that sharing of eating utensils with infected individuals may lead to transmission of the virus is lower than 10.3% reported by Lwelamira et al 15. Some of the respondents claimed that HIV could be transmitted through mosquito bite, but their proportion (13.6%) is lower than that reported by previous studies 16, 17. Maimaiti et al reported that 59.5% of their study population agreed that HIV may be transmitted through mosquito bite 16, while Bamise et al 17 reported 48.2% in their study. Another study among some nurses also reported that 16.2% of the respondents agreed that casual contact with HIV positive individuals may lead to transmission of the virus18. The lower rate recorded in this study could have been as a result of improvement in the knowledge over time as a result of better public enlightenment based on reports by previous studies. The difference could also have been as a result of the differences in the educational background of respondents in the studies as the study by Bamise et al 17 was carried out among secondary school students, while those in this study are mostly university graduates (57.5%). However, it should be noted that there had not been any reported case of such transmission of HIV through mosquito bite and this need to be gotten across to the public in order to reduce stigmatization of those people living with HIV/AIDS.
Sharing of toothbrush was considered to be a possible route of transmission of the virus by 68.5% of the respondents. Although, there had not been any reported case of transmission of the virus through sharing of toothbrush, most toothbrushes are said to be heavily contaminated with microorganisms following use 19-22and there had been reported cases of transient bacteremia following tooth brushing procedure 23-25. This theoretically will increase the possibility of transmission of infectious diseases through the sharing of toothbrush with others. Therefore, the habit of sharing of toothbrush with others should be discouraged as much as possible.
The fact that a greater percentage of the female respondents agreed that breastfeeding could transmit HIV, could have been as a result of their exposure to health talk at the antenatal clinics, which often include HIV counseling and testing 26-28. This difference in the responses based on the sex of the respondents could also have been due to the fact that only women are concerned with breastfeeding of children, with the likelihood of men not showing concern on the possibility of transmission of any infectious disease through breastfeeding.
Limitations of the study: the convenience sampling technique that was used in the selection of respondents that presented at the dental clinic may not be a good reflection of what obtains in the general public. This is because majority of those presenting in the clinic may have better health-seeking behavior than that of the general populace.
Conclusions
In conclusion, the respondents had reasonable knowledge of possible routes of transmission of HIV, but there were a lot of misconceptions, which needed to be addressed in order to reduce the spate of social stigmatization of those living with HIV/AIDS, and thus encourage individuals to go for voluntary counseling and testing.
Footnotes
Competing Interests: The authors have declared that no competing interests exist.
Grant support: None
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