Attitudes, knowledge, and practices of Turkish dentists regarding HIV/AIDS: a cross-sectional study

Abstract

Background

HIV/AIDS remains a global public health concern with considerable amounts of stigma impacting patient care. Dentists, as primary care providers, play a crucial role in providing healthcare to people living with HIV (PLWH). However, there are gaps in knowledge and attitudes among dentists regarding HIV/AIDS, resulting in discrimination and barriers to care.

Methods

This national cross-sectional study assessed the knowledge and attitudes of Turkish dentists toward HIV/AIDS using an adapted and validated questionnaire. The questionnaire included sections on discriminatory attitudes and behaviors, scientific knowledge regarding HIV/AIDS, and infection control practices. Data were collected from November to December 2024 via an online survey distributed by the Turkish Dental Association. The target sample size was 381 participants, and 383 were included in the study. Since all eligible participants were enrolled, a response rate is not applicable. In total, the data from 383 dentists were analyzed using descriptive and inferential statistics.

Results

Among participants, 43.6% reported hesitation to treat PLWH due to fear or insufficient training. Dentists in the private sector were more likely to express hesitation than those in the public sector (OR = 2.05, p = 0.002). Knowledge gaps were evident: 41.5% were unaware of the HIV window period, with dentists unaware of this period significantly more likely to work in the private sector (OR = 2.15, p = 0.001). Female dentists were more likely to state the importance of knowing a patient’s HIV status (OR = 0.42, p = 0.004), while male dentists more often reported patient inquiries about infection control (OR = 1.62, p = 0.032).

Conclusions

Despite generally good adherence to infection control protocols, significant gaps in knowledge and attitudes persist among Turkish dentists. Findings from multivariate analyses underscore that sector of employment and gender significantly influence dentists’ attitudes and knowledge regarding HIV/AIDS. Targeted educational interventions are needed to reduce stigma and improve the quality of dental care for PLWH.

Background

Globally, HIV/AIDS remains a major public health concern. The 95–95–95 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) provide an important roadmap for ending the HIV pandemic. These targets call for 95% of people living with HIV (PLWH) to know their status, to have access to antiretroviral treatment, and of people receiving treatment to achieve viral suppression [1]. These efforts have been complemented by a recent target, the “fourth 95” target, added by UNAIDS, which focuses on quality of life (QoL) [2]. Furthermore, zero new HIV infections, HIV-related deaths, and HIV-related discrimination cases, which are crucial for eliminating the barriers faced by PLWH in accessing health care services, are the targets set by the World Health Organization for 2030 [3]. Stigma and discrimination greatly undermine efforts to end the HIV epidemic and negatively impact the QoL of PLWH.

A report published by the European Center for Disease Prevention and Control highlighted the challenges of HIV-related stigma and discrimination in healthcare settings [4]. This report revealed significant deficits in the knowledge, attitudes, and behaviors of healthcare professionals, particularly dentists, toward PLWH. Dentists play a critical role in providing care to PLWH; however, challenges related to stigma and discrimination in dental services limit the access of PLWH to quality health care [5, 6]. Recent studies conducted among dentists have reported a low level of awareness regarding HIV/AIDS, which negatively affects patient care [7, 8]. Additionally, fear of providing health services to PLWH, discrimination, lack of education, and misinformation regarding HIV/AIDS reinforce these attitudes [9, 10].

The violations of rights experienced by PLWH because of stigma and discrimination in health services were highlighted in the 2023 report by Pozitif-İz association, a nongovernmental organization in Türkiye. This report emphasized that the lack of knowledge and negative attitudes toward PLWH are predominant in the services provided by dentists. The challenges identified in dentists’ attitudes toward PLWH limited PLWH’s access to healthcare and created a barrier to HIV/AIDS awareness in general [11].

To the best of our knowledge, there are limited studies on the knowledge and attitudes of dentists regarding HIV/AIDS in Türkiye, implying that more research is needed to improve the healthcare services provided to PLWH. Thus, the current study assessed the knowledge and attitudes of dentists toward HIV/AIDS.

Methods

Participants and data collection process

This cross-sectional study was conducted as a national survey to evaluate the knowledge and attitudes of dentists regarding HIV/AIDS in Türkiye. Data were collected using an online questionnaire created using Google Forms from November 6 to December 29 2024.

The questionnaire was adapted from a previously validated study entitled “Attitudes and practices of dentists treating PLWH in the era of new antiretroviral therapy: A 12-year update” by Giuliani et al. after obtaining their permission [7]. The original study’s questionnaire was structured into three main sections: (1) discriminatory attitudes and behaviors (16 questions), (2) scientific knowledge regarding HIV/AIDS (5 questions), and (3) precautions to prevent transmission of infection (12 questions). During the adaptation process, the questionnaire was translated into Turkish using the forward and backward translation method to ensure linguistic and conceptual equivalence. The final version of the questionnaire was reviewed by a panel of eight experts in dentistry, infectious diseases, and epidemiology to ensure clarity and cultural relevance, which resulted in minor modifications for better comprehensibility. The original questionnaire mainly focused on attitudes and practices. We adapted it to explicitly assess scientific knowledge related to HIV/AIDS through linguistic refinements and clearer categorization, without adding any new questions.

• Section 1: Attitudes and Experiences of Dentists Regarding the Treatment of People Living with HIV.

• Section 2: Knowledge of Dentists about HIV Transmission and Epidemiology.

• Section 3: Infection Control and Precautionary Practices Among Dentists in Clinical Settings.

To ensure participation from dentists across the country, the Turkish Dental Association (Türk Diş Hekimleri Birliği) distributed the survey link to their members via email and official professional social media groups.

Sample size

The required sample size was calculated assuming a 50% prevalence rate, with a 95% confidence level. Based on this assumption, a minimum of 381 participants was deemed necessary to achieve adequate statistical power. According to 2024 data from the Turkish Dental Association, there are 46,378 registered dentists in Turkey. To ensure regional representation, participants were proportionally distributed across different regions, and a total of 383 dentists were included in the final sample.

To avoid an unnecessarily large sample—which could result in overpowered results and statistically significant yet practically irrelevant findings—the survey was closed once the targeted sample size was reached. Since the sample size was achieved and no additional participants were recruited, a response rate per se is not applicable.

Selection of study participants

Participation in the study was entirely voluntary. Completion of the questionnaire was considered to imply informed consent. To maintain anonymity, no personal identifiers were collected, and the estimated time to complete the survey was approximately 10 min.

Participants were recruited through an online survey disseminated by the Turkish Dental Association via email and official professional social media groups. Recruitment followed a regionally stratified sampling approach, based on dentist population data, to ensure geographic representativeness and to minimize the risk of selection bias. Although random sampling was not employed, regional proportionality was preserved throughout the recruitment process.

Ethical considerations

This study was approved by the Ethics Committee of Tepecik Training Hospital (approval date/number: 04.12.2024/11 − 01), and the hospital administration supervised the recruitment of participants.

Statistical analyses

Statistical analyses were performed using IBM SPSS Statistics version 28.0 (Chicago, IL, USA). Continuous variables were assessed for normality and analyzed using appropriate statistical tests. Categorical variables were presented as frequencies and percentages and compared using chi-square or Fisher’s exact test where applicable. A p-value of ≤ 0.05 was considered statistically significant.

Multivariate analyses were conducted to control for potential confounding variables. Logistic regression analysis was performed for the categorical dependent variables to evaluate the association between independent variables and outcomes. Additionally, linear regression was used for age because it is a continuous dependent variable. Although some independent variables are binary, linear regression can handle both continuous and categorical predictors. Model assumptions were checked to ensure validity.

Reliability analysis

The Cronbach’s Alpha coefficients for Sects. 1 and 3 were 0.563 and 0.517, respectively. These relatively low values may be partly attributable to the binary (dichotomous) response format of the items, which limits variance and can reduce internal consistency estimates.

Results

The study group consisted of 55.4% women (n = 212) and 44.6% men (n = 171). The mean age of the participants was 36.65 ± 11.23 years (range: 24–71), and the mean duration of work experience was 12.54 ± 11.62 years (range: 1–47). A total of 68.7% (n = 263) of the participants were graduates of dental faculties, while 31.3% (n = 120) had received postgraduate education. The distribution of the work settings of participants shows that 40.2% (n = 154) work in the public sector, while 59.8% (n = 229) work in the private sector. Furthermore, 78.1% (n = 299) of the group reported working in urban centers, whereas 21.9% (n = 84) worked outside urban areas.

The distribution of responses to the 16 questions in the distributions of responses in the “Attitudes and Experiences of Dentists Regarding the Treatment of People Living with HIV” section is summarized in Table 1.

Table 1.

Distributions of responses in the “attitudes and experiences of dentists regarding the treatment of people living with HIV” section

1) What is your experience in treating PLWH?	High: 14 (3.7%) Moderate: 36 (9.4%) Low: 165 (43.1%) None: 168 (43.9%)
2) Have you ever hesitated to treat PLWH due to their HIV or AIDS status?	Yes: 167 (43.6%) No: 216 (56.4%)
3) If you answered “Yes” to question 2, please specify the main reason. n: 167 (43.6%)	Feared getting infected: 93 (24.3%) Did not receive specialized training in HIV: 27 (7.0%) Feared transmitting infection to other patients: 22 (5.7%) Feared losing patients if it became known that I treated PLWH: 15 (3.9%) Feared infecting my staff: 10 (2.6%)
4) If you answered “Yes” to question 2, how do you usually inform the PLWH about the procedures you could not perform? n: 167 (43.6%)	Refer to specialized center: 41 (10.7%) Missing equipment: 37 (9.7%) Lack of specialized training: 36 (9.4%) Other reasons: 24 (6.3%) Refer to colleague: 20 (5.2%) Don’t treat PLWH: 9 (2.3%)
5) How concerned are you about treating PLWH?	Completely scared: 18 (4.7%) Highly: 91 (23.8%) Moderately: 121 (31.6%) Slightly: 96 (25.1%) Not concerned: 57 (14.9%)
6) Do you think it is an appropriate approach not to treat a PLWH?	Yes: 43 (11.2%) No: 340 (88.8%)
7) If you answered “Yes” to question 6, why do you think it is correct not to treat PLWH? n: 43 (11.2%)	Fear of infection: 21 (5.5%) Lack of special HIV training: 8 (2.1%) Fear of losing patients due to treatment disclosure: 5 (1.3%) Fear of infecting staff: 4 (1.0%) Fear of infecting other patients: 4 (1.0%) Belief that PLWH are unreliable: 1 (0.3%)
8) What type of treatment have you administered to PLWH?	Never treated a PLWH: 166 (43.3%) All treatments: 99 (25.8%) Operative dentistry: 48 (12.5%) Oral surgery: 25 (6.5%) Orthodontics: 19 (5.0%) Periodontology: 14 (3.7%) Prosthetics: 12 (3.1%)
9) How do you typically recognize when you encounter PLWH?	Reported in medical history: 340 (88.8%) Suspected in oropharyngeal exam: 31 (8.1%) Recognized by appearance: 12 (3.1%)
10) Do you think it is necessary to know if a person seeking to get treated is PLWH?	Yes: 318 (83.0%) No: 65 (17.0%)
11) Do you think it is necessary to take special precautions in addition to standard precautions when treating PLWH?	Yes: 298 (77.8%) No: 85 (22.2%)
12) Do you consider all your patients as people with potential infectious diseases, such as HIV and Hepatitis B/C, for the purpose of preventing the spread of infections?	Yes: 286 (74.7%) No: 97 (25.3%)
13) Do you think that PLWH should be charged a different fee?	Yes: 68 (17.8%) No: 315 (82.2%)
14) Have your patients ever asked you whether you treat PLWH?	Yes: 103 (26.9%) No: 280 (73.1%)
15) Have your patients ever asked what procedures you follow to prevent infectious diseases in your practice?	Yes: 161 (42.0%) No: 222 (58.0%)
16) Do you think treating a PLWH is more stressful?	Yes: 322 (84.1%) No: 61 (15.9%)

The total number of respondents for each question is 383, unless otherwise specified

Table 2 presents knowledge of dentists about HIV transmission and epidemiology. As seen in the table, the majority of participants believe they have sufficient scientific knowledge about HIV, with 57.7% answering “Yes” to the first question. The sources of their knowledge vary, with most citing their university education (68.7%) as the primary source. When asked about the most common route of HIV transmission, a significant majority (91.4%) identified the parenteral route, including sexual transmission. Additionally, 58.5% of dentists were familiar with the concept of the window period, and among them, the majority (30.0%) believed it lasts between 0 and 40 days.

Table 2.

Knowledge of dentists about HIV transmission and epidemiology

1) Do you think you have sufficient scientific knowledge about HIV and its transmission?	Yes: 221 (57.7%) No: 162 (42.3%)
2) How did you acquire your knowledge about HIV?	University: 263 (68.7%) Internet: 55 (14.4%) Professional association courses: 20 (5.2%) Books: 18 (4.7%) Colleagues: 12 (3.1%) Distance learning: 9 (2.3%) Journals: 6 (1.6%)
3) What do you think is the most common route of transmission for HIV?	Parenteral (including sexual route): 350 (91.4%) Orofecal route: 19 (5.0%) Saliva route: 14 (3.7%)
4) Have you heard of the window period before?	Yes: 224 (58.5%) No: 159 (41.5%)
5) If you answered “Yes” to the previous question, do you know how many days the window period lasts? n: 224 (58,5%)	0–40 days: 115 (30.0%) 40–120 days: 83 (21.7%) 120–365 days: 26 (6.8%)

The total number of respondents for each question is 383, unless otherwise specified

Table 3 presents the infection control and precautionary practices among dentists in clinical settings. The majority of dentists reported using gloves (99.5%, n = 381) and surgical masks (92.7%, n = 355). Protective glasses were used by 74.9% (n = 287), while 72.1% (n = 276) reported using a surgical vacuum. Protective face shields were used by 75.7% (n = 290), and 97.9% (n = 375) reported packaging dental instruments. The majority also indicated that they change gloves between patients (98.2%, n = 376) and wash their hands between patients (93.7%, n = 359). Almost all dentists reported washing instruments before sterilization (99.0%, n = 379), and 93.2% (n = 357) sterilize all instruments. Additionally, 97.4% (n = 373) use sterilized instruments for each patient, while 36.8% (n = 141) have a waterline disinfection system in their dental units. Double gloves are used when treating PLWH by 81.2% (n = 311), and 70.0% (n = 268) believe post-exposure prophylaxis is possible following potential HIV exposure.

Table 3.

Infection control and precautionary practices among dentists in clinical settings

Question	Yes (n, %)	No (n, %)
1) Do you use gloves?	381 (99.5%)	2 (0.5%)
2) Do you use a surgical mask?	355 (92.7%)	28 (7.3%)
3) Do you use protective glasses?	287 (74.9%)	96 (25.1%)
4) Do you use a surgical vacuum?	276 (72.1%)	107 (27.9%)
5) Do you use a protective face shield?	290 (75.7%)	93 (24.3%)
6) Do you package dental instruments?	375 (97.9%)	8 (2.1%)
7) Do you change gloves between patients?	376 (98.2%)	7 (1.8%)
8) Do you wash your hands between patients?	359 (93.7%)	24 (6.3%)
9) Do you wash instruments before sterilization?	379 (99.0%)	4 (1.0%)
10) Do you sterilize all instruments?	357 (93.2%)	26 (6.8%)
11) Do you use sterilized instruments for each patient?	373 (97.4%)	10 (2.6%)
12) Do you have a waterline disinfection system in your dental unit?	141 (36.8%)	242 (63.2%)
13) Do you use double gloves when treating PLWH?	311 (81.2%)	72 (18.8%)
14) Do you believe postexposure prophylaxis is possible after potential HIV exposure?	268 (70.0%)	115 (30.0%)

The total number of respondents for each item was 383

Analysis

Sex

Prior to conducting the multivariate logistic regression analysis, univariate analyses were performed to identify variables significantly associated with sex (male = 1), (female = 0). Variables that showed statistically significant associations in the bivariate analyses were subsequently included in the multivariate logistic regression model. According to the regression results, dentists who stated that “it is necessary to know whether a patient is PLWH” were significantly more likely to be female (OR = 0.42, 95% CI: 0.24–0.76, p = 0.004). In contrast, participants who reported being asked by patients about infection prevention procedures were more likely to be male (OR = 1.62, 95% CI: 1.04–2.51, p = 0.032). No other variables in the model showed a statistically significant association with gender (p > 0.05) (Table 4).

Table 4.

Multivariate logistic regression predicting gender

Variable	B	SE	OR	95% CI for OR	p Value
Question 1.10 (Ref: No)	−0.857	0.296	0.42	0.24–0.76	0.004
Question 1.15 (Ref: No)	0.482	0.224	1.62	1.04–2.51	0.032
Non-significant variables (ns): Questions:1.1, 1.2, 1.6, 1.13, 1.14, 3.10	ns	—	—	—	> 0.05

Gender coded as: Male = 1, Female = 0. Variables included in the model were selected based on univariate analyses (p < 0.05). Question 1.10:"Do you think it is necessary to know if a person seeking to get treated is PLWH?” (reference category = No). Question 1.15:"Have your patients ever asked what procedures you follow to prevent infectious diseases in your practice?” (reference category = No). Only statistically significant variables are shown in detail; non-significant (ns) variables included but not shown in the table were Questions 1.1, 1.2, 1.6, 1.13, 1.14, and 3.10

Education

Variables that were significant in the univariate analyses were included in a multivariate logistic regression model. The dependent variable in the model was dentists’ specialty status (general dentist = 1, specialist dentist = 0). The analysis showed that dentists who reported never having treated PLWH were significantly more likely to be general dentists (OR = 1.76, p = 0.022). Conversely, dentists who believed that special precautions beyond standard measures are necessary when treating PLWH were more likely to be specialists (OR = 0.55, p = 0.046). Additionally, dentists who reported that their patients had asked about the infection control procedures they follow were significantly more likely to be general dentists (OR = 1.85, p = 0.011) (Table 5).

Table 5.

Multivariate logistic regression analysis based on dental education level

Variable	B	SE	OR	95% CI for OR	p Value
Question 1.8 (Ref: Other treatment)	0.568	0.248	1.76	1.08–2.87	0.022
Question 1.11 (Ref: No)	−0.592	0.296	0.55	0.31–0.99	0.046
Question 1.15 (Ref: No)	0.613	0.240	1.85	1.15–2.95	0.011
Non-significant variables (ns): (Questions:1.1, 3.3)	ns	—	—	—	> 0.05

Education level coded as: General dentist = 1, Specialist = 0. Variables significant in univariate analyses (p < 0.05) were included in the multivariate logistic regression model. Question 1.8:"What type of treatment have you administered to PLWH?” (reference category = Other treatment). Question 1.11:"Do you think it is necessary to take special precautions in addition to standard precautions when treating PLWH?” (reference category = No). Question 1.15:"Have your patients ever asked what procedures you follow to prevent infectious diseases in your practice?” (reference category = No). Only statistically significant variables are shown in detail; non-significant variables included but not shown were Questions 1.1 and 3.3

Sector

Univariate analyses were first conducted to identify variables significantly associated with dentists’ sector of employment (public vs. private). Variables that showed statistical significance were then included in a multivariate logistic regression model, with the dependent variable defined as sector (private sector = 1, public sector = 0). Multivariate logistic regression analysis revealed that dentists who reported hesitation to treat PLWH had more than twice the odds of working in the private sector (OR = 2.05, p = 0.002). Conversely, dentists lacking sufficient scientific knowledge about HIV were more commonly employed in the public sector (OR = 0.51, p = 0.005). Dentists unaware of the HIV window period were more likely to work in the private sector (OR = 2.15, p = 0.001). Regarding infection control practices, not using surgical vacuum devices was associated with working in the public sector (OR = 0.54, p = 0.014), while not using protective glasses was more common among private sector dentists (OR = 2.40, p = 0.002) (Table 6).

Table 6.

Multivariate logistic regression predicting working sector

Variable	B	SE	OR	95% CI for OR	p Value
Question 1.2 (Ref: No)	0.719	0.229	2.053	1.311–3.214	0.002
Question 2.1 (Ref: Yes)	−0.681	0.242	0.506	0.315–0.813	0.005
Question 2.4 (Ref: Yes)	0.766	0.240	2.151	1.343–3.446	0.001
Question 3.4 (Ref: Yes)	−0.626	0.255	0.535	0.324–0.882	0.014
Question 3.5 (Ref: Yes)	0.875	0.278	2.400	1.391–4.141	0.002
Non-significant variables (ns): Question 1.15 (Ref: No)	Ns	-	-	-	> 0.05

Working sector coded as Private = 1, Public = 0. Variables included in the model were selected based on univariate analyses (p < 0.05). Question 1.2:"Have you ever hesitated to treat PLWH due to their HIV or AIDS status?” (reference category = No). Question 2.1: “Do you think you have sufficient scientific knowledge about HIV and its transmission?” (reference category = Yes). Question 2.4: “Are you aware of the HIV window period?” (reference category = Yes). Question 3.4:"Do you use surgical vacuum?” (reference category = Yes). Question 3.5:"Do you use a protective face shield?” (reference category = Yes). Only statistically significant variables are shown in detail; the non-significant variable included but not shown in the table was Question 1.15

Age

Univariate analyses were initially conducted to explore relationships between individual variables and participants’ age. Subsequently, a multiple linear regression analysis was performed to identify independent factors associated with age. Younger dentists were more likely to report feeling sufficiently knowledgeable about HIV and its transmission (p = 0.030), and less likely to use surgical vacuum systems in clinical settings (p = 0.005). Conversely, older dentists were more likely to have heard of the HIV window period (p < 0.001), to use protective face shields (p = 0.023), and to believe in the possibility of post-exposure prophylaxis following potential HIV exposure (p = 0.002) (Table 7).

Table 7.

Multiple linear regression predicting age

Variable	B	SE	β (Beta)	t	p Value
Question 2.1	−2.54	1.17	−0.11	−2.18	0.030
Question 2.4	5.13	1.15	0.23	4.48	< 0.001
Question 3.4	−3.54	1.25	−0.14	−2.84	0.005
Question 3.5	2.89	1.26	0.11	2.28	0.023
Question 3.14	3.74	1.19	0.15	3.16	0.002
Non-significant variables (ns): Questions 1.2, 1.5, 1.12, 1.16, 3.2, 3.10	ns	-	-	-	> 0.05

Univariate analyses were initially conducted to explore relationships between individual variables and participants’ age. Variables significant in univariate analyses (p < 0.05) were included in the multiple linear regression model. Question 2.1:"Do you think you have sufficient scientific knowledge about HIV and its transmission?” Question 2.4:"Have you heard of the window period before?” Question 3.4: “Do you use surgical vacuum?” Question 3.5: “Do you use protective face shield?” Question 3.14:"Do you believe postexposure prophylaxis is possible after potential HIV exposure?” Only statistically significant variables are shown; non-significant variables included but not detailed were Questions 1.2, 1.5, 1.12, 1.16, 3.2, and 3.10

Discussion

The findings of this study reveal significant gaps in the knowledge, attitudes, and practices of dentists regarding HIV/AIDS in Türkiye. These gaps are particularly concerning given the pivotal role dentists play in providing inclusive and comprehensive care. Despite decades of educational advancements and global widespread of awareness campaigns, this study underscores the persistence of stigma and misinformation in healthcare settings. Many dentists, as shown in this study, continue to harbor misconceptions about HIV/AIDS transmission and adopt practices that may inadvertently stigmatize PLWH. These results suggest the need for targeted educational initiatives and policy adjustments to bridge the disparities and guarantee equal care for all patients in line with universal health coverage and human right principles. These findings are consistent with international studies, highlighting the widespread stigma and educational shortcomings among healthcare professionals on a global scale [12–15].

Sex-based differences

This study uncovered significant differences in attitudes and practices based on sex. Female dentists were significantly more likely to express the importance of knowing a patient’s HIV status, while male dentists more frequently reported patient inquiries regarding infection control procedures. These findings may suggest gendered differences in communication styles and perceptions of occupational risk, consistent with previous literature noting that female healthcare providers often report higher sensitivity to infection-related anxieties [16]. These findings are consistent with those of studies conducted in Brazil and Jordan, which has demonstrated that sex significantly influences the perception and handling of PLWH [15, 17].

Educational gaps and their impact

Education emerged as a critical determinant of dentists’ practices. Specialist dentists exhibited greater confidence and provided a wider range of treatments than general practitioners, underscoring the need for targeted educational programs that address the unique challenges of treating PLWH. On the other hand, general dentists were more likely to report never having treated an PLWH and to be asked about infection control by their patients. Conversely, specialists were more inclined to believe that special precautions beyond standard measures are required when managing PLWH. These distinctions might reflect differing clinical exposures or perceived medicolegal responsibilities between generalists and specialists. They also raise concerns about possible over-precautionary attitudes, which can contribute to stigmatization. International studies, including studies from Croatia and India, support the role of comprehensive training in improving healthcare providers’ attitudes and reducing stigma [13–15].

Notably, educational interventions targeting dentists have also been demonstrated to increase adherence to infection control protocols, reducing unnecessary practices, such as “double-gloving,” which may stigmatize patients [18]. However, these interventions must be tailored to address region-specific challenges. For instance, in Türkiye, integrating HIV/AIDS-focused modules into dental education curricula and offering hands-on workshops can bridge the knowledge gaps identified in this study. Furthermore, fostering collaboration between academic institutions and professional dental organizations can provide up-to-date information to dentists and train them for managing PLWH.

The contribution of continuing professional education cannot be overstated. Specifically, regular training sessions for practicing dentists, similar to those found in Brazil and the UK, can help correct misconceptions about HIV/AIDS transmission and enhance their attitudes toward treatment [19]– [20]. These sessions should also focus on ethical issues, aiming to eradicate stigma and discrimination in dental care. Additionally, establishing mentorship programs, wherein experienced practitioners guide younger dentists, can increase the confidence of younger dentists in effectively managing PLWH.

Sector-based variations

Dentists working public sector were less hesitant to treat PLWH compared with their counterparts in private sector. This disparity can be attributed to differences in institutional policies and resource availability. Public institutions often provide regular training sessions and enforce standardized infection control protocols, which may enhance dentists’ confidence in treating high-risk patients. Conversely, the private sector focuses on client retention; however, resource constraints in this sector may hinder the adoption of such measures.

Similar findings were reported in a European study, where public sector dentists demonstrated higher adherence to infection control protocols and were more likely to undergo regular training than private sector dentists [4]. However, this study also highlighted significant stress levels among public and private sector dentists when treating PLWH. To address this issue, harmonized policies that promote uniform training and support systems across sectors are needed.

Furthermore, public sector dentists exhibited gaps in implementing certain infection control measures, such as the use of surgical vacuum systems. These findings resource disparities between the two sectors were evident in this study. For instance, private sector dentists reported more frequent use of advanced tools, such as surgical suction, whereas public sector practitioners relied more on protective face shields. These variations highlight the need for resource standardization to ensure equitable care for PLWH. Therefore, policy interventions should aim to bridge these gaps by allocating funds for equipment upgrades and training programs, especially in under-resourced settings [21, 22].

Stigma-reduction initiatives should be integrated into both sectors. Workshops and seminars focusing on the human rights of PLWH and the importance of inclusive healthcare can transform the attitudes of dental professionals, ultimately improving patient outcomes [18]. Furthermore, collaborative efforts among government bodies, nongovernmental organizations, and professional associations are critical for achieving these goals.

Age and experience

Age-related trends also emerged. Younger dentists demonstrated greater confidence in their HIV-related knowledge, whereas older dentists showed higher awareness of the window period and were more likely to adopt advanced protective practices such as face shields and post-exposure prophylaxis. This generational divide may reflect curricular improvements in recent years but also highlights the potential value of experience in influencing protective behavior [23]. These findings aligned with studies conducted in Israel and the UK, which emphasized the role of experience in mitigating fears and improving clinical practices [12, 19, 24]. Additionally, reducing stigma through targeted education can boost confidence among younger practitioners, helping to address these disparities [25].

Implications for dental education and policy

Our findings emphasize the urgent need for comprehensive changes in dental education and policies. Integrating robust HIV/AIDS-related training into dental curricula is crucial. Moreover, this training should address common misconceptions about HIV/AIDS transmission, encourage ethical and nondiscriminatory practices, and improve familiarity with postexposure prophylaxis protocols to ensure that healthcare providers are adequately prepared to manage the needs of PLWH effectively.

Regular education and training sessions for practicing dentists, as implemented in many countries, have proven to be effective in reducing stigma and improving patient care [17, 26]. Standardizing infection control guidelines across sectors can help bridge the gaps observed between public and private sector dentists [4, 27]. Moreover, evidence suggests that focusing on practical measures, such as stigma-reduction workshops, can improve patient experiences and clinical outcomes [25].

Limitations

This study has several limitations that warrant consideration. First, the use of self-reported data may have introduced response bias, particularly regarding socially sensitive topics such as attitudes and practices toward PLWH. Second, due to the nature of online data collection, the sampling strategy relied on convenience sampling within regionally stratified quotas. Although we aimed to ensure geographic representation aligned with national dentist distributions, the absence of random sampling limits the generalizability of the findings and introduces potential selection bias. Additionally, the response rate could not be calculated precisely, as the survey was closed upon reaching the predetermined sample size. While this approach helped avoid inflating the sample and the risk of overpowered significance, it may have affected the representativeness of the broader dentist population.

Finally, the cross-sectional design precludes causal inference and limits our ability to evaluate changes in knowledge, attitudes, and practices over time. Future studies should adopt longitudinal designs and include qualitative methods—such as in-depth interviews with PLWH and dentists—to explore the impact of stigma-reduction interventions and better understand the lived experiences of both providers and patients. Given these methodological constraints, the findings should be interpreted with caution.

Conclusion

Taken together, these findings suggest that while general knowledge and protective practices are satisfactory among Turkish dentists, critical gaps persist, particularly related to advanced concepts like the window period and post-exposure protocols. Sociodemographic and professional characteristics such as gender, age, specialty status, and sector of employment significantly shape dentists’ knowledge and behavior. Addressing these disparities through targeted, evidence-based training programs and institutional support is essential for improving HIV-related care and reducing stigma in dental settings.

Abbreviations

PLWH

Antiretroviral therapy: people living with HIV

QoL

Quality of life

UNAIDS

Joint United Nations Programme on HIV/AIDS

Authors’ contributions

All authors have read and agreed to the published version of the manuscript. A.I., O.I., and S.S. conceptualized the study. Methodology was developed by A.I., V.Z.S., A.S., and G.A.D. Data collection and processing were performed by A.I., S.S., V.Z.S., and O.I. Literature search was conducted by A.I., V.Z.S., S.S. Validation was carried out by A.I., O.I., V.Z.S., and P.H. Visualization tasks were handled by A.I., V.Z.S., and G.A.D. Supervision was provided by A.S., P.H., and G.A.D. All authors reviewed and edited the manuscript.

Funding

This research received no external funding.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The research received ethical approval from the Ethics Committee of Tepecik Training Hospital (approval date/number: 04.12.2024/11 − 01) and the hospital administration overseeing the recruitment of participants. This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants electronically provided informed consent before their inclusion in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.