Knowledge, Attitude, and Behavior in

Managing Patients with HIV/AIDS Among

a Group of Indian Dental Students
Ashish Aggarwal, M.D.S.; Sunil R. Panat, M.D.S.
Abstract: With increasing numbers of people with HIV/AIDS receiving oral dental care, dentists should have sufficient knowledge of the disease, and their attitude should meet professional expectations. HIV and AIDS-related knowledge among dental
students provides a crucial foundation for efforts aimed at developing appropriate education on these topics. Accordingly, the
aim of this study was to assess the HIV/AIDS-related knowledge and attitudes amongst the 460 dental students of the Institute
of Dental Sciences, Bareilly (UP), India. A self-administered survey consisting of fifty-three structured questions was conducted
with the students. Overall, the response rate was 79.7 percent. The total mean knowledge and attitudes scores were 78.8 percent
(excellent) and 77.7 percent (positive). There was no statistically significant difference between the knowledge and attitude scores
of males and females. Regarding oral manifestations, Kaposis sarcoma and candidiasis were the most identified. The results
indicated that the students knowledge on HIV/AIDS generally increased as they progressed through the curriculum, but their
utilization of all barrier techniques for infection control and clinical protocol lacked consistency and compliance. Hence, there is
a need to address, more clearly, the students misconceptions and attitudes towards the disease.
Dr. Aggarwal is Senior Lecturer, Department of Oral Medicine and Radiology, Institute of Dental Sciences, Bareilly, Uttar
Pradesh, India; and Dr. Panat is Professor and Head, Department of Oral Medicine and Radiology, Institute of Dental Sciences,
Bareilly, Uttar Pradesh, India. Direct correspondence and requests for reprints to Dr. Ashish Aggarwal, Department of Oral
Medicine and Radiology, Institute of Dental Sciences, Pilibhit Bypass Road, Bareilly, Uttar Pradesh, India 243006;
drashishagg@rediffmail.com.
Keywords: dental education, clinical education, dental students, HIV/AIDS, India
Submitted for publication 10/5/11; accepted 9/21/12

IV/AIDS (Human Immunodeficiency Virus/

Acquired Immunodeficiency Syndrome) has
profoundly affected every aspect of health
care. The first case of HIV was recognized in the
United States in 1981 and has since been diagnosed
in populations around the world.1 Statistics from the
Joint United Nations Program on HIV/AIDS and the
World Health Organization published in December
2009 estimated that the number of people living with
HIV in the world totaled 33.4 million. An estimated
2.7 million people were said to be newly infected
with HIV, and an estimated two million had lost
their lives to AIDS. It has been estimated that more
than 40 million people between the ages of fifteen
and twenty-four will have contracted HIV by the
year 2020.2
In 2009, it was estimated that 2.4 million people
were living with HIV in India, which equates to a
prevalence of 0.3 percent.3While this percentage may
seem low, because Indias population is so large, it
represents the third greatest number of people living
with HIV in the world.4 However, the estimated number of people diagnosed with new HIV infections in
India has declined drastically in recent yearsfrom
5.5 million in 2005 to below 2.5 million in 2007.5
September 2013 Journal of Dental Education

According to the United Nations 2011 AIDS report,

there has been a 50 percent decline in the number
of new HIV infections in the last ten years in India.3
As people are diagnosed with HIV and live longer
lives due to the success of antiretroviral therapies,
these patients will require increasingly competent
and compassionate health care services, including
oral health care.6
Since 1988, the World Health Organization
has stated that all dentists should treat HIV-positive
patients.7 Despite these recommendations, ignorance
of the risk of HIV transmission during dental procedures has led many dentists around the world to
refuse and/or become reluctant to treat patients with
HIV/AIDS.8-10 As recently as 2007, researchers in
countries like South Africa, Brazil, Japan, and Sudan have found that dental students had insufficient
knowledge about HIV/AIDS-related information and
management of patients with HIV/AIDS, particularly
in relation to transmission.7,11-13
Despite the importance of oral health care
for people living with HIV/AIDS, many of these
individuals fail to receive adequate oral health care
treatment. This is particularly important in developing countries like India where patients with HIV/

1209

AIDS do not receive adequate professional oral care

due to financial barriers as many such patients live
at or below the poverty level. In India, as elsewhere,
people living with HIV face stigma and discrimination in a variety of contexts. Research in India has
shown that stigma and discrimination against HIVpositive people and those perceived to be infected
are common in hospitals and act as barriers to their
seeking and receiving critical treatment and care
services.14 Considerations concerning the safety of
oral health care providers treating patients with HIV
and other infectious communicable diseases make it
imperative to educate students optimally about these
patients and all aspects of their treatment, including
infection control.9
Data on oral health care needs of people with
HIV should alert dental educators regarding the
importance of including these issues in dental and
dental hygiene curricula.15,16 It is not surprising that
the Institute of Medicine report on the future of dental
education also stressed the significance of preparing future oral health care providers to effectively
deliver care for diverse and underserved patient
populations.17
The Institute of Dental Sciences at Bareilly,
India, provides a five-year training program for
about 500 students (100 students per year), in which
students are taught basic biomedical science subjects
in the first two years and clinical subjects in years
three and four. In the second year, students acquire
knowledge regarding HIV in the subjects of General
Pathology and Microbiology. In the third year, the
subject of Oral Pathology gives them a greater insight
regarding the oral manifestations of HIV. In the fourth
year, these students are taught regarding dental considerations and precautions to be taken with patients
with HIV/AIDS in the subjects of Oral Medicine
and Oral Surgery. The fifth year consists of clinical
rotations in dental specialty departments. Thus, the
students are given a solid theoretical background
about the manifestations, modes of transmission,
diagnosing, and treatment of infectious diseases such
as HIV and Hepatitis.
Willingness, however, to treat patients with
HIV/AIDS among dental students appears to be related to their knowledge of the disease, recognition
of oral manifestations, and understanding the modes
of transmission.18 Appropriate knowledge may also
instill confidence in students about their own ability
to manage patients with HIV.19 Thus, gaining insight
into students knowledge about HIV/AIDS and their
attitudes regarding how to effectively manage pa-

1210

tients with HIV/AIDS is essential in assessing the

adequacy of HIV/AIDS education in curricula.6
Studies have been published on the knowledge
and attitude of Indian dental students towards HIV/
AIDS. Jain et al.20 reported that the overall knowledge
and attitude among dental students in their study was
found to be satisfactory, with 69.80 percent having
a positive attitude regarding HIV/AIDS education.
Shan et al.21 also concluded that a group of students
knowledge and attitude perspectives were both moderately adequate. There was still a need for higher
levels of knowledge as only three-quarters of those
students were knowledgeable, and the remaining
one-quarter needed additional education and practice
with patients who are HIV-positive. Also, certain
items like transmission through saliva were not well
understood by students in the previous studies.
Our study was designed to assess whether the
dental students at our institute have sufficient knowledge of HIV/AIDS and its transmission. Also, we
planned to evaluate the attitudes of the students about
related issues such as infection control regulations,
their perception of their ethical obligations, and their
willingness to treat HIV-positive patients.

Methods
The cross-sectional survey was carried out
from January to March 2011 at the Institute of Dental
Sciences, Bareilly, Uttar Pradesh, India. The studys
population consisted of undergraduate students from
all four years of study plus the fifth-year internship.
All the 460 students (first year=60, second year=100,
third year=100, fourth year=100, and internship=100)
who were enrolled at the dental school in 2011 were
invited to participate in the study.
The surveys were distributed to the students at
the end of regularly scheduled classes, which meant
that students not present on a given day due to illness,
external rotations, or other reasons did not receive the
survey. Interns (residents) completed the questionnaire
during their clinical postings in their respective departments. The differences in the response rates were,
therefore, primarily a function of class attendance
rates. All students were informed that participation
was voluntary and that the refusal to participate would
not affect their grades. No identifying information was
gathered. The students returned their completed surveys to the researchers in sealed envelopes. The study
was approved by the Ethical Committee, Institute of
Dental Sciences, Bareilly, Uttar Pradesh, India.

Journal of Dental Education Volume 77, Number 9

The survey instrument was a self-administered

anonymous questionnaire in English, containing
questions regarding HIV and AIDS-related knowledge, oral manifestations of HIV, students attitude
towards patients with HIV, and student interest in a
need for further education about HIV-positive patient
care. This instrument had been employed previously
among dental students in Iran.22 This survey instrument had a moderate degree of internal consistency
as indicated by Cronbachs alpha correlation coefficient (=0.6).
The survey was made up of four major categories. First were demographic factors, including
gender and academic year. Second were eighteen
closed-ended questions about knowledge of HIV and
modes of transmission of HIV/AIDS. The knowledge
questions were answered using the options of correct and incorrect. A total knowledge score was
obtained by adding the points given for each true/
false question with each correct response receiving
two points and each incorrect answer getting zero
points. Hence, a students total score could range
from 0 to 36. A higher score indicated a greater
level of knowledge. Scores less than 25 percent
were deemed a weak level of knowledge, between
25 percent and 50 percent a moderate knowledge
level, between 50 percent and 75 percent a good
knowledge level, and more than 75 percent an excellent knowledge level. Third were fifteen questions
about oral manifestations of HIV/AIDS, with answer
options yes and no. Fourth were seventeen questions about attitudes regarding treating HIV-positive
patients, right of HIV-positive health personnel to
practice, and willingness to treat. The answer to each
question about attitudes was rated on a five-point
Likert scale from strongly agree to strongly disagree
with a maximum score of 85. The professional attitudes scores were computed from five to one and
negative attitudes, conversely. Scores of more than
75 percent were considered positive, between 50 percent and 75 percent considered passive, and less than
50 percent were considered negative. The positive
attitudes (higher scores) were considered as professional attitudes. A pilot test to check the applicability
of questions was conducted at the Institute of Dental
Sciences at Bareilly with fifty dental students, and
the data collected from these students were included
in the main study.
The data were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0. A one
way ANOVA (Analysis of Variance) was used to
compare students means for knowledge levels and

September 2013 Journal of Dental Education

attitudes towards HIV/AIDS between genders, years

of study, and age groups. For multiple intergroup
comparisons, a post hoc analysis was done. Pearson
correlation coefficient was conducted for the correlation of age and class with knowledge and attitude
score. A p-value of <0.05 was considered statistically
significant.

Results
The overall response rate to the survey was 79.7
percent (N=367), with 80 percent participation for
first-year students (N=48), 84 percent for second-year
students (N=84), 72 percent for third-year students
(N=72), 88 percent for fourth-year students (N=88)
and 75 percent for students doing internships (N=75)
(Table 1). Out of the total students, 70.1 percent
(N=257) were females, and 29.9 percent (N=110)
were males (Table 2); in India, the vast majority of
dental students are females.
The total scores (based on correct responses)
ranged from 24 to 32. The total mean knowledge
score was 28.4 out of the maximum score of 36 (a
total mean percentage of 78.8 percent, an excellent
knowledge score), with a total mean of 28.5 for females and 28.3 for males. There was no statistically
significant difference between knowledge scores for
males and females. The maximum correct response
(97.5 percent) was obtained for the question HIV/
AIDS patients can contaminate dental workers,
Table 1. Sample selection and response rate


Year of Study

Total Number Number of

of Students Respondents Response
(N=460)
(N=367)
Rate

First
Second
Third
Fourth
Internship

60
100
100
100
100

48 80%
84 84%
72 72%
88 88%
75 75%

Table 2. Distribution of study population by gender

Year of Study

Males

Females

First
14
Second
26
Third
19
Fourth
28
Internship 23
Total
110

Total

34 48
58 84
53 72
60 88
52 75
257
367

1211

Table 3. Students who gave correct responses to knowledge statements about HIV/AIDS
Knowledge Statement

Correct Response

HIV/AIDS patients can contaminate dental workers.

HIV/AIDS patients can be diagnosed with oral manifestations.
ELISA is a screening test for HIV infection.
The specificity of the HIV tests is 100%.
Western blot is a definite test for HIV/AIDS diagnosis.
Dental workers can act as an intermediary for transmission of HIV.
Saliva can be a vehicle for the transmission of AIDS.
All sterilization methods have cidal effects against HIV.
Needlestick injury can transmit HIV.
The negative HIV tests surely indicate that the persons are free of viruses.
Hepatitis B is more communicable than HIV/AIDS.
Infection control methods for Hep B provide adequate protection against HIV transmission.
Medical staff are more prone for cross-contamination.
There is a lot of HIV in the saliva of HIV/AIDS patients.
HIV can be transmitted through aerosols by handpieces.
There are special dental clinics for treatment of HIV/AIDS patients in India.
Now, AIDS is the most important health problem in the world.
CPR for patients with AIDS can transmit HIV infection.

and the least correct response was for CPR in patients with AIDS can transmit HIV infection (60.4
percent) (Table 3). Regarding oral manifestations,
95.2 percent of the students correctly identified oral
candidiasis, 94.5 percent Kaposis sarcoma, and 93.8
percent ANUG. There was no statistically significant
difference between male and female knowledge
regarding oral manifestations (Table 4).
The total mean attitude score was 66.1 out of
total possible 85 (a total mean percentage of 77.7
percent, a positive attitude score), with a mean of
66.2 for females and 66.0 for males. The attitude
Table 4. Students knowledge about oral manifestations
of AIDS
Oral Manifestation

Yes (%)

Oral candidiasis
95.2%
Kaposis sarcoma
94.5%
ANUG 93.8%
Major aphthous
92.6%
Cytomegalovirus 90.4%
Hairy leukoplakia
88.2%
Severe periodontitis
85.7%
Xerostomia 82.5%
Salivary gland infection
80.6%
Gingivitis 75.8%
Herpes zoster
74.3%
Herpes simplex
72.9%
Condiloma 57.3%
Papiloma 50.5%

1212

97.5%
96.2%
94.3%
92.8%
89.5%
87.9%
86.5%
86.1%
85.3%
84.6%
83.2%
78.6%
75.3%
71.4%
70.2%
68.2%
64.8%
60.4%

scores ranged from 56 to 79. There was no statistically significant difference in attitude scores between
males and females. Most students (84.9 percent)
disagreed or strongly disagreed with the statement
that treatment of HIV/AIDS patients means wasting national resources; this statement obtained the
highest positive attitude score. Also, the majority of
students (87.2 percent) agreed or strongly agreed with
the statement I have a right to know if my patients
are HIV-positive; this statement obtained the highest
negative attitude score (Table 5).
Post hoc analysis showed that students of each
class had significantly different knowledge and attitude score from other classes. In other words, the
longer a student had been in dental school, the higher
the knowledge and attitude scores (Tables 6 and 7).
Also, as each class became more educated, its knowledge level increased (r=0.958; p<0.001). Similarly,
the attitude scores showed a significant increase with
the increase in the students class (r=0.964; p<0.001),
showing that as members of a class became more educated, their attitude became more positive (Tables 8
and 9). Also, correlation between age and knowledge
score was highly significant (r=0.901; p<0.001) and
attitude was highly significant (r=0.909; p<0.001),
showing that as the age of the student increased,
both the knowledge and attitude scores increased
significantly. It was also noted that students with high
knowledge had positive attitudes in treating patients
with HIV (r=0.979; p<0.001) (Tables 8 and 9).

Journal of Dental Education Volume 77, Number 9

Table 5. Students responses to questions about their attitudes towards patients with HIV/AIDS

Attitude Statement

Strongly Strongly
Agree
Agree
Neutral Disagree Disagree

Treatment of HIV/AIDS patients means wasting national resources.

3.7%
All dental patients should be considered potentially infectious.
5.3%
If I know that my friend has HIV, I end the friendship.
4.7%
Supporting HIV/AIDS patients improves community health.
10.5%
Dentists with HIV/AIDS should not be allowed to treat patients.
8.2%
HIV/AIDS patients should be treated at a separate ward.
2.5%
A blood test should be taken for diagnosis of HIV in all dental patients.
12.3%
I am morally responsible to treat HIV/AIDS patients.
7.3%
HIV/AIDS patients can live with others in the same place.
5.4%
I am not obligated to treat HIV/AIDS patients.
9.5%
HIV/AIDS patients can lead a normal life.
8.5%
I can safely treat HIV/AIDS patients.

I will treat HIV/AIDS patients.

My knowledge about infection control is enough to treat HIV/AIDS patients.
I worry about being infected with HIV by my patients.
28.5%
I will do CPR if HIV/AIDS patients need it.
1.4%
It is my right to know if my patients are infected by HIV.
52.5%

5.1%
60.2%
17.5%
46.6%
10.5%
37.2%
25.4%
13.3%
18.2%
40.2%
22.1%
10.1%
15.8%
8.6%
53.1%

34.7%

6.3%
30.4%
9.9%
31.5%
20.4%
52.4%
38.7%
60.5%
62.1%
22.3%
52.2%
53.8%
50.6%
41.7%
7.3%
15.7%
8.4%

58.2%
1.9%
55.2%
5.1%
50.3%
3.5%
11.1%
10.2%
9.5%
25.6%
10.4%
22.5%
23.4%
20.1%
11.1%
50.5%
3.8%

26.7%
2.2%
12.7%
6.3%
10.6%
4.4%
12.5%
8.7%
4.8%
2.4%
6.8%
13.6%
10.2%
29.6%

32.4%
0.6%

Table 6. Year-wise differences in knowledge and attitude

Year of Study

Number

Mean Knowledge Score

First
48
Second
84
Third
72
Fourth
88
Internship 75
Total
367

Percentage

Mean Attitude Score

Percentage

25.2 70.0% 57.8 68.0%

26.6 73.8% 62.1 73.1%
28.1 78.0% 64.6 76.0%
30.2 83.8% 69.7 82.0%
32 88.8% 76.5 90.0%
28.4 78.8% 66.1 77.7%

Table 7. Multiple comparison using post hoc Tukey HSD

Comparison of Year of Study
First vs. second year
First vs. third year
First vs. fourth year
First year vs. internship
Second vs. third year
Second vs. fourth year
Second year vs. internship
Third vs. fourth year
Third year vs. internship
Fourth year vs. internship

Knowledge Score

Attitude Score

Mean Difference

p-value

Mean Difference

p-value

1.336 (0.122)
2.900 (0.126)
4.977 (0.122)
6.789 (0.125)
1.563 (0.109)
3.641 (0.103)
5.453 (0.108)
2.078 (0.108)
3.889 (0.112)
1.812 (0.107)

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001

4.304 (0.231)
6.809 (0.238)
11.899 (0.229)
18.707 (0.236)
2.505 (0.205)
7.595 (0.194)
14.403 (0.202)
5.090 (0.203)
11.898 (0.210)
6.808 (0.200)

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001

Discussion
In our study, the mean of students knowledge
about patients with HIV/AIDS was excellent (78.8
September 2013 Journal of Dental Education

percent), and this knowledge was significantly associated with the willingness to treat these patients.
The overall mean knowledge score was comparable
to the results obtained by Sadeghi and Hakimi, who
1213

Table 8. Age-wise differences in knowledge and attitude

Age

Number

17
18
19
20
21
22
23
24
Total

Knowledge Score

25
65
70
86
46
24
22
29
367

Percentage

Attitude Score

Percentage

26.4 73.3% 62.1 73.0%

26.9 74.7% 63.3 74.4%
27.7 76.9% 65.6 77.1%
28.1 78.0% 65.7 77.2%
28.5 79.1% 66.3 78.0%
30.6 85.0% 69.5 81.7%
29.7 82.5% 68.4 80.5%
29.3 81.4% 68.1 80.1%
28.4 78.8% 66.1 77.7%

Table 9. Correlation analysis

Age

Knowledge Score

Attitude Score

Class

r-value
0.831*
p-value <0.001

0.958*
<0.001

0.964*
<0.001

Age

r-value
p-value

0.901*
<0.001

0.909*
<0.001

Knowledge score

r-value
p-value

0.979*
<0.001

*Correlation is significant at the 0.01 level.

reported an overall knowledge score of 82.1 percent

for Iranian dental students.22 Also, the results of our
study show that these dental students attitudes towards treating patients with HIV/AIDS were positive
(77.7 percent). The overall attitude score was comparable to the results of Seacat and Inglehart (81.1
percent)9; however, our results were higher than the
findings of Hu et al. (51 percent).8 In 1993, Rankin
et al. reported that less than half of the dental students
from three dental schools in Texas were willing to
treat patients who were HIV-positive.23
In our study, 15.8 percent of the students were
willing to treat patients with HIV/AIDS. Although
there is evidence that dentists willingness to treat
patients with AIDS has improved in recent years,24-26
among our group of respondents, evidence of negativity remains. A previous study reported that factors
associated with refusal to treat patients with HIV/
AIDS include, primarily, a lack of ethical responsibility, fears related to cross-infection, loss of other patients if dental care is provided to patients with HIV/
AIDS, cost of infection control procedures, etc.27
In our study, 49.7 percent of the dental students
agreed that I am not obligated to treat HIV/AIDS
patients. In a 2002 study, 83 percent of Kuwaiti
family physicians chose to opt out of treating patients

1214

with HIV in family practice.28 Dentists are ethically

obligated to provide care for patients with infectious diseases.29 Overestimation of the transmission
risk of HIV was the most important reason for fear
among dental students in providing dental care to
HIV/AIDS patients in the study done by Erasmus et
al.11 Students fear may overpower their intellectual
and practical ability to cope with the treatment and
management of such patients.11
Most students (65.5 percent) in our study
thought that each patient should be considered potentially infectious. This feeling may be warranted since
some patients with HIV/AIDS abstain from declaring
their illness out of fear of being denied dental care.30
Based on these considerations, the concept of universal precautions (all patients treated as potentially
infectious) continues to be the most important method
in treating all patients, and patients must be treated
with the same infection control procedures that
should be routinely applied in every dental treatment
(sterilized instruments, non-contaminated operative
field, and professionals wearing gloves, masks, caps,
glasses). At the Institute of Dental Sciences, Bareilly,
students are taught the significance and the various
methods of sterilization in the second academic
year in their course on microbiology and in all the

Journal of Dental Education Volume 77, Number 9

specialty dental departments in the third and fourth

academic years. Special attention is paid so that the
students learn each and every aspect of sterilization.
Also, it is important to note that 34.5 percent
of the students in our study did not consider all
patients to be potentially infectious. This could be
because of the lack of knowledge of dental students
regarding infectious diseases and their transmission
in the dental settings. Hence, there is need to modify
our curriculum to increase awareness of potentially
infectious diseases among the students.
In our study, most of the students were aware
of the major oral manifestations of AIDS. Kaposis
sarcoma and candidiasis, two of the most common
oral lesions in HIV-positive patients, were the most
identified in our study. This was similar to the findings
of the research by Samaranayake et al.31 and Sadeghi
and Hakimi.22 From our study, it can be concluded
that these Indian dental students knowledge level
regarding oral manifestations is comparable with that
of students from developed countries such as Scotland
and the United States. In their study, Angelilo et al.32
concluded that early diagnosis of HIV was important
to prevent the spread of the disease. Although the
possibility of HIV transmission in the oral health care
setting is very rare (no cases reported in the United
States), the dental clinic has become a helpful setting
for early diagnosis of HIV/AIDS with at-risk populations, as most lesions of HIV infection present orally
during the first stages of the disease.33
Eighty-seven percent of the students in our
study agreed that dental professionals can act as
intermediaries for transmission of HIV, which
suggested that most students are aware of disease
transmission. These findings clearly highlight the
importance of teaching dental educators about HIV
disease transmission. It is vital that universal precautions should also be adopted through faculty policy
and reinforced at an early level of study, so that all
barrier techniques become protocol and the norm in
the daily practice of clinicians. This will eventuate in
a truly professional and patient-centered oral health
care provider.9
On the question of whether HIV could be transmitted through aerosols produced by a handpiece,
29.8 percent of the students in our study responded
negatively. This may be because of the fact that reports of HIV transmission through this route are very
rare; however, the theoretical possibility exists.34 A
patients oral fluids and blood can be aspirated into a
handpiece or dental unit waterline, and unless water
quality is controlled, a practitioner or new patient

September 2013 Journal of Dental Education

could be exposed to the microbes of previous patients. In addition, a practitioners skin and eyes are
often not completely protected, thereby increasing
the possibly of spatter and aerosol contact.35
Regarding the possible risk of transmission
through saliva, 13.5 percent of the students in our
study did not know that contact with saliva contaminated with the blood of a patient with HIV/AIDS is
a possible route of transmission of the virus. Contact
with saliva has never been shown to transmit HIV
because of the ability of the glandular saliva to inhibit
its infectivity.9,36 However, the Centers for Disease
Control and Prevention recommends the application
of universal precautions to saliva in a dental setting.37
It is notable that 85.3 percent of the students
knew that needlestick injury can transmit HIV.
Needlestick injuries can be a potential risk factor for
dental professionals; therefore, it is imperative that
more emphasis be placed on the prevention protocol.
Although the risk of HIV infection after percutaneous
exposure is very low (0.3 percent), needlestick injuries can be quite alarming to the practitioner, creating
extreme psychological stress. Therefore, students
need to be made aware of the proper protocols for
prompt management.11
In our study, only 1.4 percent of the students
were willing to perform cardiopulmonary resuscitation (CPR) if patients with HIV/AIDS needed it. The
less positive response in this aspect might be the fear
of transmission of HIV while doing CPR. The risk
of HIV transmission through mouth-to-mouth resuscitation is extremely slim because of low infectious
virus titers and properties of saliva that inhibit HIV.
In the absence of blood, mouth-to-mouth resuscitation cannot result in HIV infection.28 In such circumstances, the potential benefit to the patient who goes
into cardiac arrest during dental procedures greatly
outweighs the small risk of transmission. Although
universal precautions are helpful in building positive treatment attitudes among dental students, they
ultimately may not impact personal sensitivity to
people with HIV/AIDS.
The results of our study are in agreement
with that of Seacat and Inglehart9 and Erasmus et
al.,11 which found that students knowledge of the
HIV/AIDS disease process and oral manifestations
increased as the level of study increased throughout
the curriculum. This finding is consistent with the students perceptions of the degree to which the program
prepared them well for treating patients with HIV.
India is a developing country with many economic and social problems. Access to health care

1215

providers is limited for most people, and the level of

knowledge among the majority of the population is
insufficient to prevent infectious diseases that have
already been controlled in developed countries. HIV
has had a significant impact on oral health delivery
services in India, mainly because of public and professional perceptions about its contagion. India is one
of the countries that still have a conservative society,
and adult education in India is still in its early stages.
Emotional reactions also play a significant role in
ones willingness to treat patients with HIV. In our
study, the reasons for certain lack of knowledge may
be due to students being more examination-oriented
and not interested in acquiring sufficient knowledge
about the disease for future clinical practice. Insufficient knowledge may also be due to deficiencies in
the curriculum and inconsistencies in the way information about the disease is presented to the students.
Our study shows that there are still inconsistencies
and deficiencies in our dental curriculum that need
re-evaluation and correction.

Limitations and Conclusion

A potential limitation of our study is that the
data were collected from students of one single dental
program. Care should be taken in interpreting the
results as the study is solely based upon self-reported
information and was solicited from individuals
volunteering to complete the survey. Though other
published studies on this topic have been limited to
single-school recruitment, this recruitment strategy
may limit the generalizability of the findings. Therefore, the data from this study should not be considered
to reflect the nature and beliefs of all dental students
in dental programs in India.
The Institute of Dental Sciences at Bareilly is
a relatively new dental school established in 2001.
Hence, the results obtained from this study would
be an assessment of the needs in a newly emerging
Indian dental curriculum. Furthermore, the results
may also help to reinforce the existing knowledge
of the dental students towards patients with HIV and
improve on the curricular shortcomings. Although
students knowledge about the disease was found to
be relatively high, it was still inadequate in preparing
them to clinically manage patients with HIV/AIDS.
On the basis of our study, we would make the
following recommendations. The dental curriculum
should include experiential opportunities for structured interaction between the students and patients

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with HIV, both in the classroom and in clinical

settings. The use of an objective structured clinical
examination (OSCE) with actual persons with HIV/
AIDS near the end of the preclinical years holds good
potential. The students should also be involved in
discussion groups regarding the dental management
of patients with HIV, guided by experienced clinicians who analyze real cases. It is important to ensure
that future dentists attitude towards these patients is
not a barrier to their receiving the best possible oral
health care. For this reason, we believe that, in addition to lectures increasing the level of knowledge
in education, there is a need to also bring about positive changes in the students attitudes and behaviors
towards patients with HIV/AIDS by making this
portion of the curriculum more clinically oriented
and removing misconceptions regarding transmission
of the infection.

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