Keywords
Students, HIV knowledge, HIV perception, HIV prevention
Abstract
Increasing people’s knowledge of transmission, prevention, early diagnosis, and available treatments is a key step toward HIV control; it means setting the conditions for empowerment and enabling individuals to make aware choices about the prevention strategy best suited to their needs. This study aims to identify unmet needs on HIV knowledge among freshman students. A cross sectional study was carried out at the University of Cagliari, which is an Italian public state university. Data were collected by means of an anonymous questionnaire; the final sample included 801 students. Results offer a detailed picture of students’ knowledge and perceptions of HIV. Several topics deserve to be better understood by students, but the main gaps relate to the pre-exposure prophylaxis and the decreased likelihood of sexually transmitting HIV due to early treatments. Students’ vision of the quality of life of people living with HIV was negatively affected by perceiving as relevant the effects of HIV on physical health or on sexual/affective domains, while conversely, it seemed positively affected by knowing that current treatments are useful for counteracting physical symptoms and decreasing the possibility of transmitting HIV. Being aware of the potential benefits of current therapies could favour a less negative view, in line with the current state of the beneficial effects of HIV treatment. Universities are a valuable setting to bridge the HIV knowledge gap and thus also contribute to tackling stigma and actively promoting HIV testing.
References
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[18] Santangelo OE, Provenzano S, Firenze A. (2018). Knowledge of sexually transmitted infections and sex-at-risk among Italian students of health professions. Data from a one-month survey. Ann Ist Super Sanità, 2018;54:40-48. doi: 10.4415/ANN_18_01_09
[19] Li XM, Lin CD, Gao ZX, Stanton B, Fang X, Yin Q, Wu Y. HIV/AIDS knowledge and the implications for health promotion programs among Chinese college students: geographic, gender and age differences. Health Promot Int 2004;19:345–356. doi: 10.1093/heapro/dah308
[20] Signorelli C, Pasquarella C, Limina RM, Colzani E, Fanti M, Cielo A, Greco M, De' Somenzi CP, Chironna M, Quarto M. Third Italian national survey on knowledge, attitudes, and sexual behaviour in relation to HIV/AIDS risk and the role of health education campaigns. European Journal of Public Health 2006:16;498-504. doi: 10.1093/eurpub/ckl024
[21] Mazzitelli M, Caridà G, Scigliano C, Vallone MC, Pirrò F, Lombardo MR, Clemente G, Bernaudo F, Postorino MC, Strazzulla A, Maselli R, Torti C. Knowledge of HIV infection and transmission: a knowledge, attitudes, beliefs and practices (KABP) survey among a sample of students at the “Magna Graecia”, University of Catanzaro. Ann Ist Super Sanità, 2016;52:530-535. doi: 10.4415/ANN_16_04_12
[22] Hughes A K, Admiraal K R. A Systematic Review of HIV/AIDS Knowledge Measures. Research on Social Work Practice 2012:22,313-322. doi: 10.1177/1049731511426277
[23] Baytner-Zamir R, Lorber M, Hermoni D. Assessment of the knowledge and attitudes regarding HIV/AIDS among pre-clinical medical students in Israel. BMC Res Notes 2014;168. doi: 10.1186/1756-0500-7-168
[24] Alawad M, Alturki A, Aldoghayyim A, Alrobaee A, Alsoghair M. (2019). Knowledge, Attitudes, and Beliefs about HIV/AIDS and People Living with HIV among Medical Students at Qassim University in Saudi Arabia. Int J Health Sci (Qassim) 2019;13:22-30. doi: 10.1186/1756-0500-7-168
[25] Regine V, Pugliese L, Boros S, Santaquilani M, Ferri M, Suligoi B. (2020). Aggiornamento delle nuove diagnosi di infezione da HIV e dei casi di AIDS in Italia al 31 dicembre 2019. Notiziario dell’Istituto Superiore di Sanità 2019;11:7-11.
[26] Campagna di comunicazione "Con l’HIV non si scherza" #HIVriguardatutti. Available at http://old.iss.it/binary/publ/cont/AGGIORNAMENTO_HIV_2018.pdfhttp://www.salute.gov.it/portale/hiv/dettaglioCampagneHIV.jsp?lingua=italiano&menu=campagne&p=dacampagne&id=138 Accessed on 26/11/2021
[27] Campagna di comunicazione "Con l’HIV non si scherza, proteggi te stesso e gli altri". Available at http://www.salute.gov.it/portale/hiv/dettaglioCampagneHIV.jsp?lingua=italiano&menu=campagne&p=dacampagne&id=117 Accessed on 26/11/2021
[28] Tosco E. E liberaci dal male…”: vent’anni di comunicazione sul tema dell’Aids. Dors – Centro Regionale di Documentazione per la promozione della salute. Available at https://www.dors.it/page.php?idarticolo=2738 Accessed on 26/11/2021
[29] Ministero della Salute. Campagne di Comunicazione HIV. Available at http://www.quadernidellasalute.it/portale/news/p3_2_6.jsp?lingua=italiano&menu=campagne&area=aids&btnCerca= Accessed on 26/11/2021
[30] Farrington EM, Bell D, Aron E. DiBacco AE. Reasons People Give for Using (or not Using) Condoms. AIDS Behav, 2016;20:2850–2862. doi: 10.1007/s10461-016-1352-7
[31] Mannheimer S, Wang L, L. Wilton L, H.V. Tieu HV, Del Rio C, Buchbinder S, Fields S, Glick S, Connor MB, Cummings V, Eshleman SH, Koblin B, Mayer KH. Infrequent HIV Testing and Late HIV Diagnosis Are Common Among A Cohort of Black Men Who Have Sex with Men (BMSM) in Six US Cities. Acquir Immune Defic Syndr 2014;67:438–445. doi:10.1097/QAI.0000000000000334
[32] Detels R, Wu J, Zunyou W. Control of HIV/AIDS can be achieved with multi-strategies. Global Health Journal 2019;3;29-32. doi: 10.1016/j.glohj.2019.06.001
[33] Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature. AIDS Behav 2018;22:3681–3691. doi:10.1007/s10461-018-2184-4
[34] Palummieri A, De Carli G, Rosenthal E, Cacoub P, Mussini C, Puro V. Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: A Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians. BMC Infectious Diseases 2017;17;734. doi: 10.1186/s12879-017-2819-5
[35] British Association of Sexual Health and HIV. UK Guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE). Available at https://www.bhiva.org/file/6074032ee885c/PEPSE-guidelines-2015.pdf Accessed on 26/11/2021
[36] Palumbo R, Annarumma C, Adinolfi P, Musella M, Piscopo G. The Italian Health Literacy Project: Insights from the assessment of health literacy skills in Italy. Health Policy, 2016;120:1087-94. doi: 10.1016/j.healthpol.2016.08.007
[37] Bor J, Fischer C, Modi M, Richman B, Kinker C, King R, Calabrese SK, Mokhele I, Sineke T, Zuma T, Rosen S, Bärnighausen T. Changing Knowledge and Attitudes Towards HIV Treatment‑as‑Prevention and “Undetectable=Untransmittable”: A Systematic Review. AIDS and Behavior 2021;25:4209–4224. doi: 10.1007/s10461-021-03296-8
[38] Deblonde J, De Koker P, Hamers F, Fontaine J, Luchters S, Temmerman M. (2010). Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 2010:20;422-32. doi: 10.1093/eurpub/ckp231
[39] Tan K, Perry Black B. A systematic review of healthcare provider perceived barriers and facilitators to routine HIV testing in primary care settings in the Southeastern United States. J Assoc Nurses AIDS Care 2018;29:357–370. doi: 10.1016/j.jana.2017.12.006
[40] White BL, Walsh J, Rayasam S, Pathman DE, Adimora AA, Golin CE. What Makes Me Screen for HIV? Perceived Barriers and Facilitators to Conducting Recommended Routine HIV Testing among Primary Care Physicians in the Southeastern United States. J Int Assoc Provid AIDS Care 2015;14:127-135. doi: 10.1177/2325957414524025
[41] Wandeler G, Johnson LF, Egger M. Trends in life expectancy of HIV-positive adults on antiretroviral therapy across the globe: comparisons with general population. Current Opinion in HIV and AIDS 2016;11:492–500. doi: 10.1097/COH.0000000000000298
[42] British HIV Association. Standards of Care for People Living with HIV. Available at https://www.bhiva.org/file/WSheCFExXGBRK/BHIVAStandardsA4.pdf Accessed on 26/11/2021
[43] Suárez-Reyes M, Muñoz Serrano M, Van den Broucke S. (2019). How do universities implement the Health Promoting University concept? Health Promotion International 2019;34:1014–1024. doi: 10.1093/heapro/day055
[44] Dooris M, Powell S, Farrier A. Conceptualizing the 'whole university' approach: an international qualitative study. Health Promot International 2020;35:730-740. doi: 10.1093/heapro/daz072
[2] World Health Organization- Regional Office for Europe. Action plan for the health sector response to HIV in the WHO European Region. Available at https://apps.who.int/iris/bitstream/handle/10665/329423/9789289052894-eng.pdf?sequence=1&isAllowed=y . Accessed on 26/11/2021.
[3] Italian Ministry of Health. Piano Nazionale di Interventi contro HIV e Aids (PNAIDS). Available at http://www.salute.gov.it/imgs/C_17_pubblicazioni_2655_allegato.pdf . Accessed on 26/11/2021
[4] UNAIDS. UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets. Available at https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/20190716_PR_UNAIDS_global_report_20197 . Accessed on 26/11/2021
[5] Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar, Sean B. Rourke SB and The Stigma Review Team. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 2015;3:15-848. doi: 10.1186/s12889-015-2197-0
[6] Reinius M, Wiklander M, Wettergren L, Svedhem V, Eriksson L. The Relationship Between Stigma and Health-Related Quality of Life in People Living with HIV Who Have Full Access to Antiretroviral Treatment: An Assessment of Earnshaw and Chaudoir's HIV Stigma Framework Using Empirical Data. AIDS and Behavior 2018;22:3795-3806. doi: 10.1007/s10461-018-2041-5
[7] Yigit I, Modi RA, Sheri D Weiser SD, Johnson MO, Mugavero MJ, Turan JM, Turan B. Effects of an intervention on internalized HIV-related stigma for individuals newly entering HIV care. AIDS 2020;34, S73-S82. doi: 10.1097/QAD.0000000000002566
[8] Svahn LG, Eriksson LE, Wiklander M. Barriers to HIV testing as reported by individuals newly diagnosed with HIV infection in Sweden. AIDS Care 2021;33:1286-1295. doi: 10.1080/09540121.2020.1844862
[9] Bedert M, Davidovich U, de Bree G, van Bilsen W, van Sighem A, Zuilhof W, Brinkman K, van der Valk M, de Wit J. Understanding Reasons for HIV Late Diagnosis: A Qualitative Study Among HIV-Positive Individuals in Amsterdam, The Netherlands. AIDS and Behavior 2021;25: 2898–2906. doi: 10.1007/s10461-021-03239-3
[10] Alvarez-del Arco D, Monge S, Caro-Murillo AM, Ramïrez-Rubio O, Azcoaga-Lorenzo A, Belza MJ, Rivero-Montesdeoca Y, Noori T, Del Amo J.. HIV testing policies for migrants and ethnic minorities in EU/EFTA Member States. European Journal of Public Health 2014;24:139–144. doi: 10.1093/eurpub/ckt108
[11] Weston HJ. Public honour, private shame and HIV: issues affecting sexual health service delivery in London's South Asian communities. Health & Place 2003;9:109-117. doi: 10.1016/S1353-8292(03)00002-9
[12] UNAIDS 2019. Power to the people. Available at https://www.unaids.org/en/20191226_WAD2019_report_power_people Accessed on 26/11/2021
[13] Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, Avihingsanon A, Cooper DA, Fätkenheuer G, Llibre JM, Molina JM, Munderi P. Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine 2015;373:795–807. doi: 10.1056/NEJMoa1506816
[14] Prati G, Zani B, Pietrantoni L, Scudiero D, Perone P, Cosmaro L, Cerioli A, Oldrini M. PEP and TasP Awareness among Italian MSM, PLWHA, and High-Risk Heterosexuals and Demographic, Behavioral, and Social Correlates. PLoS One 2016;11: e0157339. doi: 10.1371/journal.pone.0157339
[15] Loconsole D, Metallo A, Bruno V, De Robertis AL, Morea A, Quarto M, Chironna M. HIV awareness: a kap study among students in Italy reveals that preventive campaigns still represent a public health priority. Annali di Igiene 2020;32:56-64. doi: 10.7416/ai.2020.2330
[16] Degroote S, Vogelaers D, Liefhooghe G, Vermeir P, Vandijck DM. Sexual experience and HIV-related knowledge among Belgian university students: a questionnaire study. BMC Research Notes 2014;7-299. doi: 10.1186/1756-0500-7-299.
[17] Anwuri C, Dunn MS, Schulze F. Determinants of Voluntary HIV/AIDS Counseling and Testing among Community College Students in the United States. Int J MCH AIDS 2017; 6:109-120. doi: 10.21106/ijma.212
[18] Santangelo OE, Provenzano S, Firenze A. (2018). Knowledge of sexually transmitted infections and sex-at-risk among Italian students of health professions. Data from a one-month survey. Ann Ist Super Sanità, 2018;54:40-48. doi: 10.4415/ANN_18_01_09
[19] Li XM, Lin CD, Gao ZX, Stanton B, Fang X, Yin Q, Wu Y. HIV/AIDS knowledge and the implications for health promotion programs among Chinese college students: geographic, gender and age differences. Health Promot Int 2004;19:345–356. doi: 10.1093/heapro/dah308
[20] Signorelli C, Pasquarella C, Limina RM, Colzani E, Fanti M, Cielo A, Greco M, De' Somenzi CP, Chironna M, Quarto M. Third Italian national survey on knowledge, attitudes, and sexual behaviour in relation to HIV/AIDS risk and the role of health education campaigns. European Journal of Public Health 2006:16;498-504. doi: 10.1093/eurpub/ckl024
[21] Mazzitelli M, Caridà G, Scigliano C, Vallone MC, Pirrò F, Lombardo MR, Clemente G, Bernaudo F, Postorino MC, Strazzulla A, Maselli R, Torti C. Knowledge of HIV infection and transmission: a knowledge, attitudes, beliefs and practices (KABP) survey among a sample of students at the “Magna Graecia”, University of Catanzaro. Ann Ist Super Sanità, 2016;52:530-535. doi: 10.4415/ANN_16_04_12
[22] Hughes A K, Admiraal K R. A Systematic Review of HIV/AIDS Knowledge Measures. Research on Social Work Practice 2012:22,313-322. doi: 10.1177/1049731511426277
[23] Baytner-Zamir R, Lorber M, Hermoni D. Assessment of the knowledge and attitudes regarding HIV/AIDS among pre-clinical medical students in Israel. BMC Res Notes 2014;168. doi: 10.1186/1756-0500-7-168
[24] Alawad M, Alturki A, Aldoghayyim A, Alrobaee A, Alsoghair M. (2019). Knowledge, Attitudes, and Beliefs about HIV/AIDS and People Living with HIV among Medical Students at Qassim University in Saudi Arabia. Int J Health Sci (Qassim) 2019;13:22-30. doi: 10.1186/1756-0500-7-168
[25] Regine V, Pugliese L, Boros S, Santaquilani M, Ferri M, Suligoi B. (2020). Aggiornamento delle nuove diagnosi di infezione da HIV e dei casi di AIDS in Italia al 31 dicembre 2019. Notiziario dell’Istituto Superiore di Sanità 2019;11:7-11.
[26] Campagna di comunicazione "Con l’HIV non si scherza" #HIVriguardatutti. Available at http://old.iss.it/binary/publ/cont/AGGIORNAMENTO_HIV_2018.pdfhttp://www.salute.gov.it/portale/hiv/dettaglioCampagneHIV.jsp?lingua=italiano&menu=campagne&p=dacampagne&id=138 Accessed on 26/11/2021
[27] Campagna di comunicazione "Con l’HIV non si scherza, proteggi te stesso e gli altri". Available at http://www.salute.gov.it/portale/hiv/dettaglioCampagneHIV.jsp?lingua=italiano&menu=campagne&p=dacampagne&id=117 Accessed on 26/11/2021
[28] Tosco E. E liberaci dal male…”: vent’anni di comunicazione sul tema dell’Aids. Dors – Centro Regionale di Documentazione per la promozione della salute. Available at https://www.dors.it/page.php?idarticolo=2738 Accessed on 26/11/2021
[29] Ministero della Salute. Campagne di Comunicazione HIV. Available at http://www.quadernidellasalute.it/portale/news/p3_2_6.jsp?lingua=italiano&menu=campagne&area=aids&btnCerca= Accessed on 26/11/2021
[30] Farrington EM, Bell D, Aron E. DiBacco AE. Reasons People Give for Using (or not Using) Condoms. AIDS Behav, 2016;20:2850–2862. doi: 10.1007/s10461-016-1352-7
[31] Mannheimer S, Wang L, L. Wilton L, H.V. Tieu HV, Del Rio C, Buchbinder S, Fields S, Glick S, Connor MB, Cummings V, Eshleman SH, Koblin B, Mayer KH. Infrequent HIV Testing and Late HIV Diagnosis Are Common Among A Cohort of Black Men Who Have Sex with Men (BMSM) in Six US Cities. Acquir Immune Defic Syndr 2014;67:438–445. doi:10.1097/QAI.0000000000000334
[32] Detels R, Wu J, Zunyou W. Control of HIV/AIDS can be achieved with multi-strategies. Global Health Journal 2019;3;29-32. doi: 10.1016/j.glohj.2019.06.001
[33] Pinto RM, Berringer KR, Melendez R, Mmeje O. Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature. AIDS Behav 2018;22:3681–3691. doi:10.1007/s10461-018-2184-4
[34] Palummieri A, De Carli G, Rosenthal E, Cacoub P, Mussini C, Puro V. Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: A Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians. BMC Infectious Diseases 2017;17;734. doi: 10.1186/s12879-017-2819-5
[35] British Association of Sexual Health and HIV. UK Guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE). Available at https://www.bhiva.org/file/6074032ee885c/PEPSE-guidelines-2015.pdf Accessed on 26/11/2021
[36] Palumbo R, Annarumma C, Adinolfi P, Musella M, Piscopo G. The Italian Health Literacy Project: Insights from the assessment of health literacy skills in Italy. Health Policy, 2016;120:1087-94. doi: 10.1016/j.healthpol.2016.08.007
[37] Bor J, Fischer C, Modi M, Richman B, Kinker C, King R, Calabrese SK, Mokhele I, Sineke T, Zuma T, Rosen S, Bärnighausen T. Changing Knowledge and Attitudes Towards HIV Treatment‑as‑Prevention and “Undetectable=Untransmittable”: A Systematic Review. AIDS and Behavior 2021;25:4209–4224. doi: 10.1007/s10461-021-03296-8
[38] Deblonde J, De Koker P, Hamers F, Fontaine J, Luchters S, Temmerman M. (2010). Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 2010:20;422-32. doi: 10.1093/eurpub/ckp231
[39] Tan K, Perry Black B. A systematic review of healthcare provider perceived barriers and facilitators to routine HIV testing in primary care settings in the Southeastern United States. J Assoc Nurses AIDS Care 2018;29:357–370. doi: 10.1016/j.jana.2017.12.006
[40] White BL, Walsh J, Rayasam S, Pathman DE, Adimora AA, Golin CE. What Makes Me Screen for HIV? Perceived Barriers and Facilitators to Conducting Recommended Routine HIV Testing among Primary Care Physicians in the Southeastern United States. J Int Assoc Provid AIDS Care 2015;14:127-135. doi: 10.1177/2325957414524025
[41] Wandeler G, Johnson LF, Egger M. Trends in life expectancy of HIV-positive adults on antiretroviral therapy across the globe: comparisons with general population. Current Opinion in HIV and AIDS 2016;11:492–500. doi: 10.1097/COH.0000000000000298
[42] British HIV Association. Standards of Care for People Living with HIV. Available at https://www.bhiva.org/file/WSheCFExXGBRK/BHIVAStandardsA4.pdf Accessed on 26/11/2021
[43] Suárez-Reyes M, Muñoz Serrano M, Van den Broucke S. (2019). How do universities implement the Health Promoting University concept? Health Promotion International 2019;34:1014–1024. doi: 10.1093/heapro/day055
[44] Dooris M, Powell S, Farrier A. Conceptualizing the 'whole university' approach: an international qualitative study. Health Promot International 2020;35:730-740. doi: 10.1093/heapro/daz072