Top

Published in:

Open Access 01-12-2020 | Nutrition | Research article

HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system

Authors: Mutiara Tirta Prabandari Lintang Kusuma, Tandalayo Kidd, Nancy Muturi, Sandra B. Procter, Linda Yarrow, Wei-Wen Hsu

Published in: BMC Infectious Diseases | Issue 1/2020

Abstract

Background

Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students’ acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory.

Methods

Students from three dietetics schools in Indonesia (n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome.

Results

The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge (p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study (p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes (p < 0.05).

Conclusions

Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients’ quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.

UNAIDS. UNAIDS data 2018; 2018. https://www.unaids.org/en/resources/documents/2018/unaids-data-2018. Accessed 26 March 2020.

de Pee S, Semba RD. Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings. Food Nutr Bull. 2010;31(4):S313–44.PubMedCrossRef

Poda GG, Hsu CY, Chao JC. Malnutrition is associated with HIV infection in children less than 5 years in Bobo-Dioulasso City, Burkina Faso: a case-control study. Medicine (Baltimore). 2017;96(21):e7019. https://doi.org/10.1097/MD.0000000000007019.CrossRef

Negessie A, Jara D, Taddele M, Burrowes S. Determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a case-control study design. BMC Nutr. 2019;5:20. https://doi.org/10.1186/s40795-019-0284-9.PubMedPubMedCentralCrossRef

Apornpong T, Han WM, Chattranukulchai P, Siwamogsatham S, Wattanachanya L, Gatechompol S, et al. Higher proportion of abnormal nutritional status among well suppressed HIV-infected elderly Asians compared to HIV-negative individuals. AIDS Res Hum Retrovir. 2020;36(7):590–6. https://doi.org/10.1089/AID.2019.0285.PubMedCrossRef

Thimmapuram R, Lanka S, Esswein A, Dall L. Correlation of nutrition with immune status in human immunodeficiency virus outpatients. Mo Med. 2019;116(4):336–9.PubMedPubMedCentral

Shin SS, Satyanarayana VA, Ekstrand ML, Carpenter CL, Wang Q, Yadav K, et al. The effect of community-based nutritional interventions on children of women living with HIV in rural India: a 2 x 2 factorial intervention trial. Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciz1009.

Dong KR, Imai CM. Medical nutrition therapy for HIV and AIDS. In: Mahan LK, Escott-Stump S, Raymond JL, editors. Krause's food and the nutrition care process. St. Louis: Elsevier; 2012.

Fields-Gardner C, Campa A. Position of the American dietetic association: nutrition intervention and human immunodeficiency virus infection. J Am Diet Assoc. 2010;110(7):1105–19. https://doi.org/10.1016/j.jada.2010.05.020.PubMedCrossRef

10.

Pribram V. Nutrition and HIV. Hoboken: Wiley-Blackwell; 2010.CrossRef

11.

Paxton S, Gonzales G, Uppakaew K, Abraham KK, Okta S, Green C, et al. AIDS-related discrimination in Asia. AIDS Care. 2005;17(4):413–24. https://doi.org/10.1080/09540120412331299807.PubMedCrossRef

12.

Waluyo A, Culbert GJ, Levy J, Norr KF. Understanding HIV-related stigma among Indonesian nurses. J Assoc Nurses AIDS Care. 2015;26(1):69–80. https://doi.org/10.1016/j.jana.2014.03.001.PubMedCrossRef

13.

Merati T, Supriyadi YF. The disjunction between policy and practice: HIV discrimination in health care and employment in Indonesia. AIDS Care. 2005;17(Suppl 2):S175–9. https://doi.org/10.1080/09540120500119932.PubMedCrossRef

14.

Gagnon M. Re-thinking HIV-related stigma in health care settings: a qualitative study. J Assoc Nurses AIDS Care. 2015;26(6):703–19. https://doi.org/10.1016/j.jana.2015.07.005.PubMedCrossRef

15.

Palar K, Derose KP, Linnemayr S, Smith A, Farias H, Wagner G, et al. Impact of food support on food security and body weight among HIV antiretroviral therapy recipients in Honduras: a pilot intervention trial. AIDS Care. 2015;27(4):409–15. https://doi.org/10.1080/09540121.2014.983041.PubMedCrossRef

16.

Lui P, Sarangapany J, Begley K, Coote K, Kishore K. Medical and nursing students perceived knowledge, attitudes, and practices concerning human immunodeficiency virus. ISRN Public Health. 2014;2014:1–9. https://doi.org/10.1155/2014/975875.CrossRef

17.

Premadasa G, Sadek M, Ellepola A, Sreedharan J, Muttappallymyalil J. Knowledge of and attitudes towards HIV/AIDS: a survey among dental students in Ajman, UAE. J Investig Clin Dent. 2015;6(2):147–55. https://doi.org/10.1111/jicd.12080.PubMedCrossRef

18.

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;7:168. https://doi.org/10.1186/1756-0500-7-168.PubMedPubMedCentralCrossRef

19.

Akin S, Mendi B, Mendi O, Durna Z. Turkish nursing students’ knowledge of and attitudes towards patients with HIV/AIDS. J Clin Nurs. 2013;22(23–24):3361–71. https://doi.org/10.1111/jocn.12378.PubMedCrossRef

20.

Liem A, Adiyanti MG. Bidan cantik: psychoeducation on HIV and AIDS to improve the service quality of midwives at Yogyakarta public health center. HIV AIDS Rev. 2013;12(1):14–22. https://doi.org/10.1016/j.hivar.2013.02.001.CrossRef

21.

Wisaksana R, Alisjahbana B, van Crevel R, Kesumah N, Sudjana P, Sumantri R. Challenges in delivering HIV-care in Indonesia: experience from a referral hospital. Acta Med Indones. 2009;41(Suppl 1):45–51.PubMed

22.

Ion A, Elston D. Examining the health care experiences of women living with human immunodeficiency virus (HIV) and perceived HIV-related stigma. Womens Health Issues. 2015;25(4):410–9. https://doi.org/10.1016/j.whi.2015.03.012.PubMedCrossRef

23.

Forsterling F. Attribution: an introduction to theories, research, and applications. Philadelphia: Psychology Press, Ltd.; 2001.

24.

Weiner B, Perry RP, Magnusson J. An attributional analysis of reactions to stigmas. J Pers Soc Psychol. 1988;55(5):738–48. https://doi.org/10.1037//0022-3514.55.5.738.PubMedCrossRef

25.

Center for Data and Information Indonesian Ministry of Health. The general situation of HIV and AIDS and HIV testing; 2017. https://pusdatin.kemkes.go.id/article/view/19042200004/situasi-umum-hiv-aids-dan-tes-hiv.html. Accessed 26 March 2020.

26.

Kim BSK, Atkinson DR, Yang PH. The Asian value scale: development, factor analysis, validation, and reliability. J Couns Psychol. 1999;46(3):342–52. https://doi.org/10.1037/0022-0167.46.3.342.CrossRef

27.

King M, Jones L, Barnes K, Low J, Walker C, Wilkinson S, et al. Measuring spiritual belief: development and standardization of a beliefs and values scale. Psychol Med. 2006;36(3):417–25. https://doi.org/10.1017/S003329170500629X.PubMedCrossRef

28.

Kim BSK, Atkinson DR. Asian American client adherence to Asian cultural values, counselor expression of cultural values, counselor ethnicity, and career counseling process. J Couns Psychol. 2002;49(1):3–13. https://doi.org/10.1037//0022-0167.49.1.3.CrossRef

29.

Jin H, Earnshaw VA, Wickersham JA, Kamarulzaman A, Desai MM, John J, et al. An assessment of healthcare students’ attitudes toward patients with or at high risk for HIV: implications for education and cultural competency. AIDS Care. 2014;26(10):1223–8. https://doi.org/10.1080/09540121.2014.894616.PubMedPubMedCentralCrossRef

30.

Mbanya D, Ateudjieu J, Tagny CT, Moudourou S, Lobe MM, Kaptue L. Risk factors for transmission of HIV in a hospital environment of Yaounde, Cameroon. Int J Environ Res Public Health. 2010;7(5):2085–100. https://doi.org/10.3390/ijerph7052085.PubMedPubMedCentralCrossRef

31.

Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. The symbolic meaning of HIV: understanding lecturers’ ambivalence over teaching HIV to dietetic students. J Int Assoc Provid AIDS Care. 2020;19:2325958220939755. https://doi.org/10.1177/2325958220939755.PubMedPubMedCentralCrossRef

32.

Indonesian National AIDS Commission. Global AIDS response progress reporting, Indonesia country progress report 2014: reporting period 2012–2013; 2014. https://www.unaids.org/sites/default/files/country/documents/IDN_narrative_report_2014.pdf. Accessed 5 April 2017.

33.

Amin Z, Hoon Eng K, Gwee M, Dow Rhoon K, Chay HT. Medical education in Southeast Asia: emerging issues, challenges, and opportunities. Med Educ. 2005;39(8):829–32. https://doi.org/10.1111/j.1365-2929.2005.02229.x.PubMedCrossRef

34.

Amin Z. Medical education in Asia: is it a time for optimism? Ann Acad Med Singap. 2004;33(2):264–6.PubMed

35.

Susanti D. Privatisation and marketisation of higher education in Indonesia: the challenge for equal access and academic values. High Educ. 2011;61(2):209–18. https://doi.org/10.1007/s10734-010-9333-7.CrossRef

36.

Asian Development Bank. Private higher education across Asia: expanding access, searching for quality. Mandaluyong City: Asian Development Bank; 2012.

37.

Vorasane S, Jimba M, Kikuchi K, Yasuoka J, Nanishi K, Durham J, et al. An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR. BMC Health Serv Res. 2017;17(1):125. https://doi.org/10.1186/s12913-017-2068-8.PubMedPubMedCentralCrossRef

38.

Sarma H, Islam MA, Khan JR, Chowdhury KIA, Gazi R. Impact of teachers training on HIV/AIDS education program among secondary school students in Bangladesh: a cross-sectional survey. PLoS One. 2017;12(7):e0181627. https://doi.org/10.1371/journal.pone.0181627.PubMedPubMedCentralCrossRef

39.

Sarma H, Oliveras E. Implementing HIV/AIDS education: impact of teachers’ training on HIV/AIDS education in Bangladesh. J Health Popul Nutr. 2013;31(1):20–7. https://doi.org/10.3329/jhpn.v31i1.14745.PubMedPubMedCentralCrossRef

40.

Harvey JH, Weary G. Current issues in attribution theory and research. Annu Rev Psychol. 1984;35:427–59. https://doi.org/10.1146/annurev.ps.35.020184.002235.PubMedCrossRef

41.

Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: a systematic review of quantitative evidence. PLoS One. 2019;14(1):e0211298. https://doi.org/10.1371/journal.pone.0211298.PubMedPubMedCentralCrossRef

42.

Rao D, Elshafei A, Nguyen M, Hatzenbuehler ML, Frey S, Go VF. A systematic review of multi-level stigma interventions: state of the science and future directions. BMC Med. 2019;17(1):41. https://doi.org/10.1186/s12916-018-1244-y.PubMedPubMedCentralCrossRef

43.

Chan KY, Stoové MA, Reidpath DD. Stigma, social reciprocity, and exclusion of HIV/AIDS patients with illicit drug histories: a study of Thai nurses’ attitudes. Harm Reduct J. 2008;5(1):28. https://doi.org/10.1186/1477-7517-5-28.PubMedPubMedCentralCrossRef

44.

Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, et al. Stigma in health facilities: why it matters and how we can change it. BMC Med. 2019;17(1):25. https://doi.org/10.1186/s12916-019-1256-2.PubMedPubMedCentralCrossRef

45.

Varas-Diaz N, Neilands TB, Malave Rivera S, Betancourt E. Religion and HIV/AIDS stigma: implications for health professionals in Puerto Rico. Glob Public Health. 2010;5(3):295–312. https://doi.org/10.1080/17441690903436581.PubMedPubMedCentralCrossRef

Title: HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system
Authors: Mutiara Tirta Prabandari Lintang Kusuma
Tandalayo Kidd
Nancy Muturi
Sandra B. Procter
Linda Yarrow
Wei-Wen Hsu
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Nutrition
Human Immunodeficiency Virus
Acquired Immune Deficiency Syndrome
Published in: BMC Infectious Diseases / Issue 1/2020
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-020-05379-8

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Emergence of human avian influenza A(H7N9) virus infections in Wenshan City in Southwest China, 2017

Eosinopenia as a diagnostic marker of bloodstream infection in a general internal medicine setting: a cohort study

Intensely clustered outbreak of visceral leishmaniasis (kala-azar) in a setting of seasonal migration in a village of Bihar, India

Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections

Animal sources for zoonotic transmission of psittacosis: a systematic review

Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page