High level of Aids-related stigma in Pakistani dentistry

Jeremy Booth, Dental Tribune International

Fri. 1. December 2023

save

ISLAMABAD, Pakistan: The number of people with HIV/Aids in Pakistan has increased dramatically in recent years, and the classification of HIV/Aids prevalence in the South Asian country has moved from low to a concentrated epidemic in major Pakistani cities. In the first study to investigate HIV/Aids-related knowledge, stigma and care practices among dental healthcare providers in Pakistan, researchers identified shortfalls in knowledge and professional practice and rampant stigma exhibited by dental teams in both public and private dental settings.

The study involved interviews with 601 dental professionals representing 200 dental care facilities. The sample population had a mean age of 31.8 years, were 59.1% men and consisted of 64.8% dentists, 15.0% dental assistants and 20.5% dental hygienists. Of the respondents, 10.8% reported having received training abroad.

In the area of knowledge, the researchers found that just 17.1% of respondents had received formal training related to HIV/Aids and that many had misconceptions about the routes of transmission of the virus. Kissing, hugging and touching, and eating and drinking with people with HIV/Aids were reported as transmission routes by 38.3% and 34.4% of respondents, respectively. The vast majority (95%) considered themselves to be at risk of acquiring HIV from a patient, despite clinical precautions, and 89% said that they would be hesitant to treat HIV-positive patients. Regarding professional practice, almost all respondents (97.5%) said that they would skip one or more treatment steps when providing oral care to patients with HIV/Aids, and 91.2% said that they would keep patients with HIV/Aids separate from other patients.

Although stigma was evident throughout the sample population, dentists showed higher levels of stigma, and respondents working in private hospitals and clinics showed higher levels of stigma than those in public oral care settings.

A total of 61.8% of respondents agreed that people with HIV/Aids should be ashamed of themselves, 96% believed that people with HIV/Aids do not care if they infect others, 76.6% believed that persons with HIV/Aids have multiple sexual partners and just 29.1% believed that patients with HIV/Aids should be treated similarly to people with other illnesses. The majority of respondents said that they would prefer not to treat men who have sex with men (55.2%) or female sex workers (57.4%).

Lead of the study Dr Beenish Rana of the Health Services Academy in Islamabad told Dental Tribune International: “This reluctance of providers to treat these patients fuels the existing health disparities and exacerbates inequalities in healthcare access and outcomes, particularly related to the management of sexually transmitted infections like HIV.”

She continued: “The absence of specific training on dealing with people living with HIV/Aids among dental healthcare providers in Pakistan has led to a reliance on stereotypes and assumptions. Unlike many neighbouring countries, the usual medical curriculum in Pakistan lacks incorporation of training on HIV/Aids-related issues, contributing to the prevalence of negative stereotypes among healthcare providers.”

The impact of HIV/Aids-related stigma

According to Dr Rana, the historically low prevalence of HIV/Aids in Pakistan has led to a lack of attention from health authorities and policymakers, resulting in a paucity of educational initiatives and limited institutional support for dental healthcare providers and ultimately perpetuating negative stereotypes and hindering the delivery of oral care; nonetheless, she said that the research team was surprised by the extent of misconception among the study population.

“Unlike many neighbouring countries, the usual medical curriculum in Pakistan lacks incorporation of training on HIV/Aids-related issues.”

“The study, being the first of its kind in Pakistan among dental care providers, uncovered a strikingly high prevalence of HIV/Aids-related stigma within various dental care facilities in the Islamabad Capital Territory,” Dr Rana said. She commented that the discriminating attitude shown towards patients with HIV/Aids not only undermines quality of care but also fosters self-stigmatisation among these patients. “This self-stigmatisation, in turn, has profound and detrimental effects on their mental health, treatment adherence and overall quality of life. When healthcare providers harbour misconceptions and judgements about HIV/Aids, it creates an environment that not only hinders open communication between providers and patients but also instils fear and hesitation in people living with the virus.”

“The impact of this stigma extends beyond the immediate healthcare interactions. People living with HIV/Aids may find themselves compelled to conceal their HIV status or provide false information to avoid judgement and discrimination. Such behaviour not only jeopardises their access to appropriate healthcare but also increases the risk of spreading the infection owing to lack of transparency in medical histories,” she explained.

“Addressing and dismantling these deeply ingrained stigmas within healthcare settings is crucial not only for the well-being of people living with HIV/Aids but also for fostering an inclusive and compassionate healthcare environment that promotes the overall health and dignity of every individual,” Dr Rana concluded.

Some 183,000 people in Pakistan were estimated to have HIV/Aids in 2020. The number of people with HIV/Aids globally was 39.0 million in 2022, compared with 26.6 million in 2000, according to the World Health Organization.

The study, titled “A cross-sectional study to assess HIV/AIDS-related stigma and its drivers among dental healthcare providers in Islamabad, Pakistan”, was published online on 9 October 2023 in the open access journal Cureus.