A questionnaire survey of 1500 PLWHA was conducted from September 1, 2018 to March 1, 2019. Among them, 101 people could not be contacted because their WeChat ID was no longer used and 220 people refused to cooperate with the survey. 13 people interrupted the online investigation due to private affairs during the investigation. The number of PLWHA who finally completed the survey was 1166 and the response rate was 77.27%. After excluding 20 invalid questionnaires with serious logical confusion, 1146 valid PLWHA samples were ultimately obtained. As shown in Table 1, the oldest age was 66 years old, the youngest was 17 years old, and the mean age was (31 ± 8) years old. 96.1% (1101/1146) of the respondents were male, 93.6% (1073/1146) were Han nationality, 53.0% (608/1146) had a bachelor’s, master’s degree or above, 72.1% (826/1146) were unmarried, 58.5% (670/1146) were from cities, 43.5% (498/1146) were the only children, and 10.6% (121/1146) were students.
Table 1
Social Demographic Characteristics of PLWHA [n (%)]
Variable
|
PLWHA(N = 1146)
|
number of people(N)
|
composition(%)
|
Gender
|
|
Male
|
1101
|
96.1
|
Female
|
45
|
3.9
|
Nationality
|
|
Han
|
1073
|
93.6
|
Minority
|
73
|
6.4
|
Education
|
|
Master degree and above
|
100
|
8.7
|
Bachelor degree
|
508
|
44.3
|
Junior college
|
252
|
22.0
|
High school or technical secondary school
|
189
|
16.5
|
Junior high school
|
89
|
7.8
|
Primary school
|
8
|
0.7
|
Marital status
|
|
Unmarried
|
826
|
72.1
|
Married
|
245
|
21.4
|
Divorced
|
69
|
6.0
|
Widowed
|
6
|
0.5
|
Domicile
|
|
City
|
670
|
58.5
|
Rural area
|
476
|
41.5
|
Only child
|
|
|
Yes
|
498
|
43.5
|
No
|
648
|
56.5
|
Are you a student
|
|
|
Yes
|
121
|
10.6
|
No
|
1025
|
89.4
|
A questionnaire survey of medical staff was conducted in July 2020. Finally, 890 valid samples were obtained, including 312 doctors and 578 nurses, with a total response rate of 89.0% (890/1000). Among the 890 medical staff, the oldest is 53 years old, and the youngest is 18 years old. The median age is P50 = 29 years (P25 = 25,P75 = 34); male 21.1% (187/890), female 78.9% (703/ 890); doctors 35.1% (312/890), nurses 64.9% (578/890); unmarried 44.3% (393/890), married 55.7% (497/890). 46.5% (414/890) have been employed for 1 to 5 years, 53.5% (476/890) have been employed for more than 5 years; 47.0% (418/890) were junior professional titles, and 37.5% (334/890) were intermediate professional titles, and 15.5% (138/890) were senior professional titles; 1.3% (12/890) graduated from high school, technical secondary school or below, 27.0% (240/890) graduated from junior college, 56.9% (506/890) graduated from bachelor’s degree and 14.8% (132/890) graduated with a master's degree or above. In addition, 43.1% (384/890) indicated exposure to PLWHA in past jobs.
Table 2
Social Demographic Characteristics of Medical Staff
Variable
|
Total N = 890
|
Doctors N = 312
|
Nurses N = 578
|
χ2
|
P
|
|
N
|
%
|
N
|
%
|
N
|
%
|
|
|
Male
|
187
|
21.1
|
139
|
44.6
|
48
|
8.3
|
76.98
|
0.000
|
Female
|
703
|
78.9
|
175
|
56.0
|
528
|
91.3
|
Age༜29
|
428
|
48.1
|
114
|
36.5
|
314
|
54.3
|
12.84
|
0.000
|
Age ≥ 29
|
462
|
51.9
|
198
|
63.5
|
264
|
45.7
|
Unmarried
|
393
|
44.2
|
104
|
33.3
|
290
|
50.2
|
11.65
|
0.000
|
Married
|
497
|
55.8
|
208
|
66.7
|
288
|
49.8
|
Employed for 1 to 5 years
|
414
|
46.5
|
114
|
36.5
|
300
|
51.9
|
9.61
|
0.002
|
Employed for more than 5 years
|
476
|
53.5
|
198
|
63.5
|
278
|
48.1
|
Junior professional titles
|
418
|
47.0
|
134
|
42.9
|
284
|
49.1
|
1.56
|
0.212
|
Intermediate/senior professional titles
|
472
|
53.0
|
178
|
57.1
|
294
|
50.9
|
Graduated from junior college or below
|
252
|
28.3
|
22
|
7.1
|
230
|
39.8
|
53.51
|
0.000
|
Graduated from bachelor’s degree or above
|
638
|
71.7
|
290
|
92.9
|
348
|
60.2
|
Exposure to PLWHA in past jobs
|
384
|
43.1
|
36
|
11.5
|
348
|
60.2
|
97.83
|
0.000
|
The incidence, type, help-seeking situation of PLWHA rejected by medical staff
Table 3 describes the incidence and help-seeking situation of rejection experienced by PLWHA. 30.2% (346/1146) of PLWHA indicated that they had encountered refusal of treatment in hospital since their diagnosis of HIV+; 17.1% (196/1146) of PLWHA indicated that they had encountered at least one different type of rejection (Non-surgical disease outpatient rejection, clinical surgery rejection, clinical postoperative care rejection, non-postoperative care rejection, psychological outpatient rejection, and other hospital rejection) in hospital in the last 12 months. Among them, the clinical surgery rejection rate is the highest; up to 10.8% (124/1146), followed by the refusal of post-operative care, 8.2% (94/1146). 13.4% (154/1146) had been rejected by the doctor and 8.8% of the participants (101/1146) had been rejected by the nurse. Among 196 people who were rejected in the last 12 months, 114 (9.9%) said they had never asked for help after being rejected and 63 (5.5%) said they had asked volunteers for help, 29 (2.5%) reported to the local health department and asked for help. Moreover, only 14 people (1.2%) had sought help from friends or family members and 74 people (6.5%) had received further treatment. The χ2 test results showed that there was no significant difference in the incidence, type and help-seek data of rejection in between men who have sex with men and those infected by other means.
Table 3
The incidence and type of PLWHA rejected by medical staff [n (%)]
Variable
|
Total(N = 1146)
|
Men who have sex with men(N = 951)
|
Infected by other means(N = 195)
|
χ2
|
P
|
Rejected since their diagnosis of HIV + a
|
346(30.2)
|
281(29.5)
|
66(33.8)
|
1.10
|
0.305
|
Rejected in the last 12 months a
|
196(17.1)
|
167(17.6)
|
29(14.9)
|
0.83
|
0.404
|
Rejected by doctors
|
154(13.4)
|
123(12.9)
|
26(15.9)
|
#
|
#
|
Rejected by nurses
|
101(8.8)
|
81(8.2)
|
20(10.3)
|
#
|
#
|
Types of rejection
|
|
|
|
|
|
Non-surgical disease outpatient rejection
|
26(2.3)
|
20(2.0)
|
6(3.1)
|
#
|
#
|
Clinical surgery rejection
|
124(10.8)
|
97(10.2)
|
27(13.8)
|
#
|
#
|
Clinical postoperative care rejection
|
94(8.2)
|
73(7.7)
|
21(10.8)
|
#
|
#
|
Non-postoperative care rejection
|
32(2.8)
|
29(3.0)
|
3(1.5)
|
#
|
#
|
Psychological outpatient rejection
|
5(0.4)
|
4(0.4)
|
1(0.5)
|
#
|
#
|
Other hospital rejection
|
18(1.6)
|
14(1.5)
|
4(2.1)
|
#
|
#
|
Asked for help after being rejected
|
|
|
|
|
|
Never asked for help
|
114(9.9)
|
101(10.6)
|
13(6.6)
|
2.82
|
0.114
|
Asked for help from friends or family members
|
14(1.2)
|
3(0.3)
|
11(5.6)
|
#
|
#
|
Asked volunteers for help
|
63(5.5)
|
52(5.5)
|
11(5.6)
|
#
|
#
|
Reported to the local health department and asked for help
|
29(2.5)
|
20(2.1)
|
9(4.6)
|
#
|
#
|
Received further treatment after asking for help
|
|
|
|
|
|
Yes
|
74(6.5)
|
64(6.7)
|
10(5.1)
|
0.69
|
0.522
|
No
|
122(10.6)
|
110(11.6)
|
12(6.2)
|
4.98
|
0.029
|
a Refers to one or more of the 6 types of rejection: non-surgical disease outpatient rejection, clinical surgery rejection, clinical postoperative care rejection, non-postoperative care rejection, psychological outpatient rejection, and other hospital rejection.
The accuracy of medical staff's answer to HIV/AIDS knowledge
As displayed in Table 4, for the 890 medical staff who responded to about 24 HIV/AIDS knowledge questions, the median number of accurate answers was 15 questions (P25 = 12, P75 = 18). The χ2 test results show that the two groups of doctors and nurses have statistical differences in their responses to 13 questions (2, 3, 5, 6, 8, 9, 13, 14, 15, 17, 19, 21, 22). Among them, the correct answer rate of 6 questions in the doctor group (2, 3, 5, 15, 19, 22) was higher than that of the nurse group; while the answer rate of 7 questions in the nurse's group (6,8,9,13,14,17,21) was higher than that of the doctor's group. According to the median number of questions answered accurately P50 = 15, all the samples were divided into two groups (≤ 14 = 1, > 15 = 2): group 1 was the group with lower accuracy and group 2 with higher accuracy. The χ2 test results show that there is a statistically significant difference in the HIV/AIDS knowledge between the two groups of doctors and nurses (χ2 = 6.13, P = 0.01). After controlling for age, marital status, education, professional title, employment years and other factors, the difference between the two groups was still statistically significant (OR = 1.69, 95%CI [1.09,2.61]) and the nurse group had higher accuracy in answering HIV/AIDS knowledge than the doctor group.
Table 4
The answer accuracy of HIV/AIDS-related knowledge(%)
Item
|
Total
N = 890
|
Doctors
N = 312
|
Nurses
N = 578
|
χ2
|
1.A person infected with HIV can immediately know whether he has been infected by a blood test.
|
78.9
|
79.5
|
78.5
|
0.05
|
2.After HIV infection, CD4 + T cells will decline first.
|
49.2
|
69.2
|
38.4
|
38.51***
|
3.HIV needs CD4 cells as receptors to enter cells.
|
56.6
|
75.6
|
46.4
|
35.35***
|
4.People infected with HIV can show no symptoms for months or years.
|
83.8
|
85.3
|
83.0
|
0.37
|
5.After HIV infection, CD4 + T cells first appear cell dysfunction, which is mainly manifested as defects in the recognition and response of soluble antigens.
|
62.6
|
71.8
|
57.1
|
9.32**
|
6.People infected with HIV are not infectious without symptoms.
|
91.5
|
86.5
|
91.5
|
7.45**
|
7.Now, AIDS has been regarded as a preventable and controllable chronic disease.
|
42.5
|
39.7
|
43.9
|
0.73
|
8.Women with HIV can transmit HIV to their babies through breastfeeding.
|
74.6
|
67.9
|
78.2
|
5.62*
|
9.There is already a vaccine to prevent HIV infection
|
66.1
|
55.8
|
71.6
|
11.36**
|
10.AIDS cannot be cured yet.
|
80.9
|
76.3
|
83.4
|
3.31
|
11.The number of people living with HIV is the same as people living with AIDS.
|
63.4
|
59.0
|
65.7
|
2.00
|
12.Abuse of addictive substances increases the chance of contracting HIV.
|
42.0
|
46.2
|
39.8
|
1.68
|
13.The volume of HIV is smaller than the gap between the molecules of the condom material, so the correct use of condoms cannot reduce the risk of HIV infection.
|
59.6
|
40.4
|
69.9
|
36.63***
|
14.Discrimination against AIDS patients will hinder the progress of AIDS prevention.
|
82.5
|
70.5
|
88.9
|
23.77***
|
15.Women with HIV can give birth to healthy babies through mother-to- child blocking technology(PMTCT).
|
44.3
|
53.8
|
39.1
|
8.93**
|
16.Highly active antiretroviral therapy (HARRT) is the treatment of AIDS through the combined use of three or more antiviral drugs that can effectively control AIDS.
|
53.3
|
48.7
|
55.7
|
1.99
|
17.Drug blocking can occur within 72 hours after HIV exposure.
|
37.1
|
30.8
|
40.5
|
4.01*
|
18.After taking antiviral drugs for HIV-infected persons, they will not be infectious once their viral load drops below the detection level (20 copies/ml).
|
67.9
|
69.9
|
66.8
|
0.44
|
19.If HIV-infected persons are given antiviral treatment on time and in quantity, they can achieve functional treatment success with almost no impact on lifespan.
|
29.7
|
37.8
|
25.3
|
7.66**
|
20.Saliva is one of the vectors of HIV transmission.
|
62.2
|
58.3
|
64.4
|
1.57
|
21.You can tell whether a person is infected with HIV by their appearance.
|
82.9
|
72.4
|
88.6
|
18.65***
|
22.HARRT is also known as "cocktail therapy", because the drug configuration method is very similar to the cocktail configuration, mixing multiple drugs and using special methods to mix them well.
|
58.9
|
72.4
|
51.6
|
18.24***
|
23.AIDS can have no symptoms or various symptoms.
|
82.0
|
79.5
|
83.4
|
1.05
|
24.As long as you come into contact with the blood, semen, vaginal secretions, and exudates from severely ulcerated wounds, you will be infected
|
34.8
|
29.5
|
37.7
|
3.02
|
*.P༜0.05; **.P༜0.01; ***.P༜0.001 |
Medical staff's attitude to HIV/AIDS
Table 5
Medical staff's attitude to HIV/AIDS(%)
Item
|
Agree & totally agree
|
χ2/t
|
Total
N = 890
|
Doctors
(N = 312)
|
Nurses
(N = 578)
|
1. AIDS has nothing to do with me.
|
4.7
|
3.8
|
5.2
|
0.41
|
2.Society should not accept people with HIV or AIDS.
|
3.8
|
1.3
|
5.2
|
4.21*
|
3.I am afraid of AIDS.
|
42.9
|
34.6
|
47.4
|
6.76**
|
4.People with HIV/AIDS are disgusting.
|
16.2
|
21.2
|
13.5
|
4.38*
|
5.AIDS is the punishment for unethical behavior.
|
8.3
|
9.6
|
7.6
|
0.53
|
6.Only people infected with AIDS from blood transfusion deserve sympathy.
|
23.1
|
26.9
|
21.1
|
1.93
|
7. AIDS patients should be isolated.
|
25.6
|
32.1
|
22.1
|
5.22*
|
8.People should support and care for AIDS patients.
|
70.8
|
69.9
|
71.3
|
0.10
|
9.People living with HIV have the right to use public facilities.
|
51.9
|
48.1
|
54.0
|
1.41
|
10.Employers have the right to dismiss HIV-infected employees.
|
16.6
|
17.3
|
16.3
|
0.08
|
11.Schools or kindergartens should not refuse to admit AIDS students and children.
|
32.4
|
32.1
|
32.5
|
0.01
|
12.Mothers who transmit HIV to their children should be punished.
|
19.3
|
27.6
|
14.9
|
10.46**
|
13.If my friend is infected with AIDS, I will cut off contact with him.
|
8.5
|
12.2
|
6.6
|
4.08*
|
14.Working or studying with people living with HIV will not bother me.
|
28.8
|
26.3
|
30.1
|
0.72
|
15.If college students are infected with AIDS, they should be expelled from school.
|
8.1
|
7.7
|
8.3
|
0.05
|
16.People living with HIV can still contribute to society.
|
69.0
|
57.7
|
75.1
|
14.33***
|
17.It is the responsibility of the whole society not to discriminate against HIV-infected/AIDS patients.
|
72.6
|
61.5
|
78.5
|
14.73***
|
18.The Ministry of Health should disclose information about people living with HIV to protect citizens.
|
27.6
|
35.3
|
23.5
|
6.97**
|
19.If there are activities to visit AIDS patients, I will participate.
|
48.1
|
44.2
|
50.2
|
1.43
|
20.I don’t mind being a colleague with people living with HIV.
|
41.1
|
44.9
|
39.1
|
1.39
|
21. Medical staff infected with HIV should be allowed to continue working.
|
29.7
|
30.1
|
29.4
|
0.03
|
22.People living with HIV/AIDS should not be allowed to work as teachers.
|
23.1
|
28.8
|
20.1
|
4.39*
|
23. Under no circumstances should people living with HIV/AIDS suffer discrimination in employment.
|
43.8
|
35.3
|
48.4
|
7.16**
|
24. People with HIV/AIDS should be allowed to adopt children.
|
25.8
|
21.2
|
28.4
|
2.76
|
Total
|
62.18 ± 9.75
|
64.34 ± 8.29
|
60.98 ± 10.28
|
3.52***
|
*.P༜0.05; **.P༜0.01; ***.P༜0.001 |
The χ2 test results displayed that there was a statistically significant difference in the answers between the doctors and nurses on 11 items (2, 3, 4, 7, 12, 13, 16, 17, 18, 22, 23). After reversing the scores of 12 reverse scoring items (8,9,11,13,14,16,17,19,20,21,23,24) in the HIV/AIDS attitude questionnaire, adds the scores of other items to obtain the total score of each sample. The total score is between 24 and 120 points. The higher the score, the more negative the attitude towards HIV/AIDS. The scores of 890 respondents ranged from 30 to 87, with an average of 62.18 ± 9.75. As shown in Table 5, the t-test results show that there were statistically significant differences in 15 items (1,3,4,5,7,12,13,15,16,17,18,23,24) and total scores between the doctors and nurses groups. After controlling for age, marital status, educational, professional title, employment years and other factors, the difference between the two groups was still statistically significant (OR = 1.55, 95%CI: 1.01, 2.38), and the doctor group’s attitude towards HIV/AIDS was more negative. After controlling for these factors, HIV/AIDS knowledge is the influencing factor of the medical staff’s attitude towards PLWHA (OR = 1.57, 95%CI: 1.06), 2.31).
Medical staff's willingness to diagnosis and treat HIV-infected /AIDS patients
Table 6
Medical staff's willingness to diagnosis and treat HIV-infected /AIDS patient(%)
Item
|
Agree & totally agree
|
χ2/t
|
|
Total
N = 890
|
Doctors
N = 312
|
Nurses
N = 578
|
1.I think it is necessary to do a HIV antibody test for all patients before surgery.
|
84.5
|
84.6
|
84.4
|
0.00
|
2.All patients in the clinic are potentially infectious and the same preventive measures should be taken.
|
69.2
|
62.8
|
72.7
|
4.61*
|
3.I may be infected with AIDS due to surgical treatment and post-operative care for PLWHA.
|
65.4
|
61.5
|
67.5
|
1.58
|
4.Medical staff should not refuse to provide services to PLWHA.
|
63.6
|
68.6
|
60.9
|
2.59
|
5.I think that in clinical practice, PLWHA must be isolated from people infected with other diseases.
|
69.7
|
69.9
|
69.6
|
0.01
|
6.I think that for PLWHA, such as tumors, surgery and other treatments should be given in time like other non-infected patients.
|
58.7
|
70.5
|
52.2
|
13.94***
|
7.I think that PLWHA should actively inform the doctor or nurse that he is PLWHA when he goes to the hospital.
|
83.6
|
82.1
|
84.4
|
0.42
|
8.I have the right to refuse service PLWHA.
|
25.4
|
31.4
|
22.1
|
4.59*
|
9.PLWHA should go to a special hospital for treatment.
|
59.6
|
60.3
|
59.2
|
0.05
|
10.I am willing to provide PLWHA with surgical treatment or post-operative care services.
|
38.7
|
38.5
|
38.8
|
0.00
|
11. If there is an appropriate financial incentive, I am willing to provide PLWHA with surgical treatment or post-operative care.
|
47.9
|
49.4
|
47.1
|
0.22
|
Total
|
5.52 ± 1.44
|
5.63 ± 1.42
|
5.46 ± 1.45
|
1.18
|
*.P༜0.05; **.P༜0.01; ***.P༜0.001 |
In this study, 11 items in Table 6 were used to evaluate the willingness of all samples for the surgical treatment of PLWHA. Reverse entries 1, 3, 7, 8, 9 are scored as 1 point for answers "disagree" and "totally disagree", 0 points for responses "agree" and "totally agree"; and forward entries 2, 4, 5, 6, 10, 11 are scored as 1 point for answers "agree" and "totally agree", 0 points for responses "disagree" and "totally disagree". The scores of 11 items are added together. The higher the score, the stronger the willingness to treat PLWHA.The scores of 890 respondents ranged from 1 to 9, with an average of 5.52 ± 1.44. The t-test results showed that there was no statistically significant difference between doctors' and nurses' willingness to diagnose and treat PLWHA. After controlling for age, gender, education, occupation, title, employment years, and whether or not you have been exposed to PLWHA in the past work, the HIV/AIDS knowledge (OR = 2.41, 95%CI: 1.31 ~ 4.43), and the attitude to PLWHA (OR = 6.74, 95%CI: 3.59 ~ 12.66) are the factors affecting the willingness of medical staff to diagnose and treat PLWHA. The medical staff have a higher accuracy rate of answering the HIV/AIDS knowledge questions but their attitude towards PLWHA is still relatively negative. Their willingness to diagnose and treat PLWHA is weak.