R e s e a r c h A r t i c l e AIDS a n d S e x u a l i t y E d u c a t io n in t h e P h y s io t h e r a p y C u r r i c u l u m INTRODUCTION S in ce the first reports in the early 1 9 8 0 s , acquired im m u ne d eficien ­ cy syndrom e (A ID S) is spreading inexorably across the A frican c o n ­ tinent. AIDS is essentially a sex u al­ ly transm itted disease, and the c au sativ e viru s is th e h u m an im m u n od eficien cy virus (H IV ). In South Africa, the prevalence of AIDS p oses a challenge. Records suggest that there are ab ou t five h u n d red th o u san d H IV -in fected people in the country, and that the response from governm ental and n o n -g o v e rn m e n ta l o rg a n isa tio n s has not m atched the exten t o f the p r o b le m 1. P u b lis h e d stu d ie s in Sou th A frica suggest a la ck of know ledge o f the transm ission and epidem iology o f A ID S, a lack of perceived risk and little evidence o f significant change towards safer sexual practices2'3. A n u m ber o f neurological m an i­ festations have b een reported in AIDS patients in A fricans1'5 and n on-A fricans5 6. T hese inclu de p ro ­ gressive polyradiculopathy, c ere ­ brovascular accid en ts, spinal cord degeneration and p eripheral n eu ­ ropathy T hese m an ifestations are reportedly caused by HIV itself and n o t by secondary o p p o rtu n is­ tic infections. It is kn ow n that m ed ical reh ab ilitation p erson n el (in clu d in g p h y sio th era p ists) are already involved in the care of A ID S p atien ts w ith o r w ith o u t neurological m anifestations. However, inaccu rate know ledge o f AIDS, along with anxiety and fear, am ong health care w orkers have been well d o cu m en ted .7'8 A study of reh abilitation person n el (in c lu d in g p h y s io th e ra p is ts ) in Z im babw e rep o rted th a t w hile m ost o f the respondents had a c cu ­ rate know ledge o f transm ission o f HIV, more than h alf o f the su b jec ts (N = 1 1 9 ) expressed fear o f b e c o m ­ ing infected w ith the virus.9 T h is in flu e n c e d th eir p ro fessio n a l behaviour in the treatm ent o f AIDS patients. In order to p rom ote a c c u ­ rate know ledge about A ID S, the study recom m en d ed that ed u ca­ tion in the pathoph ysiology and m ethods of transm ission o f HIV and treatm ent o f people w ith AIDS be included in the undergraduate p h y sio th e ra p y c u rr ic u lu m in Z im b ab w e and o th e r A frican countries. At the U niversity o f the W estern C ape, a set o f q u estion naires is adm inistered to new first-year stu ­ d ents during the annual University orien tation program m e. T he stu ­ d en ts are in fo rm ed in w ritin g about the purpose o f each q u es­ tion naire, and their rights to refuse to divu lg e an y in fo rm a tio n requested. E ach qu estion naire is com pleted anonym ou sly to m ain ­ tain confidentiality. O n e o f the q u estion naires is a validated 3 0 - item q u estio n n a ire w h ic h m e a ­ sures know ledge o f A ID S and a tti­ tudes towards people w ith AIDS an d h o m o s e x u a l p e r s o n s .10 C urrently, there is a d earth o f inform ation on the im p act o f AIDS on physiotherapists and p h y sio­ therapy services in Sou th Africa. T herefore the aim o f this study was to evaluate the available data on the know ledge and attitu d es of p h y sio th e ra p y stu d e n ts in the University o f the W estern Cape regarding AIDS. T he o u tco m e of the study was intend ed to establish Lhe exten t o f the stud ents' k n o w l­ edge deficits, and to provide data to inform cu rricu lu m d evelopm ent in physiotherapy edu cation. METHOD Data supplied by three groups of prospective first-year p h y sioth era­ py stud ents in 1991 (N = 3 5 ), 1 9 9 2 (N = 2 8 ) and 1 9 9 3 (N = 4 1 ) were retrieved from the data b a n k w h ich con tain ed in form ation on all first-year stud en ts w ho atten d ­ ed the o rien tation program m e in the specified period. T he p ro sp ec­ tive stud en ts indicated that they d esired to study physiotherapy but n o t all o f them were adm itted into the program m e. O nly 19, 2 7 and 3 0 stud ents respectively registered for p h ysiotherapy in 1 9 9 1 , .1992 and 1 9 9 3 . O nly qu estion s w hich were responded to by m ost o f the su b jec ts over the three years were c o n sid e r e d . T h u s re s p o n s e s to only 2 0 item s on the 3 0 -ite m q u es­ tion n a ire (Tables I & II) w ere analysed. T he stud en ts w ho were adm itted in to the physiotherapy program m e in 1 9 9 3 are cu rren tly in the fourth year o f training. In order to evalu­ ate any difference betw een their level o f know led ge and attitu des in the first and fourth years o f train­ ing, the 2 0 -ite m qu estion naire was readm inistered to this group of students. An additional q uestion was inclu ded w h ich assessed w ill­ in g n ess to give p h y sio th e ra p y treatm en t to a patient w ith AIDS. T h e in fo rm a tio n retriev ed included sociod em og rap h ic item s, five item s on attitu d es towards people w ith A ID S and fifteen item s m easuring know ledge about the causes o f A ID S and m ode o f tran s­ m ission o f the H IV virus. All item s testin g a ttitu d e and kn ow led ge were rated as “True”, “False", and “D on't K now ”. Levels o f anxiety c on cern in g c o n tact w ith a person w ith AID S were m easured on a 3- p o in t L ik ert-ty p e scale, w ith a score o f 1 reflecting n o anxiety, and a score o f 3 reflecting m u ch anxiety. In ad dition , there were ABSTRACT The need for physiotherapy in the multidisciplinary man­ agement of patients with AIDS is generally acknowledged. Physiotherapists should understand the disease, and devel­ op appropriate attitudes towards individuals with AIDS. Data obtained from questionnaires completed at the University of the Western Cape by prospective physiother­ apy students between 1991 and 1993, on knowledge of and attitudes about AIDS, were analysed. The same ques­ tionnaire was re-administered to a group of physiotherapy students completing their fourth-year of study. Although most of the students indicated accurate knowledge about AIDS, their attitudes were uncertain. Students expressed anxiety about contact with persons with AIDS. The findings suggest the need for the inclusion of AIDS education in the physiotherapy education curriculum at the University of the Western Cape. AUTHORS: SL Amosun, BSc (Hons.) Physiotherapy, PhD R Shabodien, BSc (Hons.) Physiotherapy M Marais, Diploma Physiotherapy U Nicholas, D.Phil, Registered Psychologist Department of Physiotherapy & Centre for Student Counselling, University o f the Western Cape. CORRESPONDENCE Seyi-Ladele Amosun (PhD), Department of Physiotherapy, University o f the Western Cape, Private Bag X I 7 Bellville 7 5 3 5 . SA Jo u r n a l o f Ph y s io t h e r a p y V o l 53 No 2 11 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) R e s e a r c h A r t i c l e three 9 -c a te g o r y item s w h ich s o u g h t in fo rm a tio n c o n c e r n in g w here the respondent first heard a b o u t sex u al in te rc o u rs e , A ID S and the use o f con dom s. Finally there were two qu estion s relating to the sexual beh aviou r o f the resp ond ents. T h e retrieved data were collated and frequ en cies for all variables reported in p erc e n t­ ages. RESULT T he m ean age of the respondents in the three groups o f prospective p hy siotherap y stud ents was 1 9 .7 y ears ( s d = 1 . 0 ) , 2 1 . 8 years (sd = 1 .1 ), and 1 8 .4 years (s d = 1 .8 ) respectively. All were unm arried. O ver 3 4 % o f all the respond ents (N = 1 0 4 ) had already had sexual in tercou rse before ad m ission to the University. Fifteen respond ents ( 1 4 .4 % ) were u n d ecid ed ab ou t w heth er they would have sex with a p erso n k n o w n to have been infected w ith a sexually tran sm it­ ted d isease (S T D ), th o u g h 8 3 respond ents ( 7 9 .8 % ) w ould not. T h e rem aining six indicated readi­ ness to have sex w ith a partner know n to have been infected with a sexually transm itted disease. T he respond ents' first learning exp osu res to AIDS were prim arily throu gh the mass media ( 3 2 .7 % ) , rea d in g ( 2 8 .8 % ) , and th ro u g h in fo rm a tio n received from their high sch o o l guidance cou n sellors ( 1 8 .3 % ) . Sim ilarly, the r e s p o n ­ dents' first learn in g exp osu res to sexual intercou rse were through reading ( 2 9 .8 % ) , parents ( 2 0 .2 % ) and gu idance cou n sellors ( 1 5 .4 % ) . First learning exp osu res to the use o f c o n d o m s were from friend s ( 4 2 .3 % ) , g u id a n c e c o u n s e llo rs ( 2 0 .2 % ) an d th ro u g h read in g (1 5 .4 % ) . In term s o f attitudes to people with A ID S, m ost o f the resp o n ­ d en ts h ad a p o sitiv e a ltitu d e (T a b le l). T he respond ents' level o f k n o w l­ edge about A ID S is show n in Table 11. A bout 6 5 % o f the 1 0 4 resp on­ den ts gave c orrect responses while a b o u t 2 0 % in d ic a te d “d o n ’t k n o w ”. T h e m ean level o f anxiety a b o u t c o n ta c t w ith a p erso n w ith A ID S w as h ig h e s t a m o n g the 1 9 9 3 c o h o rt. R esp o n d en ts had a m e a n s c o re o f 2 . 9 3 ( s d = 1 .1 1 ; N = 4 1 ) , w hile in 1 9 9 1 and 1 9 9 2 , th e m e a n s c o r e s w ere 1 .7 1 ( s d = 0 . 6 2 , N = 3 5 ) an d 1 .7 1 ( s d = 0 .6 6 ; N = 2 8 ) respectively. In re-ad m in isterin g the q u e s ­ tion n aire to cu rren t fo u rth -y ear stu d en ts, data was obtain ed from 15 (ou t o f a total o f 2 4 ) students. Eleven stud en ts ( 7 3 .3 % ) indicate that they w ould not readily have sex w ith a person kn ow n to have b e e n in fe c te d w ith a sex u a lly transm itted disease. T he rem aining 4 stu d en ts ( 2 6 .7 % ) were u n d ec id ­ ed. In testing the level o f k n ow l­ edge a b o u t A ID S, the average TABLE I Respondents'attitudes towards people with AIDS (1991-1993; n=104) TRUE FALSE DON'T KNO W % % % AIDS is God's punishment against homosexual people 14.4 50.0 26.0 (n=94) If my housemate/roommate had AIDS, 1 will ask h im /h e r to move out 20.2 54.8 24.0 (n=103) Students who have AIDS should not be allowed to attend classes in this University 17.3 69.2 ooIIc K00 Adults who contract AIDS get pretty much what they deserve 12.5 63.5 21.2 (n=101) People with AIDS should be quarantined 12.5 52.9 33 .7 ( n = l03) N ote: The sample sizes vary slightly because information was missing for some items 12 SA Jo u r n a l o f Ph y s io t h e r a p y V o l 53 No 2 n u m b er o f stud en ts w ho gave c o r ­ rect responses was 12 (Table IV). T h e level o f an xiety expressed about c o n ta ct with a p erso n with AID S show ed a m ean score o f 1 .7 3 ( s d = 0 . 5 7 ) . F o u r re s p o n d e n ts ( 2 6 .6 % ) w ere read y to give hydrotherapy, in a p o o l, required in the treatm en t o f a patien t with A ID S, but 10 resp ond ents ( 6 6 .7 % ) were un decid ed. DISCUSSION A ttitu d es The attitu d es o f the respondents can affect the quality o f patient care. It seem s few resp ond ents had negative attitu des tow ards people with A ID S (Table 1). H ow ever an a p p rec ia b le n u m b e r o f re s p o n ­ den ts were un d ecid ed a b o u t their attitudes. A dding the n u m b er of re s p o n d e n ts w ith neg ative a tti­ tudes to those w ho were u n d e c id ­ ed, there appears to b e a sizeable n u m b er o f the p rospective p h y sio ­ therapy stud en ts w ho had negative a ttitu d es tow ard s p e o p le w ith AIDS. It w ould seem that the a tti­ tude o f fou rth -year stud en ts had im p ro v ed c o m p a re d to th ose expressed by this c o h o rt in 1 9 9 3 , b u t a few stu d e n ts exp ressed u n certain ty about th eir attitudes. T h e u n c e rta in tie s in a ttitu d es expressed in this study is sim ilar to those reported am on g reh ab ilita­ tio n p e rs o n n e l in Z im b a b w e 9, occu p atio n al therapy stud en ts in the U S 11, and prospective students in Social W ork at the U niversity of the W estern C a p e.10 KNOWLEDGE M ost o f the respond ents gave c o r ­ rect responses to the statem ents regarding the causes o f A ID S and m od e o f transm ission o f the HIV virus. T he percentage w ho gave correct responses was 4 8 .6 % in 1 9 9 1 , 7 5 .0 % in 1 9 9 2 , and 7 3 .2 % in 1 9 9 3 . R esponden ts in this study seem to have a high er level of k n o w led g e a b o u t A ID S than p ro s p e ctiv e stu d e n ts in S o cia l W o r k .10 T h e p e rc e n ta g e w ho reflected c orrect resp onses am on g p ro sp e ctiv e s tu d e n ts in S o cia l W ork was 4 6 .6 % in 1 9 9 1 , 5 7 .4 % in 1 9 9 2 , and 6 3 .8 % in 1 9 9 3 . W h e n the q u estio n n aire was re­ adm inistered to fou rth -year phys­ ioth erapy stu d en ts in 1 9 9 6 , 8 0 % R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) R e s e a r c h gave correct responses, w hich was an im provem ent w hen com pared w ith 1 9 9 3 . In 1 9 9 6 , there was also a decrease in the level o f anxiety abou t c o n tact w ith a person with AIDS. However, the decrease in anxiety was not reflected in the w illingness o f the fourth -year stu ­ den ts to give hydrotherapy in a pool for the rehabilitation o f a patient w ith AIDS. An appreciable n u m b er o f the resp o n d en ts ( 3 4 % ) had already had sexual intercou rse at the time they w ere a d m itted to the U niversity. F ifte e n re s p o n d e n ts (1 4 .4 % ) were u n certain w hether they w ould have sex readily w ith a p a rtn er k n o w n to have b e e n infected w ith a sexually tran sm it­ ted disease in the past. A com p ari­ son o f the 1 9 9 3 prospective stu ­ dents ( N = 4 1 ) and the sam e coh ort o f fourth-year p hysiotherapy stu ­ dents (N = 1 5 ), show ed that 1 4 .6 % in 1 9 9 3 , and 2 6 .7 % in 1 9 9 6 were un decided about having sex w ith a p artn er kn ow n to be infected with a sexually transm itted disease. F or m ost o f the prospective students, the m ajor sou rces o f first-learning exposure about AIDS, sexual in ter­ course and safe sexual p ractices were through reading m aterials, the m edia, and guidance c o u n sel­ lors in high schools. T he U niver­ sity therefore faces a challenge to find ways o f d issem inating rele­ vant in fo rm atio n ab ou t h ealthy lifestyles to new students. A ttitu d es ex p re sse d by the prospective and cu rren t physio­ therapy stud ents to A ID S, cou pled with the un certain ty abou t safe sexual p ractices, as well as the learning resources used , suggest an urgent need for the in clu sio n of AIDS and sexuality in the p h y sio ­ therapy curricu lu m . Su ch m aterial will assist in o rien tin g the students towards a healthy lifestyle, as well as preparing them to offer treat­ m en t to patients w ith A ID S by im proving their level o f know ledge and attitudes towards AIDS. Such m aterial m ay n o t be lim ited to first year stud ents but should be re­ inforced at every stage in the phys­ iotherapy ed u cation program m e. T he same m aterial m ay also be A r t i c l e useful for stud en ts in o th er facul­ ties in the University CONCLUSION The prevalence o f AIDS in South Africa poses a challenge to health p ro fe ssio n a ls. W h ile th e data reported here represent in fo rm a­ tion from a lim ited sam ple, it does suggest that im proving the level of kn o w led g e an d the a ttitu d es towards AIDS am on g ph y sioth era­ py stud en ts m ay be one o f the steps w h ich w ould assist in c o m ­ b atin g p reju d ice, and preparing the stud ents to w ork w ith AIDS patients. Based on the inform ation presented here, it is recom m en ded that a cou rse o n A ID S and sex u ali­ ty be inclu d ed in the u n dergradu­ ate physiotherapy ed u cation c u r­ ricu lu m at the U niversity o f the W estern Cape. TABLE II Respondents' knowledge about AIDS (1991-1993, n= 104) TRUE FALSE DON'T KN O W 0 / 0/ 0/ I /o /o /o \ Health workers and others who care for people with AIDS are likely to contract AIDS themselves 19.2 56.7 19.2 I (n=99) I ! The country's blood supplies are probably contaminated by the HIV virus at the present time 27.9 44.2 27.9 i (n=l 04) i | You can contract AIDS by giving blood 37.5 , 46.2 16.3 (n=l 04) Most people who have HIV virus in their blood will eventually develop AIDS 36.5 , 24.0 33.7 . (n=98) | It is impossible to contract AIDS without an exchange of body fluids 58.7 16.3 25.0 > = 1 0 4 ) A person can have no symptoms and still be infectious 74.0 ! 2.9 21.2 (n=l 02) Intravenous drug users are in the high risk group for contracting AIDS 61.5 1 6.7 22.1 (n=94) If one is in contact with a person with the HIV virus, there is a high risk o f contracting AIDS by: sharing coffee cups 1.9 77.9 10.6 (n=94) contact with their blood 83.7 1.0 5.8 ! (n=94) j touching their clothing 5.8 86.5 2.9 (n=99) 1 using the same toilet 11.5 5 7.7 2.2 (n=94) ; sexual intercourse 98.1 0.0 1 0 (n=l 03) touching the genitals with the hands 12.5 39.4 38.5 (n=94) | kissing on the lips 6 .7 65.4 ( 1 8 - 3 (n=94) kissing on the cheek 1 1.9 87.5 10.6 (n=104) N O TE: The sample sizes vary slightly be cause information wa i ! \ \ s missing for sorne items. ! i SA Jo u r n a l o f Ph y s io t h e r a p y V o l 53 No 2 13 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) E L I T E Recruitment Specialists Physiotherapists For long a n d short term positions th ro u g h o u t G re a t Britain • Excellent Rates of Pay • Regular Bonus Schemes • Prompt Weekly Payment • Proffesional Registration Cash Back • Free Personal Tax Advice • Assistance with Bank Account and National Insurance • Subsidised Training Courses • Free Malpractice Insurance • Elite Social & Recreational Club For a most e ffic ie n t a n d personalised service contact Johan Bosch Dalmari van Zyl P.O. Box 53 P.O. Box 512, Bethlehem 9700 . W hite River 1240 Cell phone: 083 2699033 Tel/Fax:(13) 7 5 1 2 2 3 5 /6 6 Fax: 058 4 2288 ^ | E L I T E M e d i c a l S e r v i c e s Ltd 4 -6 B ury Street, St James's, London SW1Y 6AB Tel: (0171) 8 3 9 5 0 0 0 (10 lines) Fax: (0171) 9 2 5 2 6 1 0 / 1 / 2 3 mins walk from Piccadilly and Green Park Stations Raising Standards in Health and Social Care USA Sponsorship Programme for Physiotherapists Due to developm ents in th e healthcare m a rke t and in licensing regulations in the USA, therapists holding a FULL and UNRESTRICTED license p r io r to ta k in g up th e ir CONTRACT are at an advantage. Therefore our programme for a select number of physiotherapists includes the following: One week ALL EXPENSES PAID TRIP TO BOSTON, USA to sit the NPT Exam FULL STUDY PROGRAMME and REVIEW SEMINAR CUSTOMISED SALARY and BENEFITS PACKAGE 18 /2 4 month CONTRACTS HIB Visa / GREEN CARD o o For more information phone: Joanne on (021) 85 16114 (9am - 5pm) or Kathy on (021) 887 2281 (6pm - 8pm) Btandford House, 67 Caledon St., P.O. Box 766, Somerset West 7129 Tel: (021) 851 6114 Fax: (021) 852 5508 email: ogpsa@iafrica.com hi J f i a u W u O’ GRADY PEYTON I n t e r n a t i o n a l REFERENCES ] Yach D. Towards health for all South Africans. South A frican M edical Jou rn al 1 9 9 4 ;8 4 ,2 5 0 -2 5 3 . 2. Padayachee GN. Evaluation of AIDS prevention programmes - the key to success. South African M edical Jou rn al 1 9 9 1 ;8 0 ,3 1 0 -3 1 1 . 3. Fnedland RH, Jankelowitz SK, De Beer M, De Klerk C, Khoury U, Csizmadia T, Padayachee GN, Levy S. Perceptions and knowledge about the acquired immunodeficiency syndrome among students in University residences. South A frican M edical Jou rn al 1 9 9 1 ,7 9 ,1 4 9 -1 5 4 . 4. Amosun SL, Gatsi LT, Mawere JH . Neurological manifestations in AIDS: Im p lication s for rehabilitation. South A frican Jo u rn a l o f Physiotherapy 1 9 9 5 ;5 1 :4 5 -4 7 5. Carneiro AV, Ferro J , Figueiredo C, Costa L, Campos J , de Padua F Herpes zoster and contralateral hemiplegia in an African infected with HIV-1. Acta M edica Portuguesa 1 9 9 1 :4 :9 1 -9 2 . 6. Leger JM , Henin D, Belec L, Mercier B, Cohen L, Bouche P, Hauw J J , Brunet R Lymphoma-induced polyradiculopathy in AIDS: Two cases. Jou rn al o f Neurology 1 9 9 2 ;2 3 9 :1 3 2 -1 3 4 . 7. Lewis CE, Freeman HE, Corey CR. AIDS-related com petence of California's primary care physicians. Am erican Jou rn al o f Public Health 1 9 8 7 ;7 7 :9 7 5 -7 9 9 . 8. Searle ES. Knowledge, attitudes and behaviour of health profes­ sionals in relation to AIDS. Lancet l9 8 7 ;i:2 6 -2 8 . 9. Gatsi LT, Amosun SL, Mhlanga FG. Rehabilitation personnel and AIDS in Zimbabwe: Knowledge, attitudes and professional behaviour. Physiotherapy Theory and Practice 1 9 9 4 ;1 0 :9 5 -1 0 2 . 10. Nicholas L, Orr NM. AIDS Knowledge and attitudes towards homosexuals and people with AIDS of prospective black first-year Social Work University students: 1 9 9 1 -1 9 9 3 . Social Work 1 9 9 5 ; 3 1 :9 0 -9 6 . 11. Vincent TA, Sch kad eJK . Knowledge and attitudes of occupational therapy students regarding AIDS. Am erican Jo u rn al o f Occupational Therapy 1 9 9 0 ;4 4 ,2 0 5 -2 1 0 . JOB OPPORTUNITIES ACROSS TH E FING AFFING S P E C I A L I S T S IN P L A C IN G T H E R A P I S T S F R O M A R O U N D T H E W O R L D I N T O P O S I T I O N S A C R O S S T H E U .S .A . Our u nprecedented full service approach ensu res that all applications are com pleted with speed, quality & value 0 Our com puterized database allows us access to the type o f work you are looking for and the geographic location you desire • Your recruiter will work closely with both you and your new em ployer to ensure that your needs are m et .WORLDWIDE STAFFING ORLDWIDE STAFFING Wo r l d w i d e s t a f f i n g J.DWiDJL£E&eB“NG G JLDWODE STAFFING RLDWIDE STAFFING 14 SA Jo u r n a l o f Ph y s io t h e r a p y V o l 53 No 2 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) mailto:ogpsa@iafrica.com