Knowledge Attitude And Practice On Circumcision For Aids Prevention Among Medical Students In A University In Chongqing

Objective: To discuss Knowledge Attitude and Practice of medicalstudents in a university in Chongqing about circumcision for AIDSprevention，and influencing factors. So as to provide basis for developingpublicity materials and propaganda mode aiming at promoting the localAIDS focus groups’ willingness to accept the circumcision, in order to offeradvice to the implementation of circumcision for AIDS prevention.Methods:⑴Data collection method: Using quantitative researchmethod combining with qualitative research. For quantitative research, acluster random sampling method was used for finding out581studentsfrom Grade1to Grade4, with the same questionnaire to conduct the survey.For qualitative research, a purposive sampling method was used to recruitthirty medical students who have done circumcision and twenty ones whohaven’t done the survey, with interview outline to conduct the individualin-depth interviews.⑵Data analysis method: For quantitative data, usingEpidata3.02to set up database, statistical analysis was done by SAS V9.0;And qualitative approach with MAXqda2for the data collected in thein-depth interview, framework analysis mainly be used.Results:⑴Quantitative research: There was high awareness rate ofknowledge about AIDS three major transmission routes and non-transmission routes such as dinner together、handshake and embracewill not be infected with AIDS (more than90%)；Lower awareness rate ofknowledge about being bitten by the mosquito and courtesy of kissing willnot be infected with AIDS (70%or so).3.33%of the participants had doneHIV testing from a year earlier. Boys have a certain understanding of thehazards of prepuce or phimosis,benefits and complications of the surgery,But full awareness rate of each of them are:39.65%、7.69%、14.07%. Only38.9%of them knew that circumcision is able to prevent HIV and othersexually transmitted diseases. Participants who considered circumcision asa secret, or didn’t want others to know that he had been circumcised, orheard that someone made fun of the ones who had circumcised, the rate ofeach of them are:6.02%，35.37%，33.33%. Reasons for unwillingness wereas follows: no effect on health and therefore no need (76.31%), worryingabout the risk of surgery (38.96%), not knowing the medical benefits ofsurgery (26.51%), worrying that surgery would affect sexual function(22.89%), and worrying that the cost maybe too high (15.66%). When itbecame clear to them that the rate of various complications was very low;the operation could prevent AIDS and other sexually transmitted diseases;and keep the reproductive system healthy, the acceptance rate increased by33.06%, and might increase by40.82%（P<.0001）. The results of themultivariate logistic regression showed that the factors affecting thewillingness to accept the surgery were as follows: whether or not they hadphimosis or prepuce; whether the surgery could increase the sexualsatisfaction in the future or not; whether or not there were close friends orrelatives, who had had this surgery, and so on. The OR value and95%confidence interval are as below:11.431(6.754,19.349)、1.（81.189，2.899）、1.609（1.031，2.510）.the hazards factors of sexually transmitted diseases were as follows: whether or not they had phimosis or prepuce, whetherusing condoms in the nearest sexual behavior or not, The OR value and95%confidence interval are:3.830(1.049-13.981)、0.244(0.064-0.932);Thefactors affecting condom using rate was whether or not they had phimosisor redundant foreskin, The OR value and95%confidence interval is0.263（0.082，0.837）.⑵Qualitative research： A considerable number of respondentsbelieved that saliva or mosquito bites will spread AIDS. People couldn’tdistinguish “at-risk groups” and “high-risk groups”, didn’t know the “ThreeIntervals distribution” of AIDS. In addition to individual respondents, therest said that they did not discriminate against people living with HIV, theywould give them care and compassion, but couldn’t frankly treat or getalong with them. Some people said that “to beware of the phenomenon thatAIDS patients take revenge on society; and due to worrying about beingdiscriminated against, some AIDS patients may conceal his medical historywhen they were hospitalized. Most of the boys neither have heard AIDSvoluntary counseling and testing nor accepted it. The results of their ownassessment of the risk of HIV infection is the influencing factor of whetheraccepting VCT or not. The way of the respondents knew aboutcircumcision related knowledge mainly include: newspapers and books、television、network、communication with other classmates and friends, aswell as classes, Then, they will look up the relevant information onself-learning, rarely turning to consult a doctor actively or talking about itwith their parents. The boys had some understanding about the hazards、benefits、indications and complications of circumcision, but were not deepand overall, Compared to the ones who hadn’t been circumcised, thosewho had been circumcised had a much better understanding. Only nine of the fifty respondents have heard that circumcision can prevent AIDS (thereare six persons who have already done the surgery and there ones whohaven’t).All of the participants didn’t know the mechanism of preventionclearly, they don’t think it is vey scientific. After hearing the principle, themajority expressed their understanding and support. Most people didn’tthink the surgery is privacy. They wouldn’t make fun of persons who havealready done the surgery,but feel embarrassed when communicating withtheir parents、elders. The safety of the surgery is what people alwaysworried about during preoperation、intraoperation and postoperation. Inaddition, some other factors are also playing an impact role to a certainextent: time、whether or not there are friends around who have done thesurgery、cost、attitudes of girlfriend or family and privacy problem.Whether or not willing to be volunteers who lead the public to preventAIDS by circumcision is mainly affected by the following factors: time、thereliability of the evidence that circumcision can prevention AIDS、privacyproblem、assessment for their own ability that whether themselves arequalified for the propaganda. For propaganda and education, the helppeople want to get is: related knowledge、skills and abilities for conveyingknowledge、skills for communicating with others、fund support.Conclusion:⑴Medical Students don’t have a depth, comprehensiveand systematic mastery of circumcision and AIDS-related information. Inorder to make people have authoritative, systematic and comprehensiveknowledge, we should make full use of school, health and epidemicprevention agencies, besides, all kinds of effective media such as television,broadcasting, networks, newspapers and magazines should also be used toenlarge propaganda.⑵People are more willing to accept circumcision if there are some persons around having done circumcision. Medical students who have donethe surgery are the best candidates. It will play a tremendous role inpromoting the surgery that they serve as the volunteers. Taking the timefactor into account, promotional activities can be unified under theregulatory mechanisms by their own schedule in flexible and diverse forms.⑶The interrelated divisions should make improvements ontechnology and the technical level of the operating person, and meanwhile,should also ensure good medical and health conditions, making the surgerysafer and easier and cheaper.⑷Build comfortable social ethics environment, all for the patient isthe principle; Respecting the will of the people, adhere to the principle ofinformed consent; respecting and protecting patients’ privacy.⑸Strengthening psychological nursing to patients during thepreoperative, intraoperative, and postoperative to relieve theirpsychological burden, so that they are more likely to accept the operationbefore the operation, have a smoothly operation intraoperatively,postoperative wound heal as soon as possible.⑹Circumcision is not a panacea.Besides the promotion ofcircumcision for AIDS prevention, other effective comprehensiveprevention measures should be adhered.Circumcision can not only reducethe other sexually transmitted diseases’ prevalence, but also can improvethe condom use frequency of people who have redundant prepuce orphimosis; with circumcision we can “kill two birds with one stone”.Thepromotion of circumcision must be aimed at suitable group, to masterstrictly indications. In order to prevent from high risk behaviors, healtheducation should also be strengthened postoperatively.