Many healthcare workers in Europe don’t know basic HIV facts, survey reveals

A large survey of healthcare workers across Europe has revealed widespread ignorance about HIV transmission and prevention. A large minority were unaware that a person with an undetectable viral load cannot pass on HIV, while a majority were unaware of PrEP.

Although doctors were on the whole better informed than other healthcare workers, 51% of the physicians who answered the survey were either unaware of PrEP or had inaccurate knowledge of it.

The survey, jointly conducted by the European Centre for Disease Control and Prevention (ECDC) and the European AIDS Clinical Society (EACS), also found that a minority of healthcare workers were reluctant to treat people with HIV; this was often due to lack of training or outdated views on transmission, but also at times due to directly stigmatising attitudes towards people with HIV.

The findings of the study were presented to the EACS Standard of Care for HIV and Co-infections in Europe meeting in Athens on 17th October. It follows on from a survey of the experience of stigma among people living with HIV, which was presented at the 2022 Standard of Care meeting in Brussels (see this report for the full findings).

In that survey, 23% of respondents had said that they “worried about being treated differently” if they disclosed their HIV status to healthcare staff, and 12% said they had avoided healthcare appointments in the last year because of that worry.

Teymur Noori of ECDC, who collaborated with EACS on the survey, presented the findings. It was distributed to 54 countries in Europe and central Asia, in 38 languages, between September and December 2023; 18,430 people replied, a large number for this sort of survey. Nearly three-quarters (74%) of respondents were female and a quarter male; 35 people (0.3%) defined as non-binary.

Forty-four per cent of respondents were doctors and 22% were nurses. The other one-third ranged from other specialists such as radiographers and dentists to admin workers and students. Fifty-eight per cent said they worked in a hospital and 17% in a primary care centre.

Only 7% worked in a dedicated HIV department. Thirty per cent were located in an infectious disease department or other inpatient hospital facility, while 13% worked in surgery or in an A&E department. A quarter worked in primary care or another outpatient facility.

Perhaps the most revealing survey results were of respondents’ basic knowledge of HIV facts. The survey asked respondents whether they agreed with, disagreed with or didn’t know the answer to three statements about U=U, PEP, and PrEP. They were:

• U=U: People living with HIV who are on effective treatment and have an undetectable viral load cannot transmit the virus sexually.
• PEP: Taking a short course of HIV medicines after a possible exposure to HIV prevents the virus from taking hold in your body.
• PrEP: Someone who does not have HIV can take HIV medicines to prevent them from getting HIV.

“I disagree” and “I don’t know” were both classed as incorrect answers.

A quarter of respondents gave no correct answers to the three questions – not many fewer than the 31% who gave three correct answers.

People tended to give more correct answers to the U=U and PEP questions. Sixty-one per cent answered the U=U question correctly (69% of doctors), and 56% the PEP question (67% of doctors). But levels of knowledge of PrEP were considerably lower, with only a minority of 41% knowing about PrEP, and even a minority of doctors (49%).

The only workplace setting where more people knew about PrEP than not was community centres, where 53% knew and replied correctly about it. Only 46% of hospital workers were aware of PrEP, and only a third of people working in primary care. In contrast, two-thirds of hospital workers answered the U=U question correctly, and a bare majority (52%) of workers in primary care.

Understandably, those who cared for more people with HIV were more likely to have correct knowledge. Of healthcare workers who were not aware of having cared for any HIV-positive patients or clients in the last year, 23% answered the PrEP question correctly, versus 89% of those who had seen more than 100 people with HIV.

The survey asked about incorrect or out-of-date knowledge of HIV transmission, especially during medical procedures. About a quarter of respondents (23%) were “worried” dressing wounds of a person with HIV, and 27% when drawing blood. Twenty-six per cent said they still used double gloves when working with a person with the virus.

The survey also asked whether people “preferred not to” provide services for four different key populations with HIV: transgender women and men, sex workers, men who have sex with men and people who inject drugs. This varied by geographical region, with scarcely any respondents in western Europe not wanting to work with the first three categories and 6% preferring not to work with people who inject drugs, whereas in eastern Europe 15% preferred not to work with the first three categories and 21% not with drug users.

Among the people expressing aversion to working with HIV-positive patients or clients, the reasons for these preferences ranged from the practical (“I haven’t had training”, with 50% of respondents giving this reason for not working with drug users and 49% with transgender people), through outdated or exaggerated risk perception (“They put me at risk”, with 43% giving this reason not to work with drug users and 38% with sex workers) to straightforward disapproval (“This group engages in immoral behaviour”, with 50% giving this as the reason not to work with men who have sex with men and 45% with sex workers).

When asked if they had observed stigmatising behaviour in other healthcare workers, 30% said they had heard discriminatory remarks, 22% had witnessed reluctance to care, and 19% said they had witnessed non-consensual disclosure of a person’s HIV status to a third party.

Teymur Noori concluded: “This study underscores the importance of implementing targeted interventions aimed at different healthcare facilities and healthcare professions to combat HIV-related stigma and discrimination.”

The full report of the ECDC/EACS survey, HIV Stigma in the Healthcare Setting, can be accessed here.

By Gus Cairns