Few health education programs include the perspective of living with HIV

Up-to-date knowledge about HIV among health care professionals is a prerequisite for good treatment and more patient-safe care. As the number of people living with HIV grows older, contact between people living with HIV and health and social care professionals in elderly care is expected to increase.

Healthcare education and training, both at vocational and university level, are hubs where knowledge is transmitted. Education and training providers can use curricula and other tools to guide content and ensure that students are prepared for future working life, both in terms of interpersonal skills and providing adequate care to users and patients.

To create a picture of how healthcare education prepares future healthcare and elderly care professionals to care for and respond to people living with HIV, HIV-Sweden has interviewed education managers, teachers and former students in healthcare education in Sweden.

In addition to creating a better understanding of how and to what extent HIV is talked about in the country's health education programs, the purpose of the survey is to understand how we can improve the knowledge of students, institutions and health professionals in the future. 

How did the survey work?

The survey was carried out using a mixed methodology involving interviews with education managers, teachers and former students. In order to distinguish differences in educational level (university - vocational program), the survey was conducted in groups of both levels.

A survey of potential respondents was conducted in early fall 2023 and resulted in a list of contact details. To create a representative sample, data was collected from nursing schools across the country. A questionnaire for mailing and telephone interviews was developed internally using literature and knowledge gathered during the process of establishing a contact list.

Total contacted:

• 5 universities with nursing programs through calls to study and career counselors, administration of nursing programs and program managers.

• 12 health care teachers in different vocational education programs

• 7 teachers in health care colleges

• 13 former students in health education

Of the five universities, three responded to our request. Two universities could not respond because there was no person in charge.

The response rate has been lower for nursing teachers in vocational programs and teachers in health care colleges; only two were able or willing to respond.

Result

University 1

The person responsible for semesters 1 and 5 reports that they include information on viruses and their structure during semester 1 in the course "clinical microbiology". During semester 5, they try to have a digital lecture on HIV. The person responsible informs that they unfortunately cannot share the digital lectures and they do not remember how HIV is mentioned in the teaching materials. He also states that they unfortunately do not have any updated literature on HIV but that they will try to review this by 2024. 

University 1

The person in charge of semester 4 informs us that under ethics and morals they address HIV. They have an interactive digital lecture with updated information about HIV. HIV-Sweden was offered to be involved the next time they update the information film. 

University 3

Informs that they briefly touch on HIV during microbiology, but admits that they could have covered more about HIV and did not consider it as an important factor for those living with HIV. Agrees that it is indeed a disease that has made tremendous medical progress, but has not been recognized by the public or the educational system.   

Pre-vocational education 1

The course deals with various blood diseases, including HIV and AIDS, and also highlights infection routes, risk of infection and treatment, but this is in brief. They wish that this could be supplemented, preferably with lectures or cases and methodological material, in order to be able to offer better knowledge about HIV to the students.

Pre-vocational education and training 2

Showing part or all of the movie Never wipe tears without gloves. Sexuality is part of the compulsory objectives of education and within this, sexually transmitted infections are highlighted. Regarding HIV, it has come up in relation to Covid and how to protect yourself against infectious diseases. HIV is also mentioned in relation to knitting materials and their handling. The person in charge also says that it is difficult to go into depth and that it is the fear of HIV that makes it included in the training.

Interview with former students

All students have graduated less than 5 years ago. Together the students represent 6 universities in Sweden. All former students are currently working as nurses around Sweden.

A majority of the informants had some kind of knowledge about HIV but few knew about the medical developments in HIV, treatment and infectiousness and the new state of knowledge, i.e. Measurable=Transmissible or Undetectable=Untransmittable. 

Despite the fact that several of the interviewees had already been treating patients with HIV after graduation, a majority said that they had not had any lectures or sessions on HIV during their training.

A nurse said that during her time at a maternity hospital in a large city in Sweden, a woman with HIV gave birth and many of the staff had treated the woman with great fear and ignorance. Finally, some of the staff reacted and an expert was called in to talk about HIV treatment, attitudes and treatment.

Discussion

The results show that HIV is included in healthcare education at university and vocational level to varying degrees. From the responses of the health education programs in the survey, it can be seen that the perspective on HIV tends to be mostly medical, virological or from an infection control perspective. However, it is not always clear whether HIV is part of teaching materials or specified in curricula, or how the inclusion of HIV in education is ensured.

Interviews with nurses indicate that HIV does not appear to be a significant or major part of nursing education. A majority of students who have completed their studies cannot recall any lectures or sessions on HIV after completing their studies. Given that few people were aware of the new state of knowledge about HIV, it is likely that there is no further significant emphasis on HIV in health education, even if it is not in the form of lectures or specific sessions during training.

The results of this survey reflect relatively well previous studies in the field. The bottom line is that there is a lack of knowledge about the infectiousness of treated HIV and knowledge about the treatment of people living with HIV among health and social care staff. The exception is professionals at infectious disease clinics who routinely diagnose new cases and treat people living with HIV. One possible explanation may be that people living with HIV have been treated almost exclusively in infectious disease clinics, but only in recent years have they been referred to primary care for, for example, public health issues.

However, the results should be interpreted with caution, as the survey contains a small sample of education programs in Sweden and the non-response rate is high. It has not been possible to distinguish differences between vocational preparation programs and education at university level due to a large dropout rate.

Conclusion

Most of the courses we have been in contact with do not include a perspective on living with HIV. Many also lack literature, teaching materials or lectures where the medical situation has been updated regarding HIV. Interviews with former students indicate that there is no major focus on HIV in healthcare education in Sweden. Treatment, stigma and the aspect of living with and aging with HIV have not been mentioned by any of the education providers.