Table 3 HIV and STIs in MENA: characteristics of users and health care professionals

Knowledge

▸ School/ High school students: HIV/AIDS knowledge and prevention: inadequate; better among high school students; needed more understanding to prevent stigmatization/ discrimination of infected persons, knowledge varied significantly by country and gender [24,25,26,27]. Most boys knew about AIDS but rarely other STIs [28].

▸ University students

• HIV/AIDS: medical university students were aware of HIV, its transmission and prevention [29], with few misconceptions [30]. Conversely, dental students had low to moderate knowledge with high misconceptions and paramedical students had low knowledge [31, 32], knowledge was sometimes associated with being male and higher years of study [32, 33].

• STIs: male medical students and dental students had low HPV knowledge [34]; clinical-years associated with better knowledge [35].

▸ General population

• HIV/AIDS: deficient knowledge, with misconceptions about prevention [36, 37]. Knowledge was positively associated with education, age, residence, experience, and socioeconomic status [38, 39].

• STIs: low HPV awareness, which was better among older clients and females [40].

▸ Special populations: HIV knowledge was high among PLWHA and alcohol/ drug abusers especially men with high education [41, 42], satisfactory in seafarers, but with some misconceptions, and low in refugees and dental patients [43,44,45].

▸ Physicians: PHC physicians sometimes had never managed an AIDS case; had low HIV/AIDS transmission, treatment and risk behaviour knowledge [46]. Knowledge was associated with years of experience, status/specialty and practice location [47].

▸ Dentists: moderate knowledge about oral HIV manifestations and transmission [48].

▸ Nurses: low HIV/AIDS disease and prevention, however, had high knowledge in risk groups identification [49].

Attitude

▸ School/ high school students: negative attitudes toward AIDS and PLWHA but were willing to be HIV tested [31].

▸ University students: undergraduates displayed moderate acceptance of PLWHA, and most were willing to care for an HIV-infected person, although attitudes fluctuated between equivocal or negative which was related to lack of HIV knowledge [29, 30, 50]. HPV vaccination was acceptable by male medical students and dental students [34], more among clinical-year students, those vaccinated for hepatitis B, and with higher HPV knowledge [35].

▸ General population: although individuals expressed eagerness to know more about HIV/AIDS [51], a sense of fatalism regarding HIV acquisition was common [36], with negative attitude toward PLWHA. Factors affecting attitude were age, sex, marital or social status, educational level, experience, and nationality [52].

▸ Special populations

• PLWHA: low adherence to treatment [53].

• Seafarers, sex workers and refugees: high risk behaviors [43, 44, 54].

• Most alcohol/ drug abusers: negative attitudes towards PLWHA, but 55.5% felt sympathy for them [42].

▸ Physicians: most PHC physicians suggested isolating PLWHA in isolated places/hospitals [46].

▸ Nurses: negative attitudes toward PLWHA/ suspected HIV cases (injecting drug users, MSM, sex workers), refusing to provide care or get blood sample; most reported that HIV patients should be ashamed of themselves [49, 55]. Attitude barriers to care included fear of getting infected with HIV, disbelief in effectiveness of infection control measures, misconceptions, fear of stigmatization, and moral judgments [56].

Perceptions

▸ Kuwait: majority of participants were satisfied with the government’s policy for AIDS prevention; and proposed that religion is important in dealing with HIV infection [38].

▸ Egypt: compared to industrial workers, tourism workers had a better perception of the magnitude of the HIV/AIDS problem worldwide and in Egypt, and the likelihood of it worsening [57].