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A survey of second-year medical students found that the stigma these future physicians still attach to HIV and AIDS is not associated with a dearth of knowledge about the illnesses but to bias against gay men and intravenous drug users, the two groups hardest hit by the epidemic, explained David Kopacz, M.D.
Kopacz, a psychiatrist at the University of Illinois at Chicago, presented his findings at APA's 1997 annual meeting in San Diego in May. He suggested that physician educators, particularly psychiatrists, cannot assume they have done a sufficient job of educating medical students about AIDS if all they have done is teach facts about the disease and its treatment.
To overcome negative attitudes about people with AIDS, "students also need intensive experience in identifying and exploring their fears" about HIV-related illnesses and the people who often suffer from them, he emphasized. In particular, it is critical that residents and attendees "model nonprejudicial attitudes and adhere strictly to the highest standards of medical professionalism."
Kopacz and his colleagues Linda Grossman, Ph.D., and Debra Klamen, M.D., surveyed 72 second-year medical students at a large urban medical school that treats many AIDS patients. Questionnaires were distributed at the start of a human sexuality course and inquired about the students' attitudes toward homosexuality and AIDS, their experience with AIDS patients, their sexual activity, and demographic data.
Forty-three percent of the study subjects were women, 95 percent said they were heterosexual, and 74 percent reported having worked with HIV-positive patients. In addition, half of the students said they had at least one friend who was gay or lesbian, and 15 percent knew of a friend who was HIV positive.
Their data showed that prior experience with AIDS patients was not linked to the students' willingness to treat them in the future. Surprisingly, Kopacz noted, with detailed knowledge about HIV transmission available for years and biohazard precautions routine in medical settings, 62 percent of these medical students still were anxious that working with HIV-infected individuals poses a health hazard to them. Nearly two-thirds of the respondents believed that HIV infection can be transmitted via routes that research has proven to be safe.
The role of stigma in attitudes toward AIDS patients was emphasized by the study's finding that similar fears about contagion did not appear when the students were asked about their willingness to treat patients with tuberculosis or hepatitis, illnesses that are more contagious and pose greater risks to medical personnel.
Also troubling for AIDS patients who will need care in the future was the response from 30 percent of the medical students who said they had the right to refuse to treat such patients, and 7 percent declared that they plan to exercise this right. More than 20 percent of these second-year students told the researchers that the AIDS epidemic was affecting their specialty choice, while 11 percent admitted that it was influencing the geographic locations in which they are willing to practice.
Kopacz and his colleagues found a significant link between possessing a tolerant attitude toward these patients and having gay friends, as well as a strong relationship between negative attitudes toward homosexuality and students' reluctance to treat people with HIV-related illnesses.
"Didactic instruction will not be enough to overcome the negative attitudes" that at least one class of future physicians holds toward patients with AIDS and groups of individuals who have so far been its chief victims, Kopacz said. He urged medical schools to establish a required format of small-group meetings during which psychiatrists would address prejudicial attitudes with the students as well as their exaggerated fears about HIV contagion. Learning the "psychological, emotional, and social dimensions" of medical practice must supplement the teaching of facts if medical schools are to turn out caring, competent physicians, he suggested.
(Psychiatric News, June 20, 1997)