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      HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system

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          Abstract

          Background

          Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students’ acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory.

          Methods

          Students from three dietetics schools in Indonesia ( n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome.

          Results

          The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge ( p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study ( p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes ( p < 0.05).

          Conclusions

          Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients’ quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.

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          Most cited references36

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          An attributional analysis of reactions to stigmas.

          In two experiments, we examined the perceived controllability and stability of the causes of 10 stigmas. Guided by attribution theory, we also ascertained the affective reactions of pity and anger, helping judgments, and the efficacy of five intervention techniques. In the first study we found that physically based stigmas were perceived as onset-uncontrollable, and elicited pity, no anger, and judgments to help. On the other hand, mental-behavioral stigmas were perceived as onset-controllable, and elicited little pity, much anger, and judgments to neglect. In addition, physically based stigmas were perceived as stable, or irreversible, whereas mental-behavioral stigmas were generally considered unstable, or reversible. The perceived efficacy of disparate interventions was guided in part by beliefs about stigma stability. In the second study we manipulated perceptions of causal controllability. Attributional shifts resulted in changes in affective responses and behavioral judgments. However, attributional alteration was not equally possible for all the stigmas.
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            Stigma in health facilities: why it matters and how we can change it

            Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
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              The Asian Values Scale: Development, factor analysis, validation, and reliability.

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                Author and article information

                Contributors
                mutiara.tirta@gmail.com
                martan@ksu.edu
                nmuturi@ksu.edu
                procter@ksu.edu
                lyarrow@ksu.edu
                wwhsu@ksu.edu
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                9 September 2020
                9 September 2020
                2020
                : 20
                : 663
                Affiliations
                [1 ]GRID grid.8570.a, Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, , Universitas Gadjah Mada, ; Yogyakarta, Indonesia
                [2 ]GRID grid.36567.31, ISNI 0000 0001 0737 1259, Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, , Kansas State University, ; Manhattan, Kansas USA
                [3 ]GRID grid.36567.31, ISNI 0000 0001 0737 1259, A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, , Kansas State University, ; Manhattan, Kansas USA
                [4 ]GRID grid.36567.31, ISNI 0000 0001 0737 1259, Department of Statistics, College of Arts and Sciences, , Kansas State University, ; Manhattan, Kansas USA
                Author information
                http://orcid.org/0000-0002-9113-2388
                Article
                5379
                10.1186/s12879-020-05379-8
                7487527
                32907539
                9f30481a-d1b3-4339-a680-56b031fc584a
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 2 December 2019
                : 28 August 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100007765, Kansas State University;
                Award ID: The 2017 Arts, Humanities & Social Sciences Small Grant Program
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Infectious disease & Microbiology
                hiv,aids,attribution theory,stigma,hiv knowledge,nutrition education,dietetic student

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