STUDENTS’ KNOWLEDGE, ATTITUDE AND PRACTICES

TOWARD PATIENTS WITH HIV/AIDS AT FORT PORTAL

REGIONAL REFERRAL HOSPITAL, UGANDA.

BY
ODONGO EMMANUEL OKELLO
BMS/0126/133/DU

A RESEARCH DISSERTATION SUBMITTED TO FACULTY

OF CLINICAL MEDICINE AND DENTISTRY IN PARTIAL
FULFILLMENT OF THE REQUIREMENT FOR THE AWARD
OF A BACHELORS DEGREE IN MEDICINE AND SURGERY OF
KAMPALA INTERNATIONAL UNIVERSITY

JUNE 2019
 ABSTRACT

Introduction: Globally, HIV continues to be a major global public health issue. The
vast majority of people living with HIV are located in low- and middle- income
countries, with an estimated 66% living in sub-Saharan Africa. Among this group
19.6 million are living in East and Southern Africa which saw 800,000 new HIV
infections in 2017. There has been a gradual increase in the number of people living
with HIV accessing treatment. In 2013, Uganda reached a tipping point whereby the
number of new infections per year was less than the number of people beginning to
receive antiretroviral treatment. This has led to increased numbers of PLWHAs who
have to, other than having to seek treatment in the face of societal stigma, may also be
faced with discriminatory practices by healthcare providers warranting the need for
continued education of the providers towards good practice as regards PLWHAs.
Objective: This study aimed to assess the knowledge, attitudes and practice of
medical students towards HIV/AIDS and PLWHAs.
Method: A descriptive questionnaire-based cross-sectional study design was used
that involved 53 BMS 143 series KIU medical students on clinical placement at
FPRRH.
Results: The knowledge was high (80%), attitudes positive (94.4%) and practice was
good.
Conclusion: The knowledge of KIU BMS 143 series medical students on clinical
placement at FPRRH concerning HIV/AIDS and PLWHAs was high, their attitudes
positive and practices good but there was need to keep up-to-date on the changing
HIV treatment protocols.

Key words: People living with HIV/AIDS, Knowledge, Attitude, Practice

i
 DECLARATION

I Odongo Emmanuel Okello declare that this research dissertation; Student's

knowledge, attitude and practices toward patients with HIV/AIDS at Fort Portal
Regional Referral Hospital, Uganda is my original work and has never been
presented in the same or different form to Kampala international university or any
other institution of learning for any academic award.

Signature …...................................................................

Date …............................................................................

ii
 APPROVAL

This research dissertation; Student's knowledge, attitude and practices toward patients
with HIV/AIDS at Fort Portal Regional Referral Hospital, Uganda has been produced
under my close supervision and guidance and I therefore recommend the student to go
ahead and hand in a copy.
Supervisor: Dr. Odong Richard Justin, MBChB (KIU 2011), MMED
PAEDIATRICS AND CHILD HEALTH (KIU 2017)

Signed………………………………………………….

Date……………………………………………….……

iii
 TABLE OF CONTENTS

ABSTRACT................................................................................................................... I
DECLARATION .......................................................................................................... II
APPROVAL ................................................................................................................ III
TABLE OF CONTENTS.............................................................................................IV
LIST OF TABLES ..................................................................................................... VII
LIST OF FIGURES .................................................................................................. VIII
LIST OF ABBREVIATIONS AND ACRONYMS ....................................................IX
OPERATIONAL DEFINITIONS ................................................................................. X
CHAPTER ONE ............................................................................................................ 1
INTRODUCTION ......................................................................................................... 1
1.1 BACKGROUND ..................................................................................................... 1
1.2 PROBLEM STATEMENT ...................................................................................... 2
1.3 OBJECTIVE OF THE STUDY ............................................................................... 3
1.3.1 GENERAL OBJECTIVE...................................................................................... 3
1.3.2 SPECIFIC OBJECTIVES ..................................................................................... 3
1.4 RESEARCH QUESTIONS ..................................................................................... 3
1.5 SIGNIFICANCE OF THE STUDY......................................................................... 3
1.6 SCOPE OF THE STUDY ........................................................................................ 4
1.6.1 GEOGRAPHICAL SCOPE .................................................................................. 4
1.6.2 CONTENT SCOPE .............................................................................................. 4
1.6.3 TIME SCOPE ....................................................................................................... 4
CHAPTER TWO ........................................................................................................... 5
LITERATURE REVIEW .............................................................................................. 5
2.0. INTRODUCTION .................................................................................................. 5
2.1. KNOWLEDGE CONCERNING HIV/AIDS ......................................................... 5
2.2. ATTITUDES CONCERNING HIV/AIDS ............................................................. 6
2.3. PRACTICES CONCERNING HIV/AIDS ............................................................. 7
CHAPTER THREE ....................................................................................................... 8
METHODOLOGY ........................................................................................................ 8
3.0. INTRODUCTION .................................................................................................. 8

iv
3.1. RESEARCH DESIGN ............................................................................................ 8
3.2. SAMPLE SIZE DETERMINATION ..................................................................... 8
3.3. STUDY POPULATION ......................................................................................... 8
3.3.1. INCLUSION CRITERIA..................................................................................... 8
3.3.2. EXCLUSION CRITERIA ................................................................................... 9
3.4. SAMPLING TECHNIQUE .................................................................................... 9
3.5. DATA COLLECTION TOOLS ............................................................................. 9
3.6. PROCEDURE ......................................................................................................... 9
3.7. QUALITY CONTROL ........................................................................................... 9
3.8. DATA ANALYSIS ................................................................................................. 9
3.9. ETHICAL CONSIDERATIONS ............................................................................ 9
3.10. STUDY LIMITATIONS AND DELIMITATIONS ........................................... 10
3.11. DISSEMINATION OF STUDY FINDINGS ..................................................... 10
CHAPTER FOUR ........................................................................................................ 11
DATA ANALYSIS AND PRESENTATION ............................................................. 11
4.0. INTRODUCTION ................................................................................................ 11
4.1. DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS ........................ 11
4.2 KNOWLEDGE OF KIU BMS 143 SERIES MEDICAL STUDENTS ON
CLINICAL PLACEMENT AT FPRRH ABOUT HIV/AIDS AND PLWHAS ......... 11
4.3. ATTITUDE OF KIU BMS 143 SERIES MEDICAL STUDENTS ON
CLINICAL PLACEMENT AT FPRRH TOWARDS HIV/AIDS AND PLWHAS ... 12
4.4. PRACTICES OF KIU BMS 143 SERIES MEDICAL STUDENTS ON
CLINICAL PLACEMENT AT FPRRH REGARDING PLWHAS ............................ 12
CHAPTER FIVE ......................................................................................................... 14
DISCUSSIONS, CONCLUSIONS & RECOMMENDATIONS ................................ 14
5.0. INTRODUCTION ................................................................................................ 14
5.1. DISCUSSIONS ..................................................................................................... 14
5.1.1. DEMOGRAPHIC CHARACTERISTICS OF KIU BMS 143 MEDICAL
STUDENTS AT FPRRH ............................................................................................. 14
5.1.2. KNOWLEDGE REGARDING HIV/AIDS AND PLWHAS ............................ 14
5.1.3. ATTITUDES TOWARDS HIV/AIDS AND PLWHAS ................................... 14
5.1.4. PRACTICES TOWARDS PLWHAS ................................................................ 15

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5.2. CONCLUSIONS................................................................................................... 15
5.3. RECOMMENDATIONS ...................................................................................... 15
5.3.1. TO THE KIU STUDENTS ................................................................................ 15
5.3.2. TO THE ADMINISTRATION AND MANAGEMENT OF KIUTH ............... 15
REFERENCES ............................................................................................................ 16
APPENDICES ............................................................................................................. 19
APPENDIX 1: CONSENT FORM .............................................................................. 19
APPENDIX 2: QUESTIONNAIRE ............................................................................ 20
APPENDIX 3: MORGAN’S TABLE ......................................................................... 23
APPENDIX 4: MAP OF UGANDA SHOWING LOCATION OF KABAROLE
(BLUE ARROW) DISTRICT WHERE FPRRH IS SITUATED IN FORT PORTAL
...................................................................................................................................... 24
APPENDIX 5: APPROVAL LETTER FROM IREC KIU ......................................... 25

vi
 LIST OF TABLES

Table 1: Demographic characteristics of BMS 143 series medical students at FPRRH

(N=53) .......................................................................................................................... 11

vii
 LIST OF FIGURES

Figure 1: Knowledge, Attitudes & Practices of KIU BMS 143 Series Medical
Students ........................................................................................................................ 13

viii
 LIST OF ABBREVIATIONS AND ACRONYMS

AIDS : Acquired Immune Deficiency Syndrome

BMS : Bachelor of Medicine and Bachelor of Surgery
FPRRH : Fort Portal Regional Referral Hospital
HIV : Human Immune Deficiency Virus
KIU : Kampala International University
MOH : Ministry of Health
NAFOPHANU: National Forum of People Living with HIV/AIDS
PITC : Provider-Initiated HIV Testing and Counseling
PLWHA : People Living with HIV/AIDS
PMTCT : Prevention of Mother-to-Child Transmission
QI : Quality Improvement
UAC : Uganda Aids Commission
UAE : United Arab Emirates
UNAIDS : United Nations Agency for International Development
WHO : World Health Organization

ix
 OPERATIONAL DEFINITIONS

Knowledge on HIV/AIDS: General understanding of familiarity with Human

Immune Deficiency Virus/Acquired Immune Deficiency Syndrome.
Medical Students: Bachelor of Medicine and Bachelor of Surgery Students
People Living With HIV/AIDS (PLWHA): Men, women and children tested and
confirmed to be positive of HIV Virus or have developed the immunodeficiency
syndrome as a result of infection with HIV.
Stigma: A mark of Infamy or disgrace.

x
 CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND
Medical education is one of the professional trainings that aim to turn a lay person into a
professional, a doctor in this context. Transformation in theoretical perspectives and teaching
strategies are abound in medical education in order to produce tomorrow doctors who are not
only knowledgeable and skillful but also behave professionally (KV, 2011).
A newly graduated doctor is almost instantly employed to be a house officer in this country.
From day one in the hospital, they are expected to clerk all patients who are admitted into
their ward. Thus, their professional behavior with the patient does impress, impact and decide
on the course of the disease, treatment adherence and prognosis of the patient, especially
patient with serious and frightening conditions such as human immunodeficiency virus (HIV)
infection and acquired immune deficiency syndrome (AIDS) (B. Coeteez et al. 2011).
HIV/AIDS is one of the major health burdens worldwide. Globally, HIV continues to be a
major global public health issue. In 2017 an estimated 36.9 million people were living with
HIV (including 1.8 million children) – with a global HIV prevalence of 0.8% among adults.
Around 25% of these same people do not know that they have the virus (U.S. Department of
Health & Human Services, 2017).
Since the start of the epidemic, an estimated 77.3 million people have become infected with
HIV and 35.4 million people have died of AIDS-related illnesses. In 2017, 940,000 people
died of AIDS-related illnesses. This number has reduced by more than 51% (1.9 million)
since the peak in 2004 and 1.4 million in 2010 (U.S. Department of Health & Human
Services, 2017).
The vast majority of people living with HIV are located in low- and middle- income
countries, with an estimated 66% living in sub-Saharan Africa. Among this group 19.6
million are living in East and Southern Africa which saw 800,000 new HIV infections in
2017 (UNAIDS., 2018).
In 2017, an estimated 1.3 million people were living with HIV, and an estimated 26,000
Ugandans died of AIDS-related illnesses (UNAIDS., 2018).
The epidemic is firmly established in the general population. As of 2015, the estimated HIV
prevalence among adults (aged 15 to 49) stood at 5.9%. Women are disproportionately
affected, with 8.8% of adult women living with HIV compared to 4.3% of men (Uganda
Ministry of Health, 2015).

1
Other groups particularly affected by HIV in Uganda are sex workers, young girls and
adolescent women, men who have sex with men, people who inject drugs and people from
Uganda’s transient fishing communities (Uganda AIDS Comission, 2017).
There has been a gradual increase in the number of people living with HIV accessing
treatment. In 2013, Uganda reached a tipping point whereby the number of new infections per
year was less than the number of people beginning to receive antiretroviral treatment
(Uganda AIDS Comission, 2017).
However, as of 2016 around 33% of adults living with HIV and 53% of children living with
HIV were still not on treatment. Persistent disparities remain around who is accessing
treatment and many people living with HIV experience stigma and discrimination (Uganda
AIDS Comission, 2017).
1.2 PROBLEM STATEMENT
As Medical students are becoming increasingly central points of contact for clinical care of
people living with HIV and AIDS, they must first be ensured adequate preparatory education.
Scattered reports have shown, however, that most Medical students in developing countries
are not well prepared during their pre-service education in the knowledge, skills and attitudes
needed to provide quality HIV/AIDS-related care.
Students need more knowledge, skills and experience dealing with HIV/AIDS; those that
have had knowledge, skills and experience have more positive attitudes than those who have
not.
Prejudices and social discrimination are some of the leading causes for certain groups of
Uganda’s population, such as sex workers and men who have sex with men, to avoid seeking
health care or HIV testing. However, even the general populations of people living with HIV
are subjected to social stigma and negative Judgement.
A 2015 survey conducted by HIV support Organizations, in partnership with the National
Forum of People Living with HIV/AIDS (NAFOPHANU), of people living with and affected
by HIV in central and south-western Uganda found stigma, both internal and external, to be
high. When the study began, more than half (54%) reported experiencing some form of
discrimination or prejudice as a result of having HIV (Drummond et al., 2015).
The People Living with HIV Stigma Index 2013 found the most common forms of
external stigma and discrimination directed at people living with HIV were: gossip –
experienced by 60% of survey participants verbal harassment, insults and threats –
experienced by 37% sexual rejection – experienced by 21.5% (NAFOPHANU.,

2
2013). Experiences of all forms of internal stigma were higher among women than men
(Uganda Bureau of Statistics, 2016).
Stigma is an attribute of social relation that exists when the following components occur:
labelling, stereotyping, separation, status loss and discrimination. HIV related stigma poses
multiple consequences on physical and psychological well-being of PLWHA including
affecting their quality of life (Hasanah, Zaliha, & Mahiran, 2011).
In this country, it was reported that perceived stigma from health care providers and
community was a major barrier for PLWHA to access prevention and treatment services from
health care system (Uganda Bureau of Statistics, 2016). Furthermore, studies have shown that
presence of stigmatization and discriminatory behaviors towards PLWHA in health care
professionals would further jeopardize the care to them (Cianelli et al., 2011).
There was a lack of evidence of these behaviors among the medical students in FPRRH.
Medical school has a role to play at the institutional level of the multifaceted and multilevel
stigma reduction strategies (Varas-Díaz, Neilands, Rodríguez-Madera, & Padilla, 2016).
Hence, this study will be set out to examine the medical students’ knowledge and
stigmatizing attitude in providing care to PLWHA.
1.3 OBJECTIVE OF THE STUDY
1.3.1 General objective
Student's knowledge, attitude and practices toward patients with HIV/AIDS at Fort Portal
Regional Referral Hospital, Uganda.
1.3.2 Specific objectives
1) To assess the students’ level of knowledge as regards HIV/AIDS.
2) To determine the students’ attitudes as regards HIV/AIDS.
3) To determine the students’ attitudes towards HIV/AIDS.
1.4 RESEARCH QUESTIONS
1) What is the level of students' knowledge regarding HIV/AIDS?
2) What are the student’s attitudes toward HIV/AIDS patients?
3) What are the students' responses about health care related practices with HIV/AIDS
patients?
1.5 SIGNIFICANCE OF THE STUDY
This study is aimed at shedding some light on the student's knowledge, attitude and practices
toward patients with HIV/AIDS and identifying the various factors that may influence the
general outcome among patients with HIV/AIDS.

3
The information obtained from this study will inform the hospital administration on the
interventions and modifiable factors that can be implemented and thus influencing
appropriate action. This is intended to reduce social stigma and mortality among patients with
HIV/AIDS.
Information obtained from this study could assist the government, Health institutions, NGOs
etc. so that appropriate measures can be implemented to prepare Medical students during
their pre-service education in the knowledge, skills and attitudes needed to provide quality
HIV/AIDS-related care.
Furthermore, the information that amassed from the study findings could be used by other
researchers for further studies on the various facility-specific interventions that could be put
in place as to improve outcomes care of patients with HIV/AIDS. It is also intended to fuel
interest for similar studies in other health facilities within the country that will ultimately
benefit patients with HIV/AIDS in those facilities and the country as a whole.
1.6 SCOPE OF THE STUDY
1.6.1 Geographical scope
Fort Portal Regional Referral Hospital (FPRRH), locally known as Buhinga, opened in 1920
as a dispensary and upgraded to a regional referral hospital in 1994. Located in Western
Uganda, the hospital serves the entire Ruwenzori region consisting of seven Ugandan
districts (Bundibugyo, Kabarole, Kyenjojo, Kasese, Kamwenge, Kyegegwa and Ntoroko) and
part of eastern Democratic Republic of Congo. Fort Portal RRH offers both general and
specialized services and is a teaching hospital.
To ensure delivery of quality HIV care and related services within the sub-region,
USAID/SUSTAIN supports various hospital areas including delivery of clinic HIV
prevention (Voluntary Medical Male Circumcision, Prevention of Mother-to-Child
Transmission of HIV), care and treatment and TB/HIV and laboratory services.
1.6.2 Content scope
The research concerned assessing knowledge, attitude and practices of KIU BMS Students
toward patients with HIV/AIDS at Fort Portal Regional Referral Hospital, Uganda
1.6.3 Time scope
The data collection for the study ran from the month of January 2019 to March 2019.

4
 CHAPTER TWO
LITERATURE REVIEW
2.0. INTRODUCTION
This chapter presents literature reviewed on the subject matter as per objectives of this study.
2.1. Knowledge concerning HIV/AIDS
Given the period of time that HIV/AIDS has been in existence, it is expected that it has come
to be known by virtually everyone in the globe. Knowledge on the transmission and
prevention goes a long way in the fight against the transmission and spread of the pandemic.
It is hoped that with adequate and proper awareness, the fight will one day be won.
Reports have gone ahead to show mixed reports on HIV/AIDS awareness with some reports
reporting good levels of awareness as that seen among newly admitted medical students in in
an Indian medical school. All the students were conscious about HIV/AIDS disease, its
causative agent and diagnostics test. Majority of the students were aware about the modes of
transmission and preventive approaches. Very few misconceptions were observed like spread
by mosquito bite (Biradar, Kamble, & Reddy, 2016).
Indian nursing students were also reported to have adequate knowledge concerning
HIV/AIDS. A study documented the overall mean knowledge to be high among these nursing
students (Dharmalingam, Poreddi, Gandhi, & Chandra, 2015), results that were even bettered
by Iranian nursing and midwifery students among who knowledge was found to be high
(94%) especially on strategies for reducing HIV/AIDS-related stigma and discrimination
(Farotimi, Nwozichi, & Ojediran, 2015).
Same impressive statistics were reported in United Arab Emirates (UAE); a study conducted
among university students here found the overall average knowledge score regarding
HIV/AIDS to be above average (61%) with non-Emirati and postgraduate students
demonstrating higher levels of knowledge compared to Emirati and undergraduate students
respectively (Haroun et al., 2016), and replicated in China where more than half of the
respondents demonstrated a good level of knowledge, although few exhibited an excellent
level. The mean scores on knowledge was 79.41 ± 6.3 out of a maximum possible score of
100, and there was no significant difference regarding sex (Li, Dong, He, & Liu, 2016).
As earlier stated, studies have reported mixed results. This fact is driven home by the very
low levels of knowledge reported among health professionals in a tertiary health-care
institution in Uttarakhand, India for instance, most of the respondents were found to have had
incomplete knowledge regarding the various aspects of HIV/AIDS (Doda, Negi, Gaur, &
Harsh, 2018), whereas secondary school students in Enugu, Nigeria showed excellent
5
Knowledge on both STIs and HIV/AIDS! There was a high level of awareness of HIV
(97.8%) and STIs (94.5%). While 74.3% had correct knowledge of modes of transmission,
60.7% incorrectly identified casual contact as modes of transmission of HIV. Only 59%
correctly identified all the HIV prevention methods tested, while 74.9% practiced all modes
of prevention (Nwatu, Young, Ezeala-adikaibe, Okafor, & Onwuekwe, 2017).
In Uganda, a study was conducted among secondary school teenagers in central Uganda
where knowledge on HIV/AIDS transmission and prevention was reported to be very
satisfactory. Results showed that 95.1% participants had knowledge on HIV/AIDS in both
urban and rural schools and 27.4% knew all the modes of HIV transmission. For HIV cure,
62.0% of study participants reported non-cure and 24.9% were not sure. About 65.7% of
participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly;
weight loss, skin rash and being very rich were mentioned. About 39.2% of the study
participants mentioned that they cannot get infected with HIV and can’t contract HIV at all
and 18.4% believed that chances of getting HIV infection were high (Rukundo et al., 2016).
2.2. Attitudes concerning HIV/AIDS
Often a times, attitude is a direct product of level of knowledge with inadequate knowledge
resulting into poor attitudes and vice-versa. This is not always the case though, as several
studies have reported poor attitudes despite of excellent knowledge, and acceptable attitudes
despite insufficient knowledge. A good example of is reported by (Doda et al., 2018) in their
study among medical professionals at a tertiary health-care institution in Uttarakhand, India
where despite most participants having inadequate knowledge regarding the various aspects
of HIV/AIDS, all of them were receptive towards people living with HIV/AIDS (Doda et al.,
2018).
Among Indian nursing students on the other hand, though, a majority had adequate
knowledge, few held discriminatory attitudes toward people with HIV/AIDS (Dharmalingam
et al., 2015). Findings that were supported by (Farotimi et al., 2015) in their study among
Indian nursing and midwifery students that showed discriminatory attitudes towards PLWAs
by the students despite satisfactory knowledge. 64% of the students had moderate
discriminatory attitude, 74% engaged in low discriminatory practice, while 26% engaged in
high discriminatory practice (Farotimi et al., 2015).
This trend was also seen among university students in the UAE where it was apparent that
adequate knowledge does not always translate into positive attitudes. A study reported that
eighty-five percent of students expressed negative attitudes towards people living with HIV,
with Emirati and single students significantly holding more negative attitudes compared to
6
non-Emiratis and those that are married respectively (Haroun et al., 2016). This was also the
case among Chinese dental students as reported by (Li et al., 2016) where it was observed
that despite their good level of knowledge, the majority (93.68%) displayed a negative
attitude (nonprofessional attitude) toward HIV/AIDS.
University students in Xinjiang, China have been reported to have negative attitudes towards
HIV/AIDS. In a study conducted among them showed that only 33.3% of them had positive
attitudes towards HIV/AIDS patients (Maimaiti, Shamsuddin, & Nurungul Tohti, &
Maimaiti, 2014). On the other hand, Ethiopian university have a poor attitude towards
HIV/AIDS and the majority never perceive themselves at risk of contracting it (Petros, 2014).
In Uganda, attitudes towards HIV/AIDS transmission and prevention, especially among
teenage secondary school teenagers, is negative with most perceived condom use, one of the
cheapest and efficient transmission control method, as a sign of mistrust, embarrassing to buy
and reduces sexual pleasure (Rukundo et al., 2016).
2.3. Practices concerning HIV/AIDS
Good practice is, expectedly, a product of sufficient knowledge and favorable attitudes, while
the reverse still stands true. Again, this is not always the case as several studies have
repeatedly shown. It is thus of importance that practice too be assessed while assessing
knowledge and attitudes.
A majority of Chinese students, despite reporting high knowledge levels for instance, fear
contracting HIV through clinical practice and feel that health care workers have the right to
know a patient’s HIV status for their own safety. The majority would wear gloves to touch a
patient if suspected of HIV (Lui, Sarangapany, Begley, Coote, & Kishore, 2014).
Indian nursing students too have been reported to portray discriminatory practices towards
PLWHAs. For instance, a study reported 64% to have moderate discriminatory attitude, 74%
engaged in low discriminatory practice, while 26% engaged in high discriminatory practice
(Farotimi et al., 2015).

7
 CHAPTER THREE
METHODOLOGY
3.0. INTRODUCTION
This chapter presents the methodology used in conducting the study and deals with the
design, population, sample size determination, sampling technique, data collection and ethical
considerations involved.
3.1. RESEARCH DESIGN
A descriptive cross-sectional design was utilized in this study to achieve the stated aim.
3.2. SAMPLE SIZE DETERMINATION
The sample size was determined using Krejcie & Morgan Sample Size Formula for Finite
Population:
s= X 2NP (1− P)
d 2(N −1) + X 2P (1− P)
Where:
s = required sample size.
X = the z value on the table value of chi for 1 degree of freedom at the desired confidence
level
(1.96 for a 95% confidence level).
N = the population size (130 students).
P = the population proportion (assumed to be .50 since this would provide the maximum
sample size).
d = the error margin (.05).
Krejcie & Morgan simplified the process of determining the sample size by coming up with
a table developed basing on the above formula. Therefore 97 participants in direct contact
with the patients in their clinical practice were considered for the study and this was
evaluated using Morgan's Table.
3.3. STUDY POPULATION
The study was carried out at FPRRH among (130) KIU BMS students on clinical attachment.
The program consists of TWO levels (Junior and senior students). All students begin their
clinical training in the hospital where they work with different categories of patients and they
can deal with patients with infectious diseases such as hepatitis, tuberculosis, and acquired
immunodeficiency syndrome (HIV/AIDS).
3.3.1. Inclusion criteria
KIU BMS students in direct contact with the patients in their clinical practice
8
3.3.2. Exclusion Criteria
Non KIU BMS students/ other students from universities other than KIU
3.4. SAMPLING TECHNIQUE
Consecutive sampling with sequential enrollment was used for the study. Study participants
were selected as per their meeting the inclusion criteria.
3.5. DATA COLLECTION TOOLS
Data needed for the study was collected by using a structured, self-administered
questionnaire regarding the students' knowledge, attitude and practices toward the HIV/AIDS
patients. The questionnaire consisted of 4 parts with total of 33 items; part one included
students' personal profile such as age, marital status and academic level, part two contains
questions to estimate students' knowledge regarding HIV/AIDS; it consisted of 5 statements as "do
you have up to date knowledge about HIV/AIDS treatment". Part three consists of 20 statements
regarding student's attitude toward HIV/AIDS patients and divided into statements to assess
students' attitude toward patients' rights, attitude toward working with HIV/AIDS patients and
attitude toward patients with HIV/AIDS in general. Part four includes 6 statements to assess
students' responses about health care related practices with HIV/AIDS patients such as "patients'
blood should never be tested for HIV/AIDS without their consent".
3.6. PROCEDURE
The questionnaire was handed down to the students in the classroom. These data were
recorded in the interviewing questionnaire sheet. A pilot study was done on 10 students and they
were included in the study and the needed modifications done for more clarity and suitability
of the tool to the students' cultural background.
3.7. QUALITY CONTROL
Students’ responses were carefully reviewed with clarifications sort from the student where
needed (e.g. where there were multiple responses for one question). Care was taken while
recording the serial numbers to avoid data mix-up.
3.8. DATA ANALYSIS
Data was collected, tabulated, scored and analyzed using Statistical Package for Social
Science (SPSS) version 20. Data was then presented in the form of statements, graphs, tables and
charts.
3.9. ETHICAL CONSIDERATIONS
An official permission was sought from the dean of faculty of clinical medicine and dentistry KIU.
All students included in this study were informed about the purpose of this study in order to
obtain their acceptance to share in the study and those students who were willing to
9
participate in the study were included. The researchers assured confidentiality of personal
responses.
3.10. STUDY LIMITATIONS AND DELIMITATIONS
The researcher anticipated financial constraints that he handled through sourcing for funds
from friends, family and well-wishers and through efficient resource allocation via
meticulous budgeting.
3.11. DISSEMINATION OF STUDY FINDINGS
Results from the study were shared between the researcher, the supervisor and the examiners.

10
 CHAPTER FOUR
DATA ANALYSIS AND PRESENTATION
4.0. INTRODUCTION
This chapter deals with analysis of data and presents it in the form of narratives, tables,
graphs, and charts.
4.1. Demographic characteristics of respondents
The study included all 53 of the BMS 143 series KIU medical students on clinical placement
at FPRRH. A total of 53 questionnaires were administered to them, the same number received
and analysed giving a response rate of 100%. The demographic characteristics were as shown
in table 1 below.
FREQUENCY (N) PERCENTAGE (%)
AGE (YEARS)
22 – 25 31 58.49
Above 25 22 41.51
SEX
Male 37 69.81
Female 16 30.19
MARITAL STATUS
Married 11 20.76
Single 42 79.24
TOTALS 53 100
Table 1: Demographic characteristics of BMS 143 series medical students at FPRRH (N=53)
The BMS 143 series from KIU on clinical placement at FPRRH were mainly single
(79.24%), males (69.81%) who were aged between 22 years and 25 years (58.49%).
4.2 knowledge of KIU BMS 143 series medical students on clinical placement at FPRRH
about HIV/AIDS and PLWHAS
The score for the 5 questions asked and answered favourably was 80% with all 53 answering
as expected to 4 out of 5 questions. All of them were in agreement that women living with
HIV/AIDS could get pregnant just like other women without HIV, all disagreed that immoral
behaviour was the only way HIV could be transmitted and spread, and that need for consent
was exaggerated in HIV testing and thus should be handled like any other routine medical
test. They also disagreed with the idea that HIV/AIDS patients should be made to pay for
testing kits, gloves and other protective equipment used while offering health care services to
them. However, only 14 (26.42%) deemed themselves as to possess up-to-date knowledge

11
concerning HIV/AIDS treatment protocols, while the remaining 39 (73.58%) were not sure if
the knowledge they possessed was up-to-date.
4.3. Attitude of KIU BMS 143 series medical students on clinical placement at FPRRH
towards HIV/AIDS and PLWHAs
A total of 19 questions assessing attitudes were asked out of which 18 (94.44%) were
answered as expected. All 53 agreed that PLWAs have the right of disclosure and deciding
who should be made known of their status, had the right to get married as long as their
statuses of both partners were known to each other, that their opinion was important and
matter, that they deserve healthcare services just like anyone else and they would readily
offer care to them just as they would any other patients and the same due diligence, that they
would be willing to share a meal with a PLWHA, they would be willing to work together
with a co-worker who they discovered that they were HIV positive. They also would
encourage PLWHAs to comply with their treatment. They also felt that sex workers (or their
clients) and intravenous drug abusers were at risk of getting infected with HIV and thus they
needed to worry about getting infected, they would buy food from a food vendor or move
into a home with a PLWA as the vendor or neighbour without any qualms.
They did not view PLWAs as bad or evil people, stupid neither do they get disgusted or
easily irritated or angry while dealing with PLWAs taken ill but 4 (7.55%) were afraid of
getting infected while treating and caring for PLWAs.
4.4. Practices of KIU BMS 143 series medical students on clinical placement at FPRRH
regarding PLWHAs
A set of 6 questions assessing practice were asked out of which all were answered as
expected. All the 53 students agreed that patients should never be tested for HIV without their
consent unless in very special circumstances (including pregnancy and surgery) and they also
would not disclose to family and friends of a patient’s status who had tested positive. They
also stated that HIV patients should not be isolated from other patients in the wards and that
their clothes and linen they use need not be disposed of or burnt.
The infographic on the knowledge, attitudes and practices scores of KIU BMS 143 series
medical students on placement on clinical placement at Fort-Portal Regional Referral
Hospital as regarding HIV/AIDS and PLWHAs based on questions asked is summarized in
figure 1 below.

12
 KAP of KIU BMS 143 Series

Practice
100%

Atitude
94.44%

Knowledge
80%

0% 20% 40% 60% 80% 100% 120%

Percentage Scores

Figure 1: Knowledge, Attitudes & Practices of KIU BMS 143 Series Medical Students
The Knowledge level was at 80%, attitudes scored 94.44% and for practices the score was
100%.

13
 CHAPTER FIVE
DISCUSSIONS, CONCLUSIONS & RECOMMENDATIONS
5.0. INTRODUCTION
This chapter presents the discussions of the study findings, conclusions arrived at and
recommendations made based on the findings and conclusions.
5.1. DISCUSSIONS
5.1.1. Demographic characteristics of KIU BMS 143 medical students at FPRRH
A total of 53 students were on clinical placement at the time of the study. They consisted of
37 males and 16 females, the majority of who were aged between the ages of 22 and 25 years
and 11 of whom were married.
5.1.2. Knowledge regarding HIV/AIDS and PLWHAs
At a knowledge score of 80%, for the 5 questions asked, the students portrayed high levels of
knowledge which may be attributable to the fact that, being senior medical students in their
final year, they had amassed a wealth of information and knowledge on the subject matter
over the years.
These results were in agreement with those reported by (Biradar et al., 2016) among Indian
medical students which found all of them to be conscious about HIV/AIDS with very few
misconceptions. They also agree with (Farotimi et al., 2015) who reported adequate
knowledge among Nigerian nursing students, and (Haroun et al., 2016) who reported an
above average knowledge among university students in the UAE. However, they contradict
(Doda et al., 2018) reports of low knowledge among health professionals in a tertiary
healthcare institution in Uttasakhand, India.
Of importance, though, is the fact that this study’s results are in agreement with reports tabled
by (Rukundo et al., 2016) in Uganda which asserted high levels of knowledge among
secondary school teenagers; knowledge in that particular study was scored at 95.1%.
5.1.3. Attitudes towards HIV/AIDS and PLWHAs
KIU BMS 143 series medical students had a positive attitude towards HIV/AIDS and
PLWHAs with an impressive score of 94.44%. this, again, goes back to emphasize the
positive impact adequate knowledge has on attitudes and shoots down the argument that
attitudes may remain negative despite sufficient knowledge as reported by (Doda et al., 2018)
in their study in Uttarakhand. It also goes ahead to further highlight that people with adequate
knowledge rarely will hold discriminatory attitudes towards PLWHAs, a fact evidenced in
the reports by (Dharmalingam et al., 2015) in their study among Indian nursing students and
(Haroun et al., 2016) in their study among university students in the UAE.
14
Of importance, though, this study’s findings go contrary to (Rukundo et al., 2016) in their
study that reported negative attitudes among secondary school teenagers in Uganda. This
could be attributable to the difference in the level of understanding of the subject matter that
may exist between the two cohorts; one being of secondary school teenagers not constantly
exposed to dealing with PLWHAs and the other being senior medical students in their final
year of study who have been for a large part of their training.
5.1.4. Practices towards PLWHAs
The medical students’ practice towards PLWHAs was beyond impressive with all portraying
favourable practice commensurate to their sufficient knowledge levels that translated into
positive attitudes and ultimately good practice. This seems to follow quite the opposite
direction compared to the findings reported by (Lui et al., 2014) and (Farotimi et al., 2015) in
their studies conducted among Indian and Nigerian nursing students respectively. In both
those studies, the students were reported to exhibit discriminatory practices towards
PLWHAs despite possessing adequate knowledge.
5.2. CONCLUSIONS
The knowledge of KIU BMS 143 series medical students on clinical placement at FPRRH
concerning HIV/AIDS and PLWHAs was high, their attitudes positive and practices good.
5.3. RECOMMENDATIONS
5.3.1. To the KIU students
Keep up the positive attitudes and good practice towards PLWHAs but scale-up their efforts
towards getting up-to-date information as concerns current treatment protocols for HIV
patients, as management of PLWHAs demands a wholistic approach.
5.3.2. To the administration and management of KIUTH
Keep on imparting knowledge on HIV/AIDS and care of PLWHAs to its students while at the
same time emphasizing the need to be conversant with current up-to-date treatment protocols
by the students since HIV/AIDS management protocols keep on being updated for the better.

15
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practice of HIV/AIDS-related stigma and discrimination reduction among nursing
students in southwest Nigeria. Iranian Journal of Nursing and Midwifery Research,
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Haroun, D., El Saleh, O., Wood, L., Mechli, R., Al Marzouqi, N., & Anouti, S. (2016).
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18
 APPENDICES
APPENDIX 1: CONSENT FORM
CONSENT FORM

STUDY TITLE: STUDENTS’ KNOWLEDGE, ATTITUDE AND PRACTICES TOWARD

PATIENTS WITH HIV/AIDS AT FORT PORTAL REGIONAL REFERRAL HOSPITAL,
UGANDA.

I am Odongo Emmanuel Okello, a final year medical student at Kampala International

University – Western Campus carrying out the above research. I would hereby wish to assure
you that the information you will provide will be accorded the confidentiality it deserves and
will not be used for purposes other than those meant for this research. Therefore, feel free.

For Respondent / Study participant

I have read and understood the research topic above on the planned study and the
explanations given to me. I understand what I have been requested to do in respect to this
study. I have asked questions and gotten clarifications about the study and I am satisfied. I
have, after due consideration, willingly consented to take part in this study as explained.

Participant’s signature …………………………… Date

………………………………………...

Investigators name ………………………………… Signature ………………………………

Date ……………………………………

19
 APPENDIX 2: QUESTIONNAIRE
STUDY TITLE: STUDENT'S KNOWLEDGE, ATTITUDE AND PRACTICES TOWARD
PATIENTS WITH HIV/AIDS AT FORT PORTAL REGIONAL REFERRAL HOSPITAL,
UGANDA.
SERIAL NO: …………………………
SECTION I: Students personal profile
a) Students’ age: a) 18-21 b) 22-25 c) >25
2. Marital status:
a) Married b) Not Married
3. Academic level:
a) Junior b) Senior
SECTION II: Students’ knowledge about HIV/AIDS
4. HIV-positive women can get pregnant
a) Don’t agree b) Agree c) Uncertain
5. HIV spreads due to immoral behavior only
a) Don’t agree b) Agree c) Uncertain
6. The need for consent is exaggerated. HIV tests should be handled like any other blood
test
a) Don’t agree b) Agree c) Uncertain
7. HIV/AIDS patients should be made to pay for gloves, HIV testing kits.
a) Don’t agree b) Agree c) Uncertain
8. Do you have up to date knowledge about HIV/AIDS treatment
a) Yes b) No c) Unsure
SECTION IIIA: Students’ attitude toward HIV +ve patients.
9. People living with HIV/AIDS have a right to decide who should know about it
a) Don’t agree b) Agree c) Uncertain
10. People with HIV/AIDS should still be allowed to get married, as long as both partners
know about it
a) Don’t agree b) Agree c) Uncertain
11. Is the opinion of the patient with HIV/AIDS important? Does it matter?
a) Don’t agree b) Agree c) Uncertain
12. Do PLWHAs deserve healthcare services just like any other patients?
a) Don’t agree b) Agree c) Uncertain
SECTION IIIB: Students’ attitude toward working with HIV/AIDS patients:
20
12. Would you be willing to share a meal with HIV/AIDS-positive persons?
a) Don’t agree b) Agree c) Uncertain
13. If you found out that a co-worker had HIV/AIDS would you be willing to work with
him/her
a) Don’t agree b) Agree c) Uncertain
14. Would you care for HIV/AIDS patients just as you would any other patient?
a) Don’t agree b) Agree c) Uncertain
15. Would you apply the same diligence while treating patient with HIV/AIDS as you would
any other patient?
a) Don’t agree b) Agree c) Uncertain
16. Would you encourage patient with HIV/AIDS to comply with their treatment?
a) Don’t agree b) Agree c) Uncertain
17. You can spend enough time with HIV/AIDS patient
a) Don’t agree b) Agree c) Uncertain
18. Are you afraid you might get infected with HIV from treating and caring for patient with
HIV/AIDS?
a) Don’t agree b) Agree c) Uncertain
SECTION IIIC: Students’ attitude toward patients with HIV/AIDS in general:
19. People who get HIV/AIDS get what they deserve
a) Don’t agree b) Agree c) Uncertain
20. Sex workers have to worry about getting HIV/AIDS
a) Don’t agree b) Agree c) Uncertain
21. People who go to sex workers or use drugs have to worry about getting HIV/AIDS
a) Don’t agree b) Agree c) Uncertain
22. If you knew that a food seller had HIV would you buy food from?
a) Don’t agree b) Agree c) Uncertain
23. Would you be willing to move into a home if the neighbor was HIV-positive?
a) Don’t agree b) Agree c) Uncertain
24. Do you believe that patients with HIV/AIDS are bad / evil people?
a) Don’t agree b) Agree c) Uncertain
25. Do you view patients with HIV/AIDS as stupid for getting it?
a) Don’t agree b) Agree c) Uncertain
26. Do you get easily irritated or angry while dealing withthe patient with HIV/AIDS
a) Don’t agree b) Agree c) Uncertain
21
27. Do patients who have been taken ill due to HIV/AIDS disgust you?
a) Don’t agree b) Agree c) Uncertain
SECTION IV: Students’ responses to health practices with patient with HIV/AIDS
28. Patients’ blood should never be tested for HIV without their consent except in very
special circumstances.
a) Don’t agree b) Agree c) Uncertain
29. Would you inform family and loved ones of a patient who has tested positive for HIV
about their status without their consent?
a) Don’t agree b) Agree c) Uncertain
30. All pregnant women should be tested for HIV
a) Don’t agree b) Agree c) Uncertain
31. Patients with HIV/AIDS should be isolated from other patients
a) Don’t agree b) Agree c) Uncertain
32. Clothes and linens used by HIV/AIDS patients should be disposed of or burned
a) Don’t agree b) Agree c) Uncertain
33. Patients should be tested for HIV before surgery
a) Don’t agree b) Agree c) Uncertain

22
 APPENDIX 3: MORGAN’S TABLE
Morgan’s Table for Determining Sample Size from a Given Population
N S N S N S
10 10 220 140 1200 291
15 14 230 144 1300 297
20 19 240 148 1400 302
25 24 250 152 1500 306
30 28 260 155 1600 310
35 32 270 159 1700 313
40 36 280 162 1800 317
45 40 290 165 1900 320
50 44 300 169 2000 322
55 48 320 175 2200 327
60 52 340 181 2400 331
65 56 360 186 2600 335
70 59 380 191 2800 338
75 63 400 196 3000 341
80 66 420 201 3500 346
85 70 440 205 4000 351
90 73 460 210 4500 354
95 76 480 214 5000 357
100 80 500 217 6000 361
110 86 550 226 7000 364
120 92 600 234 8000 367
130 97 650 242 9000 368
140 103 700 248 10000 370
150 108 750 254 15000 375
160 113 800 260 20000 377
170 118 850 265 30000 379
180 123 900 269 40000 380
190 127 950 274 50000 381
200 132 1000 278 75000 382
210 136 1100 285 1000000 384
Where N= population size, S= sample size Source: Morgan, & Krecjie (1970)
23
APPENDIX 4: MAP OF UGANDA SHOWING LOCATION OF KABAROLE (BLUE
ARROW) DISTRICT WHERE FPRRH IS SITUATED IN FORT PORTAL

24
APPENDIX 5: APPROVAL LETTER FROM IREC KIU

25