ABSTRACT
OBJETIVOS: Dilucidar el alcance de los conocimientos prácticos que tienen los médicos de Barbados sobre el VIH y el sida y su actitud hacia las personas que padecen la enfermedad. MÉTODOS: En el año 2000 la Asociación de Médicos Generales de Barbados llevó a cabo una encuesta para evaluar las opiniones de los socios en torno a asuntos relacionados con el VIH y el sida. Durante un período de dos meses se entrevistó a 203 médicos (76% de los que ejercen en el país). En la encuesta se incluyeron tanto médicos del sector público como de consultorios privados. Las entrevistas fueron individuales y versaron sobre sus actitudes hacia la orientación de los pacientes, conocimientos prácticos, nociones de prácticas inocuas, temor de exponerse al contagio, modo de ver las cuestiones éticas, experiencia con el tratamiento de pacientes con VIH o sida y formación médica continua en el campo de VIH/sida. RESULTADOS: Comparados con los médicos egresados más tarde, los graduados en 1984 o antes habían tratado a menos pacientes con infección por VIH o sida, tenían menos conocimientos de la enfermedad, se inclinaban más a administrar la prueba diagnóstica sin el consentimiento válido del paciente y era menos probable que hubieran asistido a algún curso de formación continua sobre el VIH y el sida. En general, tenían poco conocimiento del tratamiento indicado y 76% no se consideraban capacitados adecuadamente para orientar a los pacientes. Más de 80% dijeron que se sentían bastante seguros atendiendo a pacientes con infección por VIH o sida. De los encuestados, 95% declararon que no entregarían los resultados diagnósticos a terceros sin el consentimiento del paciente, mientras que 33% dijeron que administrarían la prueba detectora sin consentimiento a un paciente grave y 15%, que lo harían si tuvieran que realizar una intervención invasora a un paciente de una población de alto riesgo, como las de homosexuales y trabajadores de la industria sexual. Solo 53% de los médicos habían participado en programas de adiestramiento en el servicio entre 1995 y 1999. CONCLUSIONES: Es preciso que la formación médica en Barbados comprenda la atención de pacientes con infección por VIH o sida, incluidos todos los aspectos, tanto clínicos como afectivos. Para los médicos del sector público debe ser obligatorio asistir a ese tipo de adiestramiento; además, es necesario examinar los planes de estudio de las escuelas de medicina para cerciorarse de que sean completos y actualizados.
Subject(s)
Prejudice , Attitude of Health Personnel , HIV Seropositivity , Acquired Immunodeficiency Syndrome , BarbadosABSTRACT
OBJECTIVE: To determine the extent of clinical knowledge of HIV/AIDS that physicians in Barbados have and their attitudes towards persons living with HIV/AIDS. METHODS: In 2000 the Barbados Association of Medical Practitioners conducted a survey in order to assess its members' views on HIV/AIDS issues. Over a two-month period 203 physicians (76% of all those practicing in the country) were interviewed. The survey included physicians working in private practice and the public sector. They were surveyed individually concerning their attitudes towards counseling as well as their clinical knowledge, perception of safe practices, fear of occupational exposure, views on ethical issues, experience treating HIV/AIDS patients, and background with HIV/AIDS continuing education. RESULTS: In comparison to physicians who had graduated in later years, physicians who had graduated in 1984 or earlier had seen fewer HIV/AIDS clients, had lower levels of knowledge about the disease, were more likely to test for HIV/AIDS without informed consent, and were less likely to have ever attended a continuing education training course on HIV/AIDS. Overall, knowledge of the clinical indications of HIV/AIDS was low, and 76% of the physicians did not think they had adequate counseling skills. Over 80% of the physicians were comfortable looking after HIV/AIDS patients. While 95% of the physicians would not release HIV test results without a patient's consent, 33% would test, without consent, a seriously ill patient, and 15% would test without consent a patient upon whom they had to perform an invasive procedure if they perceived the patient to be from a high-risk population such as gay men or commercial sex workers. Only 53% of the physicians had attended an HIV/AIDS in-service training program between 1995 and 1999. CONCLUSIONS: Physician training in Barbados should focus on all aspects of HIV/AIDS care, including clinical and emotional factors. Attendance at such training should be mandatory for public sector physicians, and medical school curricula need to be examined to ensure their HIV/AIDS content is current and comprehensive.
Subject(s)
Acquired Immunodeficiency Syndrome/psychology , Health Knowledge, Attitudes, Practice , Physicians/psychology , Prejudice , Barbados , Clinical Competence , Female , Humans , Male , Practice Patterns, Physicians'ABSTRACT
OBJECTIVES: To evaluate the impact of zidovudine (ZDV) intervention on vertical transmission and HIV-related mortality in two groups of pregnant mothers and their respective infants. METHODS: A modified long course Paediatric AIDS Clinical Trial Group 076 protocol was used. None of the infants was breast-fed. Maternal CD4 T lymphocyte counts and viral loads were not monitored. Infants were followed for clinical progress, and serial serologic testing was performed to the age of 24 months, or until two successive HIV (enzyme-linked immunosorbent assay) tests were negative. In a historically case-controlled prospective study, the transmission rate in ZDV-untreated mother-infant pairs in which infants were born during 1991 through 1995 was compared with the transmission rate in ZDV-treated mother-infant pairs in which infants were born between 1996 and 2000. RESULTS: In the 151 HIV-seropositive pregnant women and their 153 infants studied (2 pairs of twins), 93 mother-infant pairs were treated, and 59 were untreated (control group). Vertical transmission occurred in 5.5% [95% confidence interval (95% CI) 1.9 to 12.5] of the treated group of infants and in 27.1% (95% CI 16.7 to 40.5) of the untreated group. There was a 79.7% (95% CI 59.8 to 92.1%) relative reduction risk of transmission, which was statistically significant (z =3.18, two tailed P= 0.0001). Three infant deaths (3.7%) were recorded in the untreated group, and 1(1%) death was recorded in the treated group. In ZDV-untreated infants, deaths occurred at age <1 year, resulting from respiratory complications. One ZDV-treated infant died at 4 years of age with Pneumocystis carinii pneumonia. CONCLUSIONS: Our study demonstrated a statistically significant reduction in the vertical transmission of HIV after intervention with ZDV therapy.
