Int J Soc Welfare 2002: 11: 331–339
Knowledge and attitudes towards AIDS: a comparison between Arab and Jewish professionals living in Israel Azaiza F, Ben-Ari AT. Knowledge and attitudes towards AIDS: a comparison between Arab and Jewish professionals living in Israel Int J Soc Welfare 2002: 11: 331–339 ß Blackwell, 2002. This paper investigates similarities and differences between Arab and Jewish professionals living in Israel regarding their knowledge and attitudes about AIDS. Although AIDS in Israel is not considered to be a pressing crisis, the aim of the research is to document and analyse what professionals in the helping professions – Arabs and Jews alike – know and how they feel about AIDS. The study also explores thoughts and feelings concerning AIDS-related education and training. This is the first scholarly attempt to compare Israeli and Arab professionals’ attitudes and knowledge about such a stigmatised topic as the AIDS epidemic. The study sample consists of 350 professionals, including 218 Jews and 132 Arabs, working in various social and healthcare agencies providing services to the Arab population. Professionals include social workers, nurses, occupational therapists, psychologists, and special education teachers and counsellors. Results indicate that Jewish professionals scored significantly higher on both knowledge and attitude scales than did their Arab counterparts. Two regression models predicting both knowledge and attitudes are presented, and their implications are discussed using several frameworks: the status of the disease, including perception of the threat; perception of adequacy of training; educational environment; and the socialisation process of Arab professionals in Israel.
The HIV pandemic continues to be volatile and to pose a far-reaching public health and social-welfare threat of catastrophic proportions. Scholars argue that the social, economic and political ramifications of AIDS will not leave any aspect of modern society untouched (Getzel, 1993; Herdt & Lindenbaum, 1992). Although Israel is ranked by the World Health Organisation among the low-incidence countries and AIDS in Israel is not considered to be a pressing crisis, the aim of the present research is to document and analyse what professionals in the helping professions – Arabs and Jews alike – know and how they feel about AIDS. The study also explores thoughts and feelings concerning AIDS-related education and training. This is the first scholarly attempt to compare Israeli and Arab professionals’ attitudes and knowledge about such a stigmatised topic as the AIDS epidemic.
Faisal Azaiza, Adital Tirosh Ben-Ari School of Social Work, University of Haifa
Key words: AIDS, professionals, knowledge, attitudes, crosscultural perspective Faisal Azaiza, School of Social Work, University of Haifa, Haifa, Israel 31905 E-mail: Adital Ben-Ari [
[email protected]] Accepted for publication January 30, 2002
A common conception in prevention education suggests the knowledge–attitude–behaviour model. According to this model, information shapes the formation of attitudes, which, in turn, influence behaviour. Since professionals in the helping professions are on the front lines in the war against AIDS, it is of major importance to study their knowledge and attitudes, as these two factors have a profound influence on the quality of services they provide in their daily work. It is a well-documented fact that knowledge about and attitudes towards AIDS are two crucial factors determining individuals’ experiences with AIDS. The relationship between individuals’ experiences and their knowledge base and attitudes pertains to many aspects of the epidemic, from safe-sex practices to comfort and willingness to provide services to people with AIDS
ß Blackwell Publishing Ltd and the International Journal of Social Welfare 2002. Published by Blackwell Publishing, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, Malden MA 02148, USA
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Azaiza & Ben-Ari (Owens, 1992). The following literature review centres around experiences of social workers and nurses in relation to AIDS, as practitioners of these two professions comprise the majority of the present sample. The National Association of Social Workers in the United States adopted its policy statement on AIDS in 1987. It reflects the serious commitment of the profession to be involved at all levels of the epidemic: research, education, social support, service delivery, resource development, civil rights, HIV testing, professional accountability and political action (Merdinger, Wrenn & Parry, 1990). In a recent publication outlining the new updates in the body of knowledge on HIV and AIDS for professionals, the important role played by mental-health providers has been emphasised, especially in promoting the extremely high degree of patient adherence that is necessary to prevent resistant strains from emerging (Cournos & Forstien, 2000). The important role of social work in responding to the AIDS epidemic has been acknowledged in parallel to the recognition of the psychosocial consequences of AIDS (Cherist, Weiner & Moynihan, 1986). AIDS confronts social workers in the essence of their practice. It challenges their ability to cope with stereotypes, prejudices and feelings about death, pain and loss. Scholars and professionals alike attest to the innovative nature of the social work field in responding to pressing needs. The AIDS epidemic provides yet one more example of this tradition (Tavares & Lopez, 1984). Because of its complex service requirements, AIDS has changed our notions of how to deliver care (Teltsch, 1991). The dual recognition of the central role of social work in confronting AIDS and the complex requirements it imposes on the profession emphasises the need for skilled professionals. The importance of professional training for social workers cannot be overestimated. Many studies have examined the experience of professionals with HIV and AIDS clients (Diaz & Kelly, 1990; Gillman, 1991; Merdinger, Wrenn & Parry, 1990; Miller & Dane, 1990; Owens, 1992; Riley & Greene, 1993; Silberman, 1991). The findings suggest that educational programmes for service providers can lower their levels of fear and increase their comfort in working with HIV and AIDS clients (Riley & Greene, 1993). Owens (1992) explored the comfort and willingness of graduate social work students in providing various services to people with AIDS. While the majority of participants showed willingness to provide such services, their comfort in doing so was related to their perception of risk and their attitudes towards clients with AIDS. That is, knowledge about and attitudes towards AIDS were important factors in determining social work practices with AIDS clients.
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In their study on the attitudes and knowledge of alumni from the Kentucky School of Social Work, Dhooper, Royse and Tran (1987–88) found that 67% of their sample were moderately or highly fearful of AIDS and that there was little evidence of the participants being well-informed about AIDS. In a nationwide study using a random sample of 379 social workers to assess their knowledge level, Peterson (1991) found that the percentage of incorrect answers was much lower than the percentage of ‘don’t know’ responses. She concluded that respondents were more likely to be uninformed than to be misinformed. She did find, however, that those participants who felt that they had personal or professional reasons to be well informed were significantly more knowledgeable than were those who did not feel this need. Even among those in the helping professions, however, AIDS is not thought of as a pressing crisis in Israel. It seems that AIDS is not viewed as a problem requiring reorganisation and immediate response by the human service delivery system. This is reflected in the lack of research studies on AIDS that have been published in Israel (Ariely-Kagan, 1991; Slonim-Nevo, 1991). Ariely-Kagan (1991) conducted a study comparing medical, social work and psychology students and found no differences in their attitudes towards AIDS. As anticipated, medical students were more knowledgeable about AIDS than their social work and psychology counterparts. The professional literature published in Hebrew also reveals that very little has been done in this area (Ben-Sira, 1987; Shenkar, 1989). Social work agencies are not yet prepared or trained to deal with AIDS. Furthermore, professional preparation of social work students to respond to AIDS is an issue that has not yet been confronted by the universities in Israel. Schools of social work in Israeli universities do not typically offer courses about AIDS in their programmes. Although nursing schools do not offer a special course about AIDS, they do include AIDS-related materials in their courses concerning infectious diseases or internal medicine. AIDS confronts not only individuals in Israel, but also its various communities and society as a whole. With the exception of medical concerns, the different needs presented by HIV-infected individuals are more likely to be met through informal frameworks than through formal ones. Two self-help groups for people with AIDS and HIV carriers, and one group for parents and significant others of those with AIDS are currently in operation. However, current information reveals that no Arab individuals participate in such groups. A national AIDS non-profit organisation and a hotline also address the various needs presented by people with AIDS, as well as their relatives and significant others. ß Blackwell Publishing Ltd and the International Journal of Social Welfare 2002
Attitudes towards AIDS among Arab and Jewish professionals The media has become an important resource in responding to AIDS (Reardon & Richardson, 1991). Following the broadcasting of a documentary programme on AIDS by the Israeli National Television network, a telephone survey was conducted to explore public awareness of the disease. Seventy-six percent of the respondents reported that the programme helped them to understand the disease and the way in which it is transmitted (Ben-Sira, 1987). It appears that while AIDS generally poses a major challenge to health professionals in understanding its psychological, social and cultural aspects and in formulating specific intervention programmes for its management and prevention throughout the world, the challenge is all the more daunting in developing countries with inadequate health-related infrastructures and rehabilitation facilities. Increasing scholarly attention is now being directed to publichealth issues such as AIDS in developing countries and communities (Elder, 2001). A cross-cultural perspective on AIDS reveals research findings in a variety of minority communities, including AfricanAmericans, Hispanics (Essien, Ross, Linares & Osemene, 2000), Chinese (Wu, Qi, Zeng & Detels, 1999), and Indians (Chandra & Prasadarao, 2000). In a recent study conducted in China (Wu et al., 1999), examining the knowledge of AIDS among 1,400 health professionals, it was found that while professionals know that AIDS is caused by an infectious agent, their knowledge of transmission routes, the ‘windows period’ and the length of the incubation period is still inadequate. Based on their research findings, the researchers concluded that there is an urgent need for more training among health professionals. In many ways, the Arab population living in Israel can be considered as a developing community. Arab society in Israel is undergoing significant social, cultural and structural changes and replacing traditional lifestyles with modern ones (Al-Haj, 1989). Arab professionals receive their education and training in Israeli or other Western educational institutions, which means that their professional socialisation is strongly influenced by Western values and ideas. However, Arab professionals living in Israel, particularly Muslims, still enter the professional world with a strong system of religious beliefs, including the tenets that a person’s destiny is predetermined and governed by God (Haj-Yahia, 1995; Kenaana, 1975) and that all variants of sexual activity outside of marriage are forbidden (Bouhdiba, 1985). These two poles create a conflict within young Israeli Arab professionals that may affect their knowledge and attitudes about AIDS. The present paper compares the knowledge and attitudes about AIDS between Jewish and Arab ß Blackwell Publishing Ltd and the International Journal of Social Welfare 2002
professionals living in Israel, in order to shed new light on the issue of professional education connected to AIDS.
Methods A translated and modified questionnaire from a previous study (Wexler, 1989) was administered to a sample of Jewish and Arab professionals in Israel. The sample consisted of 350 participants, including 218 Jewish and 132 Arab professionals working in various social and health-care agencies in the northern part of Israel. The Jewish professionals included 27 males (12.4%) and 191 females (87.6%). Their mean age was 36.1, with a standard deviation of 8.75. The number of years of their work experience ranged from 1 to 35 years, with a mean of 10.91 years and a standard deviation of 7.74. A majority of 169 participants (77.5%) had formal education higher than high school. The distribution of the sample according to professions was as follows: 40.7% were social workers, 28.5% were nurses, 6.8% were special education teachers and counsellors, 1.2% were psychologists and 2% were medical doctors. The rest worked in social agencies, but did not fall within any of the above occupational categories. Most participants described their specialisation as clinical (86.2%). The Arab professionals included 56 males (43.7%) and 75 females (57.3%). Their mean age was 31.2, with a standard deviation of 7.4. The number of years of their work experience ranged from 1 to 31 years, with a mean of 8.0 years and a standard deviation of 7.0. About 92% had a university education. The distribution of the sample according to professions was as follows: 58.0% were social workers, 16.8% were nurses, 12.2% were special education teachers and counsellors, 1.5% were psychologists and 6.9% were medical doctors. The rest worked in social agencies, but did not fall within any of the above occupational categories. As in the Jewish sample, most participants described their specialisation as clinical (75.3%). The questionnaire, in its modified form, included 39 items pertaining to knowledge (9), attitudes (14), demographics (11), and training (5). The attitude and knowledge items were measured on a scale of 1–4, indicating levels of agreement (ranging from 1 ‘absolutely agree’ to 4 ‘absolutely disagree’). The direction of all scale items was changed so that a higher score designates a higher level of knowledge or a more appropriate attitude (maximum knowledge or attitude score 4). According to Wexler (1989), the term ‘appropriate attitude’ refers to those attitudes and their behavioural implications which, in light of available scientific evidence, would permit HIV-
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Azaiza & Ben-Ari Table 1. Comparison of knowledge about AIDS between Jewish and Arab professional.
AIDS is caused by a kind of bacteria (F) AIDS can be transmitted by sharing food, drink or eating utensils (F) AIDS can be sexually transmitted (T) All children who have AIDS have at least one parent who has the disease AIDS causes the body to lose its ability to fight off infections (T) A positive result on the AIDS Antibody Test means that a person has AIDS (F) Using condoms reduces the risk of getting AIDS (T) Cleaning needles or syringes with soapy water reduces the risk of getting AIDS (F) Currently, there is no cure for AIDS (T) Total score
infected individuals the greatest degree of equity, social integration and social participation. Professionals were asked to complete the questionnaire in their staff meetings. Cronbach-alpha coefficients for the knowledge scale and attitude scale were 0.7 and 0.5, respectively.
Results As Table 1 shows, there is a significant variation in the responses given to individual items. Among the group of Jewish professionals, the proportion of correct answers to knowledge items ranged from 72.8% to 99.5%. The item that received the highest score on the knowledge scale was: ‘Using condoms reduces the risk of getting AIDS’. Over 99% of the participants agreed with this statement. The item that received the lowest score was: ‘A positive response on the AIDS Antibody Test means that the person has AIDS’. About 37% did not agree with this statement. The total knowledge score was examined in relation to various demographic characteristics, such as age, gender, type of profession, specialisation, administrative or clinical orientation, number of years of work experience and perception of adequate training. With the exception of perception of adequate training, none of the demographic variables seem to statistically relate to the total knowledge score. Professionals who felt that they had received adequate training to deal with AIDS scored higher on the knowledge scale than did those who felt that they had not received such training (t 1.7, df 364, p
