Measuring HIV knowledge and attitudes in the health care setting: Italian results from an ECDC/EACS survey

Introduction: In 2023, ECDC and EACS conducted a survey aimed to assess health care providers' knowledge of human immunodeficiency virus (HIV) on key concepts of HIV transmission and prevention, and their behaviours towards people living with HIV (PLWH) in the WHO European Region. The present work describes data from Italy to identify areas requiring implementation at the national level. Methods: We anonymously collected and analysed cross-sectional survey data from 438 Italian health care professionals from Italy and described them by clinical settings and years of practice. Results: There were 438 respondents (36 ± 11 years, 77.8% physicians and 38.3% HIV care providers). Less than half of them (43.8%) had received training on “equity, diversity, or inclusion” and “HIV stigma/discrimination.” Less than a fifth (17.4%) disagreed with the statement “Undetectable = Untransmittable”, and 23.4% and 39.8% were unaware of the preventive benefits of pre-exposure and post-exposure prophylaxis (PEP). Knowledge was lower among non-HIV care providers and those with <5 years of work experience. Concerns about acquiring HIV through routine, low/no-risk clinical activities were more common among non-HIV care providers and less experienced professionals, leading to inappropriate and stigmatizing practices (e.g., use of double gloves) in up to 52.4% of cases. Over a fifth (29.2%) of respondents were unaware of workplace protocols for HIV-specific infection control and PEP. Discriminatory behaviours, including unwillingness to care for PLWH and unauthorized disclosure of HIV status, were reported by 21.9% and 12.5% of respondents. Conclusions: These findings highlight significant knowledge gaps and improper or stigmatizing practices for HIV care in the Italian health care system. Improved educational initiatives, starting before entering the workforce and extending to institutions outside HIV care settings, are needed to reduce stigma and improve health care practice.