歯科診療所におけるHIV陽性者の診療受入れ姿勢と関連する要因  [in Japanese] Factors Related to the Attitude of General Dental Practitioners toward Treatment of HIV Carriers  [in Japanese]

歯科診療所におけるHIV陽性者の歯科診療受入れ姿勢に関連する要因を明らかにする目的で,471名の歯科診療所の開設者あるいは勤務者である歯科医師を対象として調査票を送付し,回収できた431件の回答内容を分析した.HIV陽性者であると判明した場合,「原則として断る」という回答が28.6%,「一般の患者と同様に対処する」という回答は4.0%であり,肝炎ウイルス陽性者への対応と大きな格差がみられた.HIVの診療を困難とする理由としては「十分な消毒・滅菌が困難」が最も多かった.肝炎ウイルス陽性者の歯科診療を受入れないという回答を除外した398件について,HIV陽性者の診療受入れ姿勢に関連する要因に関する多重ロジスティック回帰分析を行った結果では,オッズ比は,「ユニバーサルプリコーション,スタンダードプリコーションについて理解している」が1.73,「針刺し事故の経験あり」および「HIV陽性患者の歯科診療の依頼を受けた経験あり」という回答者では,それぞれ0.57および3.50,口腔外科あるいは麻酔系の経験ありという回答者では1.78で,いずれも有意であった.感染予防対策に関する基本的な認識ならびに,臨床上の経験が,HIV陽性者の歯科診療受入れ姿勢に関連する重要な要因であることが示唆された.歯科診療室における最新の感染防御に関する知見(CDC2003等)に準拠し,受診者を区別せず同等の標準的な院内感染防止対策を図るための知識の普及と併せて,感染予防対策の実技や,感染者自身の参加などの工夫により,医療者の行動変容をもたらすような研修システムの開発が,HIV陽性者の人権にも配慮した歯科診療の促進と安全な歯科医療の普及のために重要であるといえる.

Objective : A survey was undertaken to ascertain the factors related to the attitudes of general dental practitioners regarding the treatment of HIV carriers. Methods : Questionnaires on infection control and awareness/experience in the treatment of HIV + or hepatitis virus carriers were delivered in March, 2004 to 471 general dental practitioners selected from lists of graduates of two dental schools and of two dental study groups in Japan. Completed sheets were returned by post anonymously. Results : Completed sheets were collected from 431 respondents (91.5%). The percentage of those who reported to have treated a HIV+ patient was 2.5%. Whereas nearly 90% showed a willingness to treat HA+, HB+, and HC+ patients, only 31.9% showed a willingness to accept HIV+ patients. Of the respondents, 28.6% stated they would refuse to treat HIV positive patients, with 33.6% for AIDS patients. The main reasons they stated concerning the difficulty of dental treatment for HIV+ patients were as follows : (1) difficulty in disinfection, (2) dental staff's acceptance, (3) negative effects on other patients, and (4) the possibility of cross infection to health workers. Multiple logistic regression analysis showed four factors to be significantly correlated with the attitude concerning the treatment of HIV+ patients. The odds ratios of the factors were : 1.73 for 'practice or understanding of standard precautions', 0.57 for 'experience of needle injury', 3.50 for 'having been asked to treat an HIV+ patient', and 1.78 for 'advanced postgraduate experience of oral surgery or oral anesthesiology'. Discussion : These results suggest many dental practitioners still have a great misunderstanding concerning infection control : while most of them would accept a hepatitis virus carrier, which might represent a stronger possibility of infection, many of them would refuse an HIV carrier, which represents a lower possibility of infection. The reasons they cited were not based on scientific knowledge, but seemed to be affected by the possible negative effect on their other patients. The results also suggested that the more a dentist was aware of infection control, the more positively he/she may would accept an HIV carrier. Effective post graduate education on infection control based on current knowledge (CDC 2003, for example) to dental practitioners for practicing universal and/or standard precautions, and a change in the attitude of dental practitioners seems to be crucial for promoting the oral health care of people living with AIDS/HIV, with the proper consideration of their human rights as well as providing safer dentistry within the community.