Perspectives & Practices

Journal of the International

Association of Providers of AIDS Care
Knowledge, Attitude, and Practices 2016, Vol. 15(5) 363–369
ª The Author(s) 2014
Reprints and permission:
Regarding Occupational HIV Exposure sagepub.com/journalsPermissions.nav
DOI: 10.1177/2325957414558300
and Protection among Health Care jiapac.sagepub.com

Workers in China: Census Survey

in a Rural Area

Qian Wu, PhD1, Xiao Fei Xue, MPH2, Dimpy Shah, MD, MSPH3,
Jian Zhao, MPH2, Lu-Yu Hwang, MD3, and GuiHua Zhuang, PhD1

Abstract
Background: Health care workers (HCWs) seek, treat, and care for patients living with HIV/AIDS on a daily basis and thus face a
significant risk to work-related infections. To assess the knowledge, attitude, and practices regarding occupational HIV exposure
and protection among HCWs in low HIV prevalence areas of rural China. Methods: A cross-sectional questionnaire survey was
carried out among all medical units in Pucheng County, Shaanxi, China. Results: Response rate of this study was 94%. The average
overall knowledge score of HCWs was 10.9 of 21.0. Deficiencies in general, transmission, exposure, and protection knowledge
were identified among HCWs at all levels. A high rate of occupational exposure (85%) and lack of universal precautions practice
behavior were recorded. Significant predictors of universal precautions practice behavior were female sex, prior training, and
greater knowledge about HIV/AIDS. Conclusion: Health care workers at various levels have inadequate knowledge on HIV/
AIDS and do not practice universal precautions. Nurses and medical technicians at the county level faced more occupation
risk than other HCWs. The key of AIDS training for different levels of HCWs should be distinguished.

Keywords
HIV, occupational exposure, prevention, health care workers

Introduction
By the end of September 30, 2013, a total of 434 000 persons
living with HIV/AIDS were reported in China. In 2862 counties
of China, 94.6% reported AIDS epidemic. Only in 97 counties
in China,1 the number of persons living with HIV/AIDS was
more than 1000. Although China is still considered a low ende-
mic area for HIV, with an overall prevalence of 0.1% among
adults, there is a continuous threat for this growing epidemic
spreading to general population.2–4
Health care workers (HCWs) are exposed to HIV-infected
patients on a daily basis. With lack of knowledge on HIV pro-
tection and inadequate safety measures, HCWs are at signifi-
cant risk for work-related infections.5,6 Not surprisingly, 20
730 HCWs in China were injured by needle sticks, and 30
HCWs might have been infected with HIV in the year 2000
alone.7–9 Another study reported that 86% of nurses had been
stuck by sharps while working, and 76% had been splashed
by blood or fluids in Heilongjiang Province, China.10
Most reports regarding occupational HIV exposure among
HCWs were based on information from the developed nations
or high prevalence areas.6,11–13 With the HIV epidemic
spreading to remote rural areas of China, the risk of HIV expo-
sure among HCWs in those areas is also growing.9 Li et al14
reported that 28% of HCWs in primary hospitals had contact
with HIV-positive patients. This group of professionals from
rural areas with low prevalence may be overlooked easily,
making them highly susceptible to the risk of HIV infection.
One such rural county with a relatively low HIV prevalence
is Pucheng County, which is located in the east of the Shaanxi
province of China. However, the incidence rates have been
steadily increasing. Since the first reported HIV-positive
patient in 2008, 10 HIV-positive cases have been detected from
1
Department of Epidemiology, Xi’an Jiaotong University School of Public
Health, Shaanxi, People’s Republic of China
2
Pucheng County Hospital, Weinan, Shaanxi, People’s Republic of China
3
Division of Epidemiology, Center for Infectious Diseases, School of Public
Health, University of Texas Health Science Center, Houston, TX, USA
Corresponding Author:
GuiHua Zhuang, Department of Epidemiology and Biostatistics, Xi’an Jiaotong
University School of Public Health, Shaanxi 710061, People’s Republic of China.
Email: 673932345@qq.com
364 Journal of the International Association of Providers of AIDS Care 15(5)
2010 to 2011. No studies examining HIV-related knowledge
and universal precaution practices for HCWs from this county
have been conducted so far.
Hence, this study was aimed at assessing the extent of
knowledge, attitude, and practices (KAP) regarding occupa-
tional HIV exposure and protection among HCWs in medical
institutions of Pucheng County, China.
Materials and Methods
Study Design and Population
A census survey was conducted from October to November
2010 among HCWs at county, township, and village hospitals
or clinics in Pucheng County, China. It has 4 county hospitals,
23 township health clinics, and 369 village clinics with a total
of 1900 HCWs, including doctors, nurses, technicians, and
administration staffs.
Data Collection
The investigation lasted for 30 days. Data collection was car-
ried out by 2 investigation teams each made up of 3 trained
investigators. Two of them were completely independent
research staffs, one of them came from the various sites. All
of the investigators for this census were trained for survey
methods, standards, and techniques. They administered ques-
tionnaires to participants in the county hospital and township
health care centers. The investigation was anonymously carried
out. The survey questionnaire was designed based on Regula-
tions on AIDS Prevention and Treatment in China Center for
Disease Control and Prevention (CDC) and other studies.
Respondents were asked to complete a KAP questionnaire with
5 parts. The first part covered the participants’ characteristics
(such as age, gender, occupation, title, unit level, and prior
training on HIV/AIDS). The second part surveyed HIV/
AIDS-related knowledge including general knowledge (5 items
such as details on pathogen, incubation period, methods of dis-
infection, the class of disease, and how long can HIV be
detected after infecting), transmission mode knowledge (9
items such as shaking hands, unprotected sex, having dinner
with HIV-positive patients, transfusion of blood or blood prod-
ucts, mosquito bites, sharing seats and books, sharing tooth-
brushes, coughing and sneezing, and from HIV-infected
mother-to-child), and occupational exposure and protection
knowledge (7 items such as principles of prevention, universal
precautions, providing care for patients living with HIV/AIDS,
exposure to urine and sweat, exposure to blood or body fluids,
measures taken after occupational exposures, and how long
should the measures be taken). A score of 1 for correct answer
and 0 for wrong or unknown answer was assigned. The sum of
general knowledge score (5), transmission knowledge score
(9), and occupational exposure and protection knowledge score
(7) yielded an overall knowledge score of 21. The third part
covered the HCWs’ attitudes that included fear, discrimination,
and willingness to provide service to patients living with HIV/
AIDS. The fourth part covered occupational exposure (2 items
such as needle stick injury and splashes to the eyes) and univer-
sal precaution practice (6 items such as wearing gloves when
working, proper disposal of sharps, washing hands after patient
contact, not recapping the needles after use, taking protective
measures after injury by sharps, and after a blood or fluid
splash to the eye). Each participant rated the possibility of
exposure and universal precaution practice on a scale from
never (0), occasionally (1) to often (2). These scores were
added to obtain occupational exposure score and universal pre-
cautions practice score. Finally, the last part covered the
HCWs’ inclination toward HIV/AIDS training and what they
hope to learn from such training, if provided in future.
The questionnaires were self-administered under the super-
vision of trained interviewers. A pilot study was carried out
among 20 HCWs of a surgical section in Pucheng County hos-
pital. Following which, a census was organized and implemen-
ted in 3 weeks. This was supported by the Health Bureau of
County and CDC in the Pucheng County. Participants’ confi-
dentiality was protected and all the procedures were approved
by the Ethics Committee of the Xi’an Jiaotong University. All
participants provided written informed consent after the
research protocols were carefully explained to them.
Collation and Analysis of Data
In order to ensure the quality of the investigation, exclusion
criteria were formulated before the survey. The questionnaire
that showed absence for more than 5 options was excluded. The
questionnaire with the obvious regularity option was excluded
(e. g. all option were chosen 4). The questionnaire was excluded,
which came from the same unit, and with same selection results.
The data were analyzed using SPSS (version 18.0; SPSS,
Chicago, Illinois). Chi-square analysis tested occupational
exposure differences among groups. Mean knowledge scores
were calculated, and analysis of variance was compared among
groups. Multiple linear regression analysis was used to exam-
ine the relationship between the behaviors of the universal pre-
cautions score and the characteristics of HCWs, general
knowledge score, transmission knowledge score, occupational
protection score, and occupational exposure score. A high cor-
relation existed between age and work experience, and unit lev-
els and education, so only age and unit levels were included in
the final analysis. Variables significant at P < .05 were retained
in the final multivariable model.
Results
Due to business trip, holiday, and refusal, 89 HCWs did not
participate. Twenty-eight unqualified questionnaires were
excluded. The participation rate of this survey was 94%, and
1783 HCWs completed the questionnaires. The average age
of the HCWs was approximately 39 years; HCWs in village
clinics were significantly older compared to the county and
township hospitals (45 versus 35 years). Overall, there were
equal number of male and female HCWs; however, there were
Wu et al 365

Table 1. Characteristics of Health Care Workers by Unit levels.a

Total County Township Village F/w2 P Value

N 1783 (93.8) 738 (93.1) 383 (97.2) 662 (92.9) – –

Age
Mean + SD, years old 38.5 + 10.9 34.2 + 8.2 35.2 + 9.8 45.1 + 11.0 249.3 .00
Female 906 (50.8) 523 (70.9) 210 (54.8) 173 (26.1) 282.6 .00
Work experience
Mean + SD, year 16.0 + 11.3 11.5 + 8.5 12.4 + 9.3 23.1 + 11.4 272.9 .00
Education 630.9 .00
High school 334 (18.7) 39 (5.3) 57 (14.9) 238 (36.0)
Secondary specialized 694 (38.9) 165 (22.4) 175 (45.7) 354 (53.5)
Associate degree 595 (33.4) 390 (52.8) 136 (35.5) 69 (10.4)
Bachelors 160 (9.0) 144 (19.5) 15 (3.9) 1 (0.2)
Occupation 575.2 .00
Doctor 996 (55.9) 209 (28.3) 192 (50.1) 595 (89.9)
Nurse 439 (24.6) 325 (44.0) 79 (20.6) 35 (5.3)
Technician 277 (15.5) 161 (21.8) 85 (22.2) 31 (4.7)
Administration staff 71 (4.0) 43 (5.8) 27 (7.0) 1 (0.2)
Prior training on HIV/AIDS 417 (23.4) 212 (28.7) 69 (18.0) 136 (20.5) 20.9 .00
Abbreviation: SD, standard deviation.
a
N (%).

a significantly higher proportion of females in the county com-
pared to village clinics (71% versus 26%). More than 72% of
HCWs finished secondary specialized or associated degree, but
only 23% had received some prior training on HIV/AIDS.
Detailed characteristics for these HCWs, stratified by their unit
levels, are presented in Table 1.
services to this population. However, only about half of them
(53%) were not afraid when contacting patients living with
HIV/AIDS and 65% of them felt they were at risk of contract-
ing HIV infection while at work. County HCWs had a better
attitude about treating patients with the same respect; but vil-
lage clinic HCWs were more willing and not afraid to provide
services to patients living with HIV/AIDS.

Knowledge
Majority (81%) of HCWs knew what causes AIDS; however,
only 17% of them knew the incubation periods for HIV. Most
of them also knew that HIV could be transmitted through blood
transfusion (90%), sexually transmission (89%), and perinatal
transmission (90%). However, only 33% knew that HIV cannot
be transmitted through mosquito bites. As shown in Table 3,
the overall HIV/AIDS-related knowledge of HCWs is poor
with an average overall knowledge score of 10.9 of 21. This
is due to the low scores for general knowledge and occupa-
tional exposure and protection knowledge (2.1 of 5 and 7,
respectively), despite a high score for transmission knowledge
(7.1 of 9). Less than half of HCWs (40%) had knowledge about
universal precautions for occupational exposure to HIV. Over-
all knowledge score of HCWs in village level was higher than
that of county.
The overall knowledge of doctors (11.65) and nurses (10.95)
was higher than that of medical technician (10.53) and admin-
istrative staff (10.15; F ¼ 19.13, P < .01).
Attitude
Health care workers had a very positive attitude toward patients
living with HIV/AIDS. More than 80% of them stated that
patients living with HIV/AIDS should be treated with the same
respect as other patients and 73% of them willing to provide
Practice
A very large proportion of HCWs (85%) reported injury with
sharps, and in more than half (57%) blood or fluid splashed
to their eyes. Further analysis of results showed that 25.6%
of the HCWs in county hospital had often got injured by sharps
(Table 3). More nurses (21.9%) and medical technicians
(23.5%) than doctors (10.5%) and administrative staffs
(9.9%) had often got injured by sharps. Compared to village
professionals, county professionals had a significantly poor
performance with regard to proper disposal of sharps immedi-
ately after use (90% versus 70%). Although majority of them
took protective measures after the exposure, only 26% did not
recap needles after using. The dangerous practice of recapping
needle was extremely high in HCWs at all the unit levels (69%
versus 78%). Similarly, overall occupational exposure and pro-
tection practices were not up to the required standards.
Predictors of Universal Precautions
In the multiple linear regression model, female sex (b ¼ 0.12,
95% confidence interval [CI]: 0.02-0.23), prior HIV/AIDS
training (b ¼ 0.17, 95% CI: 0.05-0.30), occupational exposure
knowledge (b ¼ 0.17, 95% CI: 0.05-0.3), transmission knowl-
edge (b: 0.12, 95% CI: 0.09-0.15), and occupational protection
knowledge (b: 0.08, 95% CI: 0.04-0.12) were the significant
366 Journal of the International Association of Providers of AIDS Care 15(5)

Table 2. HIV/AIDS-Related Knowledge, Attitude, and Practice of HCWs by Unit Levels.a

Total County Township Village F/w2

Knowledgeb
Overall knowledge score (21 points) 10.9 + 2.6 10.6 + 2.5 11.1 + 2.8 11.2 + 2.3 12.16c
Basic knowledge score (5 points) 2.1 + 1.1 1.9 + 1.1 2.2 + 1.1 2.2 + 1.2 22.06c
Transmission knowledge score (9 points) 7.1 + 1.6 6.8 + 1.7 7.3 + 1.6 7.3 + 1.4 17.20c
Occupational exposure and protection knowledge score (7 points) 2.1 + 1.5 2.2 + 1.4 2.0 + 1.5 2.1 + 1.5 5.14c
Attitude
Treat patients living with HIV/AIDS with the same 1466 (82.2) 626 (84.8) 319 (83.3) 521 (78.7) 16.88c
respect as any other patients
Do not feel afraid when contacting patients living with HIV/AIDS 945 (53.0) 319 (43.2) 207 (54.0) 419 (63.3) 74.66c
Willing to provide services 1302 (73.0) 319 (72.8) 264 (68.9) 501 (75.7) 12.21c
Risk of contracting HIV while working 1150 (64.5) 539 (73.0) 253 (66.1) 358 (54.1) 80.23c
Practice
Got injured by sharps 1510 (84.7) 634 (85.9) 311 (81.2) 565 (85.3) 4.66
Often 273 (15.3) 189 (25.6) 39 (10.2) 45 (6.8) 109.93d
Occasionally 1237 (69.4) 445 (60.3) 272 (71.0) 520 (78.5)
Never 273 (15.3) 104 (14.1) 72 (18.8) 97 (14.7)
Had blood or fluid splashes to their eyes 1008 (56.5) 439 (59.5) 195 (50.9) 374 (56.5) 7.54
Do not recap needle after use 465 (26.1) 232 (31.4) 89 (23.2) 144 (21.8) 19.02d
Proper disposal of sharps immediately 1435 (80.5) 522 (70.7) 316 (82.5) 597 (90.2) 85.31d
Wearing gloves when taking blood 1574 (88.3) 672 (91.1) 379 (83.3) 583 (88.1) 11.84d
Washing hands after patient contact 1649 (92.5) 686 (93.0) 341 (89.1) 622 (94.0) 2.55
Taken measures after getting injured by sharps 1619 (90.8) 670 (90.8) 335 (87.5) 614 (92.7) 8.11d
Taken measures after an eye splash 1432 (80.3) 595 (80.6) 286 (74.7) 551 (83.2) 16.74d
Abbreviations: HCWs, health care workers; SD, standard deviation.
a
N (%).
b
Mean + SD.
c
P value < .05.
d
P value < .01.

predictors of the universal precautions practice score (Table 4).
Interestingly, other factors such as age, occupation, title, and
unit levels were not associated with universal precautions
practice.
Training Requirement
An overwhelming majority of HCWs (85%) stated that they
would like to participate in HIV/AIDS training. About training
approaches, half of them would like to join ‘‘expert lectures,’’
while the other half were interested in ‘‘feature film’’ approach.
They also revealed that the topics of most interest for these
future trainings would be universal precautions, transmission
mode knowledge, and diagnosis and treatment of HIV/AIDS.
Discussion
This unique study demonstrated that overall HIV/AIDS-
related knowledge was inadequate in HCWs of rural China.
An overall fear and inhibition with regard to providing
services to patients living with HIV/AIDS was observed.
Furthermore, they had a high rate of occupational exposure
and did not practice universal precautions, thus making
them highly susceptible to contracting HIV infections.
Females with prior training and greater knowledge about
HIV/AIDS practice behavior with significantly better uni-
versal precautions.
Greater lack of knowledge about HIV/AIDS was shown by
the respondents of the current study compared to other
research.5,16 In fact, the overall knowledge score of HCWs
from similar studies was 8.6 of 10, compared to 10.9 of 21 in
the current study.17 Particularly, knowledge about occupational
exposure and universal precaution was very low. Although the
transmission knowledge score was high, nontransmission
issues, especially the ‘‘mosquito bites can’t spread HIV,’’ were
answered correctly by less than 40% of HCWs. This lack of
transmission knowledge may explain HCWs’ fear of getting
infected while working with HIV-infected patients, as also
observed by a previous study.15
Most HCWs could actively work with patients living with
HIV/AIDS. Some, however, did feel afraid with HIV-positive
patients around and were concerned about the risk of infection
to self. Although working in fields with a high rate of occupa-
tional exposure, they lacked awareness about methods of pro-
tection. To be able to reduce the risk of HIV infection,
HCWs should have an adequate grasp of knowledge regarding
universal precautions.
About 85% of HCWs in the current study stated that they
had got injured by sharps, which is consistent with the studies
in developing countries,18,19 however, much higher than
reported in those studies in developed countries (37%).20 In the
United States, it has been reported that approximately 500 000
percutaneous blood exposures might occur annually among
HCWs.13 As also reported by an earlier study, HCWs in the
Wu et al 367

Table 3. HIV/AIDS-Related Knowledge, Attitude, and Practice of HCWs by Occupation.a

Medical Administrative
Doctor Nurse Technician Staff F/w2

Knowledgeb
Overall knowledge score (21) 11.65 + 2.68 10.95 + 2.93 10.53 + 2.63 10.15 + 2.87 19.13c
Basic knowledge score (5) 2.25 + 1.11 1.95 + 1.08 1.67 + 1.04 1.65 + 1.14 26.40c
Transmission knowledge score (9) 7.27 + 1.41 6.86 + 1.84 6.82 + 1.79 6.80 + 1.79 10.74c
Occupational exposure and protection knowledge score (7) 2.13 + 1.46 2.13 + 1.51 2.04 + 1.43 1.70 + 1.49 2.403
Attitude
Treat patients living with HIV/AIDS with the same respect as 824 (82.7) 365 (83.1) 221 (79.8) 56 (78.9) 7.411
any other patients
Do not feel afraid when contacting patients living with HIV/AIDS 588 (59.0) 203 (46.2) 124 (44.7) 30 (42.3) 36.991c
Willing to provide services 746 (74.9) 310 (70.6) 198 (71.5) 48 (67.6) 6.422
Risk of contracting HIV while working 612 (61.4) 314 (71.5) 180 (65.0) 44 (61.8) 15.142d
Practice
Got injured by sharps 855 (85.8) 393 (89.5) 218 (78.7) 44 (62.0) 44.849c
Often 105 (10.5) 96 (21.9) 65 (23.5) 7 (9.9) 94.773c
Occasionally 750 (75.3) 297 (67.7) 153 (55.2) 37 (52.1)
Never 141 (14.2) 46 (10.5) 59 (21.3) 27 (38.0)
Had blood or fluid splashing to their eyes 589 (59.1) 252 (57.4) 147 (53.1) 20 (28.2) 27.481c
Do not recap needle after use 232 (23.3) 149 (33.9) 71 (25.6) 13 (18.3) 20.336c
Proper disposal of sharps immediately 871 (87.4) 347 (79.0) 176 (63.5) 41 (57.7) 105.354c
Wearing gloves when taking blood 884 (88.8) 411 (93.6) 235 (84.8) 44 (62.0) 2.611
Washing hands after patient contact 937 (94.1) 423 (96.4) 242 (87.4) 47 (66.2) 5.032
Taken measures after injured by sharps 927 (93.1) 406 (92.5) 237 (85.6) 49 (69.0) 57.102c
Taken measures after an eye splash 830 (83.3) 337 (76.8) 221 (79.8) 44 (62.0) 18.802c

Abbreviation: SD, standard deviation.

a
n (%).
b
Mean + SD.
c
P value < .01.
d
P value < .05.

Table 4. Predictors of Universal Precautions Practice among HCWs.a,b

Unadjusted Adjusted

b Coefficients (95% CI) t P Value b Coefficients (95% CI) t P Value

Female sex 0.08 (0.03 to 0.19) 1.46 .15 0.12 (0.02 to 0.23) 2.31 .02
Prior HIV/AIDS training 0.12 (0.01 to 0.25) 1.83 .07 0.17 (0.05 to 0.3) 2.70 .01
Occupational exposure knowledge score 0.17 (0.10 to 0.23) 5.17 .00 0.16 (0.1 to 0.22) 5.00 .01
Transmission knowledge score 0.13 (0.10 to 0.16) 7.51 .00 0.12 (0.09 to 0.15) 6.91 .01
Occupational protection knowledge score 0.08 (0.05 to 0.13) 4.27 .00 0.08 (0.04 to 0.12) 4.04 .01
Unit level 0.12 (0.18 to 0.06) 3.88 .00 0.04 1.44 .15
Occupational title 0.18 (0.24 to 0.11) 5.04 .00 0.03 1.19 .23
General knowledge score 0.09 (0.04 to 0.14) 3.77 .00 0.02 0.75 .45
Marital status 0.12 (0.23 to 0.00) 2.00 .05 0.02 0.60 .55
Occupation 0.05 (0.12 to 0.01) 1.64 .10 0.00 0.03 .81
Age 0.00 (0.0 to 0.01) 0.24 .81 0.03 0.01 .99
Abbreviations: CI, confidence interval; HCWs, health care workers.
a
Universal precaution behaviors include wearing gloves, not recapping needles, proper disposal of sharps, washing hands after patient contact, taking protective
measures after being injured by sharps, and after an eye splash.
b 2
R ¼ .12.

county hospitals experienced a higher risk than those in town-
ship and village clinics in this study.14 Unfortunately, recap-
ping of needles remained a frequent behavior and this
matches the findings of other research studies, which suggest
the lack of injection safety in developing countries.21–23 Pro-
moting adherence to standard universal precautions may be the
best method of reducing risk in medical institution. It is also
highly recommended that HCWs in medical institution should
have enhanced training in HIV/AIDS-related knowledge. Thus,
provision of simple equipment such as gloves and ensuring
workers are trained in safety methods can be very efficacious
for reducing risk in HCWs.5
368 Journal of the International Association of Providers of AIDS Care 15(5)
More HCWs in county hospital received AIDS training than
that in township and village clinics. The HCWs’ score of occu-
pational exposure and protection knowledge in county were
higher than that of those in the village level. In county level,
31.4% HCWs did not recap needle after use, which was higher
than that reported in village (21.8%); 25.6% of HCWs in
county often got injured by sharps, which was significantly
higher than those in township and village. However, HCWs’
score of general and transmission knowledge in county hospital
was lower than that in village level. The county HCWs were
less likely than the village HCWs to dispose of sharps properly.
This suggested that the HCWs in county level had more
resource than those in townships and villages. Health care
workers in county level faced more occupation risk than those
in townships and villages. Health care workers in village level
was fuzzy on recap needle sleeve after use. Based on the above
discussion, the key of AIDS training should be distinguished
for different levels of HCWs.
In the current study, only 23% of HCWs in medical institu-
tion received HIV/AIDS-related training, while Li et al14
reported 73% of HCWs had received HIV-related training in
Yunan, China. Another study found that the mean pre-
workshop knowledge score was 16 (24), while the mean
post-workshop knowledge score was 20 (24).24 Thus, participa-
tion in training improved the score on HIV/AIDS knowledge
significantly.25,26 It is hypothesized that such training would
have a positive impact on their work. In addition, hospitals
should be equipped with sufficient personal protective equip-
ment and encouraging voluntary reporting and an active sur-
veillance system.27
A number of limitations should be considered while inter-
preting the results of this study. It was carried out in medical
institutions of a low HIV prevalence area such as Pucheng
County. Hence, the findings should be extrapolated with care
as they might not apply to all the HCWs in China, especially
the urban settings. However, this study gives a vivid picture
of the situation in the remaining parts of China where the over-
all HIV prevalence is also low. Since an equal number of
participants from the county, township, and villages were
surveyed, we were able to identify the areas of concern for
HCWs at different unit levels. In fact, the response rate
(94%) for this study was remarkably higher compared to
similar studies conducted in developed countries.28,29 This high
participation rate ensured quality and reliability of the census
results. Due to the cross-sectional nature of this study, a tem-
poral association between HIV/AIDS-related knowledge and
training and the universal precaution behavior could not be
established. Hence, we recommend a longitudinal study to
identify the true impact of HIV/AIDS training on improving the
knowledge of HCWs and ultimately better universal precau-
tions practice behavior.
Conclusion
In summary, rural HCWs in low HIV prevalence areas of rural
China have inadequate AIDS/HIV exposure and protection
knowledge and do not practice universal precautions. A high
rate of occupational exposure occurred among HCWs in low
HIV prevalence areas of rural China. Nurses and medical tech-
nicians in county level faced more occupation risk than other
HCWs. As mentioned earlier, we recommend that medical
technicians should be trained and enhance their capabilities
to protect themselves from occupational exposure. The key
of AIDS training should be distinguished for different levels
of HCWs. Expert lecture and feature film can be considered
favorite approaches of HCWs to gain HIV/AIDS knowledge.
Acknowledgments
We thank the staff of CDC and Health Bureau in Pucheng County for
their help with the data collection.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This survey
was supported by 2 grants: one from the Ministry of Science and Tech-
nology, People’s Republic of China (2007BAI07A12), the other from
Xi’an Jiaotong University (xjj2014138).
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