Knowledge of HIV prevention strategies based on antiretroviral treatment (PrEP and PEP) among medical students

INTRODUCTION

Human immunodeficiency virus (HIV) represents a significant challenge to public health worldwide. According to the World Health Organization (WHO), it is estimated that 39.0 million people are living with HIV globally [1]. Despite this, there has been a significant reduction in the HIV incidence rate on a global scale [2]. Since 2015, the WHO has recommended the use of antiretroviral therapy for both the treatment and prevention of HIV infections [3]. Effectively combating the HIV epidemic and other sexually transmitted infections relies on several key strategies: free and anonymous testing, rapid implementation of therapy upon detection of infection, access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and education aimed at reducing stigma and explaining the importance of preventive measures [4]. In Poland, from the start of testing in 1985 to November 30, 2023, HIV infection was diagnosed in 32,753 Polish citizens and individuals of other nationalities residing in Poland. Among the total registered cases, at least 6,497 were infected through drug use, 2,482 through heterosexual contact, and 5,188 through sexual contact be-tween men [5]. The country’s policy regarding the HIV and acquired immunodeficiency syndrome (AIDS) epidemic is outlined in the current Regulation of the Council of Ministers dated February 15, 2011, concerning the National Pro-gram for Preventing HIV Infections and Combating AIDS (Journal of Laws item 227) [6]. The standards for treating HIV patients and guidelines for implementing PEP and PrEP therapy are presented in the 2023 recommendations of the Polish Scientific AIDS Society [7]. Antiretroviral treatment for HIV patients in Poland is provided free of charge [8]. In cases of non-occupational and occupational exposure to HIV, such as rape or needlestick injuries of unknown origin, post-exposure prophylaxis is reimbursed by the National Health Fund [9]. However, despite the potential contribution of pre-exposure prophylaxis pharmacotherapy to slowing the ongoing epidemic, individuals interested in PrEP bear all associated costs [10].
The aim of the research was to assess the knowledge of medical students regarding PrEP, which involves the preventive use of antiretroviral drugs in uninfected individuals to reduce the risk of acquiring HIV infection, and PEP therapy, which entails the prompt initiation of antiretroviral treatment following exposure to HIV.

MATERIAL AND METHODS

The study, conducted anonymously and voluntarily, took place from April 2021 to February 2024 among medical students. It used an online survey and paper questionnaires distributed during promotional events organized by the Nursing Science Club at the Polish Nursing Association of the Medical University of Lodz. This descriptive cross-sectional study was conducted among 302 students to assess their knowledge and awareness of HIV prevention, including PrEP, PEP, and antiretroviral therapy (ARV). The study group was mainly composed of women (82.1%), while male students made up 17.9%. Most respondents were between 18 and 21 years old (70.2%), 26.2% were between 22 and 24 years old, and only 3.6% were over 24 years old. In terms of place of residence, 53.6% lived in cities with a population of over 50,000, 19.2% in smaller towns, and 27.2% in rural areas.
The survey instrument was a custom 12-question questionnaire created using Google Tools. The survey began with demographic questions about gender, age, and place of residence. Then, participants were asked to self-assess their level of knowledge about HIV prevention as good, average, or poor.
The main part of the survey assessed factual knowledge using a series of one-choice questions. These questions assessed participants’ understanding of key concepts such as the definition and purpose of PrEP, its target audience, and who finances PrEP and ARV therapies in Poland. One of the questions tested whether respondents correctly understood that PrEP is intended for people with a negative HIV status. Another study concerned awareness of the difference in effectiveness between PrEP and PEP. Each knowledge question offered three possible answers: a correct answer, an incorrect answer, and an “I don’t know” option to identify areas of uncertainty.
The final section of the survey explored participants’ previous exposure to formal infection prevention education. Respondents were asked whether they had received training related to HIV prevention, hospital infection control, and procedures following occupational exposure to biological material. These questions aimed to determine the role of educational experiences in shaping students’ awareness and preparation.
Informed consent was obtained from all respondents. The study adhered to the principles of the Declaration of Helsinki, and confidentiality of data was maintained at all stages [11]. The collected data were analyzed using descriptive statistics. Frequencies and percentages were calculated for each response, including rates of correct, incorrect, and uncertain responses. Microsoft Excel was used to organize and analyze the data.
In addition, the chi-square (χ²) test was applied to assess whether selected demographic and educational variables were significantly associated with participants’ level of knowledge about HIV prevention. Specifically, the test was used to evaluate whether gender, age, place of residence, and prior training had a statistically significant impact on students’ awareness and understanding of PrEP, PEP, and antiretroviral therapy.

RESULTS

The surveyed population consisted predominantly of female students (82.1%), with the majority aged between 18 and 21 years (70.2%). Most respondents (53.6%) resided in urban areas with populations exceeding 50,000 inhabitants. A complete demographic characterization of the participants is provided in Table 1.
When asked to self-assess their level of knowledge regarding HIV prevention, 23.5% of students described it as good, 61.3% as average, and 15.2% as poor. These results are detailed in Table 2. The main section of the questionnaire assessed students’ factual knowledge about HIV prevention using five single-choice questions related to PrEP and PEP. Each question offered one correct answer, one incorrect option, and an “I don’t know” response, designed to distinguish between knowledge gaps and uncertainty, rather than evaluate competence.
A significant portion of respondents demonstrated limited knowledge in key areas of HIV prevention. A total of 41.4% did not know what PrEP therapy involves, and 54.3% were unaware that PrEP is intended for HIV-negative individuals. Additionally, 62.9% of students did not know how PrEP therapy is financed in Poland, while 65.2% were not informed about the funding mechanism for antiretroviral treatment (ARV). Only 23.2% of respondents correctly answered the question on ARV funding, and 11.6% selected an incorrect response. Notably, 79.1% of participants were unable to determine whether PEP therapy is more effective than PrEP.
The final part of the survey investigated prior educational exposure to topics related to HIV infection prevention and occupational exposure protocols. Over half of the students (54.3%) reported that they had never participated in any training on HIV prevention. Furthermore, 58.6% had not received instruction on hospital infection control or safe medical practices, and only 57.3% felt confident in their ability to manage occupational exposure to biological material. These findings are presented in Table 4.
To identify potential determinants of students’ knowledge levels, the χ² test was used to evaluate relationships between self-assessed knowledge and sociodemographic or educational factors, including gender, age, place of residence, and prior training. No statistically significant relationship was found between knowledge level and gender, with Pearson’s χ² = 0.8777 (df = 2, p = 0.6448) and Wald’s test χ² = 0.9363 (p = 0.6262), indicating no association. However, a statistically significant correlation was observed between age and self-assessed knowledge level. Pearson’s χ² test yielded a value of 40.0388 (df = 24, p = 0.0212), while the NW test showed χ² = 36.7692 (p = 0.0461), suggesting an age-related increase in awareness of HIV prevention.
The analysis did not reveal significant associations between knowledge and place of residence (Pearson’s χ² = 0.1795, df = 4, p = 0.9962; NW χ² = 0.1794, p = 0.9962), participation in general educational training (χ² = 0.2071, df = 2, p = 0.9016), infection prevention training (χ² = 0.1985, p = 0.9055), or training on post-exposure procedures (χ² = 0.7601, p = 0.6838). These results are detailed in Tables 5-10.
In summary, the only variable that demonstrated a statistically significant influence on self-assessed knowledge regarding HIV prevention was age. Gender, residence, and prior educational training did not show measurable effects, emphasizing the need to strengthen formal education and training in HIV-related topics, especially among younger students in medical education programs.

DISCUSSION

Available data clearly indicate an insufficient level of knowledge among the student population, including medical students, regarding HIV prevention measures – specifically PEP and PrEP. Despite the increasing availability of these preventive strategies and their inclusion in clinical guidelines, both the self-reported knowledge and practical application of these methods remain limited, in Poland as well as globally.
In a study by Xu et al. [12], although most respondents were aware of the existence of PrEP and PEP (61.4% and 53.0%, respectively), only 5.6% had ever used either method. These findings are consistent with the observations presented by Ajayi et al. and Okeke et al. in studies involving Nigerian students, where the proportion of participants demonstrating any practical knowledge or use of PrEP and PEP was marginal [13, 14]. Similarly, in the study by Thongsutt et al. [15], despite a relatively high willingness to use PrEP (39.7%), only 20.8% of respondents reported being familiar with this form of prevention. These results confirm the discrepancy between general awareness and the clinical implementation of effective HIV prevention strategies.
Comparable results were observed among student populations in Poland. In the study by Łukaszek [16], 63.1% of respondents rated their knowledge level as “average”, while 20.7% rated it as “low” or “very low”. In the survey conducted by Janiszewska et al. [17], only 40% of participants correctly identified the main routes of HIV transmission. A more detailed analysis of pharmacological prevention knowledge revealed that 31% of students did not know what PrEP was, and 36.7% provided incorrect answers – findings corroborated by Bochdziewicz et al. [18] in their study. Only 30.3% answered the PrEP-related question correctly, while 64.8% identified the definition of PEP. In the authors’ own research, 54.3% of medical students reported never having participated in any training related to HIV prevention, and more than half were unaware that PrEP is intended for HIV-negative individuals.
The analysis of the above data clearly indicates that the level of knowledge regarding HIV prevention – even among students preparing for medical professions – is insufficient from the standpoint of public health safety and the quality of future healthcare services. Self-declared knowledge, often superficial, does not translate into the ability to effectively implement recommended HIV prevention practices. Meanwhile, healthcare workers, including physicians, nurses, midwives, and paramedics, are among the professional groups most at risk of exposure to potentially infectious material, including HIV.
Therefore, it must be emphasized that education on HIV prevention, particularly regarding PEP and PrEP, should be included as a mandatory component of curricula in all medical degree programs. This requires the implementation of integrated educational activities, encompassing both theoretical instruction and practical training, as well as ensuring that students have direct access to information about the indications, availability, and application of antiretroviral prophylaxis. Maintaining up-to-date knowledge and competencies in this field should be recognized as a fundamental requirement for training a responsible and informed healthcare workforce.

CONCLUSIONS

The study demonstrated that the basic knowledge of medical students regarding HIV virus prevention is still inadequate. Therefore, education on pre- and post-exposure prophylaxis for HIV is essential. The study revealed that age was the only factor significantly associated with students’ self-assessed knowledge of HIV prevention, with older students showing greater awareness. No significant associations were found with gender, place of residence, or prior training. These findings suggest the need to enhance and standardize HIV prevention education early in medical training to ensure consistent knowledge among all students.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References