title: Universal precautions in Central Asia: the need for multiple strategies in this window of opportunity.
abstract: BACKGROUND
  Adoption of universal precautions remains a global concern. In low- and middle-income countries, the problem is exacerbated by a shortage of protective supplies, lack of training among clinicians, and an expanding human immunodeficiency virus (HIV) epidemic.
  
  
  OBJECTIVE
  To describe the perceptions of medical students about the risk of HIV and use of universal precautions, and to identify recent exposures to blood or bodily fluids.
  
  
  METHODS
  A cross-sectional study was conducted among Kazakh medical students taking a newly-implemented infection control course in 2013. Participants completed a survey to investigate the use of precautions and exposures to blood or bodily fluids. Attitudes towards HIV were explored. Bivariate analyses identified factors related to attitudes about universal precautions, and self-reported behaviours and exposures.
  
  
  RESULTS
  Half (49.6%) of the 785 participants expressed 'a lot of concern' about contracting HIV while caring for patients, and 40.5% of students thought that physicians sometimes refuse to treat HIV-positive patients due to a fear of contracting HIV. Regarding precautions, only half (51.5%) of the students reported that they always use gloves, and even fewer reported that they always use masks or eye protection. Exposure to contaminated blood or bodily fluids was reported by 10.1% of respondents.
  
  
  CONCLUSIONS
  The findings underscore the urgent need for interventions to improve universal precautions and reduce the fear of infectious diseases. Perhaps even more concerning, these data may underestimate the true magnitude of the problem given cultural impediments to transparency.
authors.affiliation: Department of HIV Infection and Infection Control, Kazakh National Medical University, Almaty, Kazakhstan. Electronic address: zhamilya.nugmanova@gmail.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Nugmanova
authors.affiliation: Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Public Health, Kazakh National Medical University, Almaty, Kazakhstan.
authors.forename: A
authors.initials: A
authors.lastname: Nurbakhyt
authors.affiliation: Department of HIV Infection and Infection Control, Kazakh National Medical University, Almaty, Kazakhstan; Almaty City AIDS Centre, Almaty, Kazakhstan.
authors.forename: G M
authors.initials: GM
authors.lastname: Akhmetova
authors.affiliation: Department of HIV Infection and Infection Control, Kazakh National Medical University, Almaty, Kazakhstan.
authors.forename: N
authors.initials: N
authors.lastname: Kovtunenko
authors.affiliation: Department of HIV Infection and Infection Control, Kazakh National Medical University, Almaty, Kazakhstan.
authors.forename: Z
authors.initials: Z
authors.lastname: Trumova
authors.affiliation: Institute for Health and the Environment, University at Albany, State University of New York, Rensselaer, NY, USA.
authors.forename: L-A
authors.initials: LA
authors.lastname: McNutt
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001826:Body Fluids / Q000821:virology; D003428:Cross Infection / Q000517:prevention & control / Q000821:virology; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D007623:Kazakhstan; D008297:Male; D010820:Physicians / Q000523:psychology; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D016635:Universal Precautions; D055815:Young Adult
keywords: Exposures; Gloves; HCV; HIV; Hospital; Infection control; Kazakhstan; Medical education; Survey; Universal precautions