Background: As there are more than 33 million PLHIV (UNAIDS, 2015), understanding nurse perceptions about caring for PLHIV is an important area for research to inform evidence-based practice. In global studies about perceptions and caring, nurses still report negative perceptions about caring for PLHIV. For example, Turkish nursing students have negative attitudes about caring for PLHIV; preferring not work with these patients because they fear being infected (Bektaş & Kulakaç, 2007; Nazik, Arslan, Özdemir, & Apay, 2012). Thai nursing students recognize their insecurity about caring for PLHIV. Perceiving high risk of HIV infection, the students are preoccupied with exceeding the level of universal precautions when interacting with PLHIV (Earl, 2010). Also, fear for caring for PLHIV is identified amongst nursing students in the United States, South Africa, Singapore, Sweden and the United Kingdom. They express negative homophobic behaviors, avoidance conduct, non-compassionate care, and rejection (Atav, Sendir, Darling, & Acaroglu, 2014; Pickles, King, & Belan, 2009, 2012). Yet, there are locations, such as Berlin, where nursing students report positive attitudes about caring for PLHIV (Lohrmann et al., 2000). The collective personal experience of this research team believes nursing faculty have attitudinal aspects similar to those indicated by the student literature but objective data to affirm this hypothesis is absent. Thus, the objective of this study is to identify the attitudes of caring for PLHIV among nursing faculty.
Methods: This was a multi-center cross-sectional study. Data was collected using an anonymous web-based version of the validated Healthcare Provider HIV/AIDS Stigma Scale (HPASS) (Wagner, Hart, Mcshane, Margolese, & Girard, 2014). This is Likert scale instrument with 30 items, explores 16 prejudices, 11 stereotypes, and 6 discriminations. A Spanish version of the HPASS, produced with a forward and reverse translation, and expert content, culture, and language validation, was used in Spanish-speaking countries. Sociodemographic data were also collected. This study was approved by the Texas Woman's University Institutional Review Board (Protocol# 19213 / Approval# FWA00000178). Four colleges of nursing participated in the study: Two from Peru, one from Spain, and one from the United States. The scale score ranged from 35 points to 175, with a lower score indicating better attitudes. Generalized linear modeling (McCullagh & Nelder, 1989) was used for data analysis. This technique is a more flexible generalization of ordinary linear regression, permitting the evaluation of associations between response variables of several kinds (scores in our case) and potential explanatory variables (importance of religion, gender, age, university and highest level of studies).
Results: A total of 119 valid questionnaires were collected for a general response rate of 89.1%. The mean participant age was 49.8 years (SD=12.3) with an average of 14.8 years of teaching experience (SD=12.1). The majority of the American and Spanish faculty (55.00%) hold doctoral degrees while the majority of Peruvian hold Master degree (55.55%). Only 11.11% of the Peruvian faculty hold a doctoral degree. The effect of the potential to explicate variables “importance of religion”, “gender”, “age”, “university” and “highest level of studies” over total score and stereotyping, prejudices and discrimination subscales was analyzed by means of generalized linear models. In relation to the total score for the Stigma scale, very low importance of religion was significantly associated with lower scores (p = 0.009), or positive attitudes about caring for PLHIV. Also related to the total score, Peruvian faculty had higher total scores (p = 0.008 and p = 0.012 respectively) which equates to negative attitudes about caring for PLHIV. No other explicative variables showed a significant association to the total score. A positive attitude for not discriminating was associated with very low importance of religion on the discrimination subscale (p = 0.010, p = 0.001 and p = 0.002 respectively). With respect to the stereotype subscale, the faculty indicating very low importance to religion had lower scores (p = 0.049); with an observed higher tendency to stereotype for the older faculty (p = 0.003). Regarding the prejudice scale, only the faculty indicating very little importance to religion reported significantly lower scores (p = 0.014).
Conclusions: The Spanish and American faculties were more highly educated than the Peruvian faculty. Attitudes about caring for PLHIV were mainly positive among nursing faculty although religiosity seemed to significantly influence discriminatory and prejudice attitudes. The Peruvian faculty were more influenced by religion than were the American and Spanish faculties. Also, the Peruvian faculty scored higher on the discrimination and stereotype scales than the other faculties. The implication of this study is that religion negatively influences the attitude about caring for PLHIV. The limitations of this study were a limited sample size, and the diversity of participant faculties.
Recommendations: Future research should explore the relationship of religiosity to caring for PLHIV. An educational intervention may be appropriate to improve the care of PLHIV by those faculties highly influenced by religion. Cultural diverse and population health practices in HIV/AIDS need to be studied to determine the impact on both the caregiver and the person receiving care.