Effectiveness of an HIV/AIDS educational programme for Chinese nurses

Negative impact of nurses' fear of COVID-19: the moderating role of implementation of knowledge management

Background

During the COVID-19 pandemic, nurses encountered substantial infection risks and psychological strain, which severely affected their emotional well-being, professional attitudes, and job performance. This study investigated the impact of nurses' fear of COVID-19 on their intention to leave the occupation and emotional labor as well as the moderating role of the implementation of knowledge management on these primary variables.

Methods

To mitigate common method bias, this research adopted a two-phase questionnaire approach, targeting nurses at a medical center in central Taiwan. In the first phase, 300 copies of questionnaire were distributed for participants to complete self-assessment surveys covering fear of COVID-19, knowledge management implementation, and demographic information. After 1 month, the participants were invited to complete a follow-up questionnaire, focusing on the intention to leave the occupation and emotional labor. The questionnaire was conducted from June to July 2022. Through this two-phase distribution method, after exclusion of invalid responses, a total of 288 valid responses were collected, resulting in a response rate of 96%. The proposed hypotheses were verified using hierarchical regression conducted with SPSS version 25.0.

Results

The findings indicated that nurses' fear of COVID-19 was significantly and positively associated with their intention to leave the occupation and surface acting, but negatively associated with their deep acting. Moreover, the implementation of knowledge management significantly moderated the positive relationship among fear of COVID-19, intention to leave the occupation, and surface acting. A robust knowledge management system weakened the positive association among fear of COVID-19, intention to leave the occupation, and surface acting.

Conclusion

In summary, nurses' fear of COVID-19 may increase their tendency to leave the nursing profession and engage in more surface acting and less deep acting. However, effective knowledge management practices can mitigate these adverse effects. Hospitals can thus establish and employ comprehensive knowledge management systems to enhance nurses' resilience and help alleviate their fear of future pandemics and their potential negative repercussions.

Health workforce governance for compassionate and respectful care: a framework for research, policy and practice

The progressive realisation of universal health coverage requires that health services are not only available and accessible, but also that they are rendered to the population in an acceptable, compassionate and respectful manner to deliver quality of care. Health workers’ competencies play a central role in the provision of compassionate and respectful care (CRC); but health workers’ behaviour is also influenced by the policy and governance environment in which they operate. The identification of relevant policy levers to enhance CRC therefore calls for actions that enable health workers to optimise their roles and fulfil their responsibilities.

This paper aims at exploring the health workforce policy and management levers to enable CRC. Through an overview of selected country experiences, concrete examples are provided to illustrate the range of available policy options. Relevant interventions may span the individual, organisational, or system-wide level. Some policies are specific to CRC and may include, among others, the inclusion of relevant competencies in preservice and in-service education, supportive supervision and accountability mechanisms. Other relevant actions depend on a broader workforce governance approach, including policies that target health workforce availability, distribution and working conditions, or wider system -level factors, including regulatory and financing aspects.

The selection of the appropriate system-wide and CRC-specific interventions should be tailored to the national and operational context in relation to its policy objectives and feasibility and affordability considerations. The identification of performance metrics and the collation and analysis of required data are necessary to monitor effectiveness of the interventions adopted.

Combating HIV stigma in low- and middle-income healthcare settings: a scoping review

INTRODUCTION

Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research.

METHODS

We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews.

RESULTS AND DISCUSSION

Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings.

CONCLUSIONS

Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

Effectiveness of an educational intervention on vulvo-vaginal discharge for family healthcare workers: A nonrandomized controlled trial

Women's delay in seeking medical advice for abnormal vaginal discharge can cause serious effects such as infertility, ectopic pregnancy, and advanced cervical cancer. Family healthcare workers are in a unique position to help in the promotion of vaginal health. A nonrandomized controlled trial was conducted among a sample of family healthcare workers in the intervention (n = 37) and a control (n = 37) group to assess the effectiveness of an educational intervention, which was a 2-day intensive workshop combining reading materials. Data were analyzed using SPSS software (version 20), and the effectiveness of the intervention was determined using a mixed between-within subjects analysis of variance. The total knowledge and attitude scores were significantly greater for family healthcare workers in the intervention group immediately and at 3 and 6 months after the educational intervention, compared to the control group. A substantial main effect was observed concerning the time, showing an increase in family healthcare workers' knowledge and attitude scores across the four time periods. A statistically significant difference in the median overall health education competency score across the two groups was also observed. The mean score differences in all sub-competencies in health education were significantly higher among the intervention group, compared to the control group between second postintervention and the baseline. The educational intervention had revealed successful and sustainable improvements in family healthcare workers' knowledge, attitude on vaginal discharge, and health education competency. This can be implemented as an in-service program for family healthcare workers to improve health education practices.

Assessing the Efficacy of a PhotoVoice-Informed HIV Stigma Training for Health Care Workers

HIV stigma is a harmful social phenomenon present in United States (US)-based health care settings. This study assessed the efficacy of a participatory PhotoVoice-informed stigma reduction training program focusing on people living with HIV (PLWH) and targeting health care workers. Seventy-three (N = 73) participants were assessed at baseline (T1), within approximately a week of the training (T2), and at a 3-month follow-up (T3) regarding their HIV/AIDS knowledge, attitudes towards PLWH, and observations of enacted HIV stigma. Findings indicated that the training increased knowledge and improved attitudes (β = 0.56, p < 0.01; β = 0.58, p < 0.01, respectively) at T2, but these effects diminished at T3 (β = - 0.03, p > 0.05; β = - 0.29, p > 0.05, respectively). The training did not, however, have an impact on observations of enacted stigma at T2 (β = 0.10, p > 0.05) or at T3 (β = 0.02, p > 0.05). Additional participatory stigma reduction programs that involve diverse groups of health care workers, offer salient study incentives, include time-saving training methods, and comprise a variety of stigma measures, may be particularly beneficial.

Experiential learning of HIV self-test among student nurses: A qualitative study

BACKGROUND

There is increasing demand for HIV self-tests, and nurses play an important role in counselling and assisting in the testing process. Traditional lecture-based nursing education has not typically focused on self-testing procedures, and there is little understanding of clients' experiences of self-testing.

OBJECTIVES

To understand the experiential learning (EL) of student nurses during the process of self-testing for HIV.

DESIGN

This study used a qualitative design.

SETTINGS

A college in northern Taiwan.

PARTICIPANTS

We recruited a purposive sample of 30 nursing students.

METHODS

The OraQuick self-test was used as the self-testing tool in this study. After participants used the OraQuick self-test, they underwent a semi-structured interview during the post-test counselling period. All interview data were subjected to line-by-line content analysis.

RESULTS

We extracted nine themes of nursing students' experiences during experiential learning of HIV self-test. In the pre-test stage, they recalled possible risk behaviors for HIV infection, decided to complete the self-test alone or asked for significant others to accompany them, and endured emotional fluctuations immediately prior to the test. When waiting for the test results, they felt isolated from the outside world. Some participants also began questioning the accuracy and safety of the test, and either viewed the results immediately or later on. In the post-test stage, some participants reported being uncertain about the results. Participants reported a greater understanding of the personal impact of testing and revealed their needs for support. Some identified a sense of loss and linked this to the rapid and direct delivery of test results.

CONCLUSIONS

Our results can be used to guide HIV-related education courses and prevention programs. Experiential learning has the potential to improve HIV pre and post-test counselling, as nurses develop both clinical knowledge and personal insight of the testing process.

Bachelor of Nursing students' HIV and AIDS knowledge in KwaZulu-Natal province: An evaluation study

BACKGROUND

 Currently, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) education and training in nursing suffer from various inadequacies and lack any real formalisation in their governance. As a result, Bachelor of Nursing students find themselves challenged in providing effective HIV and AIDS healthcare management, largely because of the deficit in training identified. An HIV and AIDS education intervention programme was introduced at a selected KwaZulu-Natal university to assist in bridging the perceived knowledge gap. This article communicates programme evaluation findings.

OBJECTIVES

 The aim of this article was to determine levels of HIV knowledge achieved following an HIV education intervention programme.

METHODS

 A pure, descriptive quantitative research design was employed, using total population sampling (N = 133). A modified G3658-11 Collecting Evaluation Data: End-of-Session Questionnaire, developed by the University of Wisconsin-Extension, was administered for data collection.

RESULTS

 Females predominated in the study, and most participants were African with 1 to 3 years of education programme exposure. Perceived HIV knowledge increase was evident: pathophysiology (n = 93, 70.2%); immunology (n = 97, 72.9%); transmission (n = 116, 87.5%); diagnosis (n = 109, 81.8%); prevention strategies (n = 118, 88.4%); staging and monitoring (n = 106, 80%); pre- and post-test counselling (n = 104, 78%).

CONCLUSION

 Pre- and ongoing in-service HIV and AIDS training can improve perceived HIV knowledge levels for both nursing students and professionals. Mandatory HIV and AIDS healthcare management training is therefore recommended in planning for its effective impartation by nursing educators.

Reducing HIV-related stigma and discrimination in healthcare settings: A systematic review of quantitative evidence

Introduction

Stigma and discrimination (SAD) related to HIV compromise access and adherence to treatment and support programs among people living with HIV (PLHIV). The ambitious goal of ending the epidemic of HIV by 2030 set by the United Nations Joint Program of HIV/AIDS (UNAIDS) will thus only be achieved if HIV-related stigma and discrimination are reduced. The objective of this review was to locate, appraise and describe international literature reporting on interventions that addressed HIV-related SAD in healthcare settings.

Methods

The databases searched were: Cumulative Index to Nursing and Allied Health (CINAHL), Excerpta Medica Database from Elsevier (EMBASE), PubMed and Psychological Information (PsycINFO) database. Two individuals independently appraised the quality of the papers using appraisal instruments from the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool from JBI. Quality of evidence for major outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results

We retained 14 records reporting on eight studies. Five categories of SAD reduction (information-based, skills building, structural, contact-based and biomedical interventions) were identified. Training popular opinion leaders (POLs) resulted in significantly lower mean avoidance intent scores (MD = -1.87 [95% CI -2.05 to -1.69]), mean prejudicial attitude scores (MD = -3.77 [95% CI -5.4 to -2.09]) and significantly higher scores in mean compliance to universal precaution (MD = 1.65 [95% CI 1.41 to 1.89]) when compared to usual care (moderate quality evidence). The Summary of Findings table (SOF) is shown in Table 1.

Conclusions

Evidence of moderate quality indicates that training popular opinion leaders is effective in reducing avoidance intent and prejudicial attitude and improving compliance to universal precaution. Very low quality evidence indicates that professionally-assisted peer group interventions, modular interactive training, participatory self-guided assessment and intervention, contact strategy combined with information giving and empowerment are effective in reducing HIV-related stigma.Further Randomized Controlled Trials (RCTs) are needed. Future trials need to use up-to-date and validated instruments to measure stigma and discrimination.

The impact of educational intervention based on the health belief model on observing standard precautions among emergency center nurses in Sirjan, Iran

Providing health care services has always been considered as a hazardous job due to a number of reasons. The risk of blood-borne viruses and the importance of their prevention has led to the formulation of principles called standard precautions (SPs). The goal of this study was to investigate the impact of an educational intervention based on the Health Belief Model constructs on the behavior of nurses in emergency centers regarding observing SPs in Sirjan, Iran. This was a quasi-experimental study. The study population included 100 emergency personnel working in health centers in Sirjan city (of Iran), who were randomly divided into two intervention (n = 50) and control (n = 50) groups. The educational intervention was conducted over two sessions each lasting for 60 min. Information was collected by a questionnaire (with 64 questions), completed in an interview conducted directly before the intervention and 3 months later. Data were analyzed using the χ2 test, t-test and paired t-test.The results showed nurses did not have enough information about SPs, but after the intervention, knowledge scores increased in both groups. In the Health Belief Model (HBM) constructs, significant differences were observed in perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action and self-efficacy, after the intervention, in the intervention group (P < 0.001), but not in the control group (P > 0.05). HBM was effective in educating SPs among emergency personnel.

Stigma Reduction Training Improves Healthcare Provider Attitudes Toward, and Experiences of, Young Marginalized People in Bangladesh

PURPOSE

Working with health providers to reduce HIV stigma in the healthcare setting is an important strategy to improve service utilization and quality of care, especially for young people who are sexually active before marriage, are sexual minorities, or who sell sex. A stigma reduction training program for health providers in Bangladesh was evaluated.

METHODS

A cohort of 300 healthcare providers were given a self-administered questionnaire, then attended a 2-day HIV and sexual and reproductive health and rights training (including a 90-minute session on stigma issues). Six months later, the cohort repeated the survey and participated in a 1-day supplemental training on stigma, which included reflection on personal values and negative impacts of stigma. A third survey was administered 6 months later. A cross-sectional survey of clients age 15-24 years was implemented before and after the second stigma training to assess client satisfaction with services.

RESULTS

Provider agreement that people living with HIV should be ashamed of themselves decreased substantially (35.3%-19.7%-16.3%; p < .001), as did agreement that sexually active young people (50.3%-36.0%-21.7%; p < .001) and men who have sex with men (49.3%-38.0%-24.0%; p < .001) engage in "immoral behavior." Young clients reported improvement in overall satisfaction with services after the stigma trainings (63.5%-97.6%; p < .001).

CONCLUSIONS

This study indicates that a targeted stigma reduction intervention can rapidly improve provider attitudes and increase service satisfaction among young people. More funding to scale up these interventions is needed.

An Integrated Intervention for Increasing Clinical Nurses' Knowledge of HIV/AIDS-Related Occupational Safety

Background: Approximately 35 new HIV (Human Immunodeficiency Virus, HIV) cases and at least 1000 serious infections are transmitted annually to health care workers. In China, HIV prevalence is increasing and nursing personnel are encountering these individuals more than in the past. Contaminated needle-stick injuries represent a significant occupational burden for nurses. Evidence suggests that nurses in China may not fully understand HIV/AIDS (Acquired immunodeficiency syndrome, AIDS) and HIV-related occupational safety. At this time, universal protection precautions are not strictly implemented in Chinese hospitals. Lack of training may place nurses at risk for occupational exposure to blood-borne pathogens. Objectives: To assess the effectiveness of integrated interventions on nurses’ knowledge improvement about reducing the risk of occupationally acquired HIV infection. Methods: We audited integrated interventions using 300 questionnaires collected from nurses at the Affiliated Hospital of Xiangnan University, a public polyclinic in Hunan Province. The intervention studied was multifaceted and included appropriate and targeted training content for hospital, department and individual levels. After three months of occupational safety integrated interventions, 234 participants who completed the program were assessed. Results: Of the subjects studied, 94.3% (283/300) were injured one or more times by medical sharp instruments or splashed by body fluids in the last year and 95.3% considered their risk of occupational exposure high or very high. After the intervention, awareness of HIV/AIDS-related knowledge improved significantly (χ² = 86.34, p = 0.00), and correct answers increased from 67.9% to 82.34%. Correct answers regarding risk perception were significantly different between pre-test (54.4%) and post-test (66.6%) (χ² = 73.2, p = 0.00). When coming into contact with patient body fluids and blood only 24.0% of subjects used gloves regularly. The pre-test knowledge scores on universal precautions were relatively high. Correct answers about universal precautions improved significantly from pre-test (83.71%) to post-test (89.58%; χ² = 25.00, p = 0.00). After the intervention, nurses’ attitude scores improved significantly from pre-test (3.80 ± 0.79) to post-test (4.06 ± 0.75; t = 3.74, p = 0.00). Conclusions: Integrated educational interventions enhance nurses’ knowledge of risk reduction for occupationally acquired HIV infections and improve the observance of universal precautionary procedures. This enhancement allows nurses to assume a teaching role for prevention and management of HIV/AIDS.

A Mixed-Methods Outcome Evaluation of a Mentorship Intervention for Canadian Nurses in HIV Care

We assessed the impact of an HIV care mentorship intervention on knowledge, attitudes, and practices with nurses and people living with HIV (PLWH) in Canada. We implemented the intervention in two urban and two rural sites with 16 mentors (eight experienced HIV nurses and eight PLWH) and 40 mentees (nurses with limited HIV experience). The 6- to 12-month intervention included face-to-face workshops and monthly meetings. Using a mixed-methods approach, participants completed pre- and postintervention questionnaires and engaged in semistructured interviews at intervention initiation, mid-point, and completion. Data from 28 mentees (70%) and 14 mentors (87%) were included in the quantitative analysis. We analyzed questionnaire data using McNemar test, and interview data using content analysis. Results indicated positive changes in knowledge, attitudes, and practices among nurse mentees, with qualitative interviews highlighting mechanisms by which change occurred. Mentorship interventions have the potential to engage and educate nurses in HIV treatment and care.

Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care

We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations.

A preliminary validation of the Brief COPE instrument for assessing coping strategies among people living with HIV in China

BACKGROUND

The Brief COPE instrument has been utilized to conduct research on various populations, including people living with HIV (PLWH). However, the questionnaire constructs when applied to PLWH have not been subjected to thorough factor validation.

METHODS

A total of 258 PLWH were recruited from two provinces of China. They answered questions involving the scales of three instruments: the Brief COPE, the Perceived Social Support Scale, and the Perceived Discrimination Scale for PLWH. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted.

RESULTS

The CFA found a poor goodness of fit to the data. The subsequent EFA identified six preliminary factors, forming subscales with Cronbach's alphas, which ranged from 0.61 to 0.80. Significant correlation coefficients between the subscales and measures of perceived social support and perceived discrimination were reported, giving preliminary support to the validity of the new empirical factor structure.

CONCLUSION

This study showed that the original factor structure of the Brief COPE instrument, when applied to PLWH in China, did not fit the data. Thus, the Brief COPE should be applied to various populations and cultures with caution. The new factor structure established by the EFA is only preliminary and requires further validation.

Network stigma towards people living with HIV/AIDS and their caregivers: An egocentric network study

HIV stigma occurs among peers in social networks. However, the features of social networks that drive HIV stigma are not well understood. The objective of this study is to investigate anticipated HIV stigma within the social networks of people living with HIV/AIDS (PLWHA) (N = 147) and the social networks of PLWHA's caregivers (N = 148). The egocentric social network data were collected in Guangxi, China. More than half of PLWHA (58%) and their caregivers (53%) anticipated HIV stigma from their network peers. Both PLWHA and their caregivers anticipated that spouses or other family members were less likely to stigmatise them, compared to friend peers or other relationships. Married network peers were believed to stigmatise caregivers more than unmarried peers. The association between frequent contacts and anticipated stigma was negative among caregivers. Being in a close relationship with PLWHA or caregivers (e.g., a spouse or other family member) was associated with less anticipated stigma. Lower network density was associated with higher anticipated stigma among PLWHA's alters, but not among caregivers' alters. Findings may shed light on innovative stigma reduction interventions at the social network level and therefore improve HIV/AIDS treatment utilisation.

Knowledge, Attitude, and Practices Regarding Occupational HIV Exposure and Protection among Health Care Workers in China: Census Survey in a Rural Area

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.

Advancing the prevention agenda for HIV and other sexually transmitted infections in south China: social science research to inform effective public health interventions

Despite widespread biomedical advances in treatment and prevention, HIV and other sexually transmitted infections (STI) continue to affect a large portion of the world's population. The profoundly social nature of behaviorally driven epidemics and disparities across socioeconomic divides in the distribution of HIV/STI and care outcomes emphasize the need for innovative, multilevel interventions. Interdisciplinary approaches to HIV/STI control are needed to combine insights from the social and biological sciences and public health fields. In this concluding essay to a Special Issue on HIV/STI in south China, we describe the evolution of the region's HIV/STI epidemics and the government response, then synthesize findings from the 11 studies presented in this issue to extend seven recommendations for future HIV/STI prevention and care research in China. We discuss lessons learned from forging international collaborations between the social and biological sciences and public health to inform a shared research agenda to better meet the needs of those most affected by HIV and other STI.

Evaluation of the effectiveness of HIV voluntary counseling and testing trainings for clinicians in the Odessa region of Ukraine

In Ukraine, only 28 % of HIV-infected individuals are aware of their HIV status. Expansion of voluntary HIV counseling and testing (VCT) in primary and specialty health care settings holds promise for increasing the number of people who know their HIV status and can access care. To build capacity among health care providers to deliver VCT, we conducted two-day trainings on basic HIV knowledge and on VCT procedures in the Odessa region of Ukraine. The training program was developed by local trainers in collaboration with faculty from the US Southeast AIDS Training and Education Center and was delivered in the clinical settings where trainees worked (n = 392). We assessed training effectiveness in terms of change in knowledge among clinician trainees, comparing HIV specialists and nonspecialists and those working in urban and rural clinical settings. All else being equal, compared with their urban HIV-specialist peers, trainees who were rural nonspecialists demonstrated significantly greater increases in general HIV knowledge scores. This effort demonstrates that brief, on-site training programs support the expansion of VCT by increasing the knowledge and skills of rural nonspecialist clinicians to levels equal with urban HIV specialists.

A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come?

INTRODUCTION

HIV-related stigma and discrimination continue to hamper efforts to prevent new infections and engage people in HIV treatment, care and support programmes. The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response.

METHODS

We conducted a systematic review of studies and reports that assessed the effectiveness of interventions to reduce HIV stigma and discrimination between 1 January 2002 and 1 March 2013. Databases searched for peer-reviewed articles included PubMed, Scopus, EBSCO Host -CINAHL Plus, Psycinfo, Ovid, Sociofile and Popline. Reports were obtained from the www.HIVAIDSClearinghouse.eu, USAID Development Experience Clearinghouse, UNESCO HIV and AIDS Education Clearinghouse, Google, WHO and UNAIDS. Ancestry searches for articles included in the systematic review were also conducted. Studies of any design that sought to reduce stigma as a primary or secondary objective and included pre- and post-intervention measures of stigma were included.

RESULTS

Of 2368 peer-reviewed articles and reports identified, 48 were included in our review representing 14 different target populations in 28 countries. The majority of interventions utilized two or more strategies to reduce stigma and discrimination, and ten included structural or biomedical components. However, most interventions targeted a single socio-ecological level and a single domain of stigma. Outcome measures lacked uniformity and validity, making both interpretation and comparison of study results difficult. While the majority of studies were effective at reducing the aspects of stigma they measured, none assessed the influence of stigma or discrimination reduction on HIV-related health outcomes.

CONCLUSIONS

Our review revealed considerable progress in the stigma-reduction field. However, critical challenges and gaps remain which are impeding the identification of effective stigma-reduction strategies that can be implemented by national governments on a larger scale. The development, validation, and consistent use of globally relevant scales of stigma and discrimination are a critical next step for advancing the field of research in this area. Studies comparing the effectiveness of different stigma-reduction strategies and studies assessing the influence of stigma reduction on key behavioural and biomedical outcomes are also needed to maximize biomedical prevention efforts.

Stigma in AIDS nursing care in sub-saharan Africa and the Caribbean

Some nurses who provide AIDS care, in addition to experiencing stigma themselves, also exhibit negative attitudes and perpetrate stigma and discrimination toward persons living with HIV (PLWHAs). We used a participatory research approach to explore the nature, context, and influence of stigma on the nursing care provided to PLWHAs in four low- and middle-income countries: Jamaica, Kenya, South Africa, and Uganda. Eighty-four registered nurses, enrolled nurses, and midwives participated in interviews and 79 participated in 11 focus groups. Nurses were very aware of the stigma and discrimination that AIDS evoked, and made adjustments to their care to decrease the manifestation of AIDS stigma. Despite the assurance that PLWHAs were treated equally, and that universal precautions were used consistently, we found that in reality, nurses sometimes made decisions about nursing care that were based on the appearance of the patient or knowledge of his or her status.

Prevalence and associated factors of depression among people living with HIV in two cities in China

OBJECTIVES

Depression has significant effects on morbidity and mortality in people living with HIV (PLWH). Current study estimated the rate of depressive disorder and identified the correlates of depressive disorder among PLWH in China.

METHODS

258 PLWH in China were recruited and interviewed with a structured questionnaire including measurements testing perceived stress, social support, perceived discrimination, and depression. Mediating effect of perceived stress between perceived discrimination and depression and moderating effect of social support on effect of perceived discrimination and perceived stress to depression were tested. Multivariate regression was used to examine the determinants of depression.

RESULTS

The prevalence of mild to severe depression is 71.9%. The relationship between the perceived discrimination and depression is fully mediated by perceived stress (perceived discrimination that was statistically significant (β=0.153) to depression became non-significant after adding perceived stress in the regression model). Interaction term between social support and perceived stress has negative effects (β=-0.117) and explained a significant amount of variance (R(2)=0.018) in depression. Lower income, and higher perceived stress predicted more depressive symptoms.

LIMITATIONS

Cross-sectional study and self-report bias are major limitations of this study.

CONCLUSION

Depression among PLWH is a severe problem in China. Primary health care workers need to be trained in recognition and treatment in depression. Stress management skills and social support for PLWH are warranted.

Systematic review of HIV prevention interventions in China: a health communication perspective

OBJECTIVES

To examine whether communication strategies and principles have been utilized in the HIV prevention intervention programs conducted in China.

METHODS

Comprehensive literature searches were conducted using PsycINFO, Medline, and Academic Search Complete with combinations of a number of keywords. Studies were included if they (1) were conducted in China and published prior to October 2011; (2) tested interventions promoting HIV/sexual risk reduction; and (3) reported empirical outcome evaluations on HIV knowledge, condom use and other condom-related variables. Data on 11 dimensions were extracted and analyzed, including formative research, theory, message targeting, messenger and channels, process evaluation, evaluation design, outcome measures.

RESULTS

The majority of the 45 intervention studies were not theory-based, did not report conducting formative research or process evaluation, used pretest-posttest control group designs, combined nonmedia channels, printed and visual materials, and employed HIV knowledge and condom use as outcome measures.

CONCLUSIONS

Many HIV prevention interventions in China have been successful in reducing HIV risk-related outcomes. This literature has its weaknesses; however, the current review illuminates gaps in the literature and points to important future directions for research.

Perceived discrimination, social support, and perceived stress among people living with HIV/AIDS in China

Perceived stress among people living with HIV/AIDS (PLWH) was associated with severe mental health problems and risk behaviors. Discrimination toward PLWH in China is prevalent. Both perceived discrimination and social supports are determinants of the stress level among PLWH. Psychological support services for PLWH in China are scarce. It is unknown whether social support is a buffer between the perceived discrimination and perceived stress. With written consent, this study surveyed 258 PLWH recruited from multiple sources in two cities in China. Instruments were validated in previous or the present study, including the perceived stress scale for PLWH (PSSHIV), the perceived social support scale (PSSS), and the perceived discrimination scale for PLWH (PDSHIV). Pearson correlations and multiple regression models were fit. PDSHIV was associated with the Overall Scale and all subscales of PSSHIV, whilst lower socioeconomic status in general and lower scores of PSSS were associated with various subscales of PSSHIV. The interaction item (PSSS×PSDHIV) was nonsignificant in modeling PSSHIV, hence no significant moderating effect was detected. Whilst perceived discrimination is a major source of stress and social support can reduce stress among PLWH in China, improved social support cannot buffer the stressful consequences due to perceived discrimination. The results highlight the importance to reduce discrimination toward PLWH and the difficulty to alleviate its negative consequences. It is warranted to improve mental health among PLWH in China and it is still important to foster social support among PLWH as it has direct effects on perceived stress.

Undergraduate nursing student's attitudes towards caring for people with HIV/AIDS

The aim of this quantitative study was to determine the attitudes of Australian nursing students towards caring for people with HIV/AIDS. This research study was conducted among second year undergraduate nursing students at a university in South Australia, during August 2007. The survey tool consisted of six demographic questions and the AIDS Attitude Scale. This questionnaire was completed by 396 students, giving a response rate of 94.7%. The vast majority (95.7%) of students participating in this study demonstrated very positive attitudes towards caring for people with HIV/AIDS and only 4.3% demonstrated negative attitudes. No statistically significant differences were found in attitude score based on participants' age, gender, previous HIV/AIDS education, previous nursing experience or previous experience of caring for someone with HIV/AIDS. A statistically significant difference in AIDS attitude score was found in relation to participants' country/region of citizenship, with nursing students from China, East Asia, South East Asia, and Central Asia and Middle East having more negative attitudes than students from other countries/regions. As an increasing number of nursing students have been recruited to Australia from these countries/regions, nurse educators need to be aware of such differences when planning and delivering HIV/AIDS educational programs in tertiary institutions.

Nurses' willingness to take care of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)--does a teaching intervention make a difference?

The aim of this study is to describe the impact of an education intervention programme on nurses' willingness to care for HIV-positive people in Lithuania.

METHODS

The study utilizes a randomized controlled trial design (RCT). The total sample comprises 185 nurses working in medical, surgical and gynaecological units, and primary health care centres from the same hospital areas in three Lithuanian hospitals. The data were analyzed using SPSS 12.0 and descriptive statistics.

FINDINGS

Our educational intervention did not have an impact on the nurses' willingness to take care of people living with HIV (PLHIV), as their level of willingness was high already before the education intervention.

CONCLUSIONS

Further research on this issue is needed to try to understand the forces acting on our nursing staff in order to ensure appropriate care for PLHIV.

Knowledge, attitudes, perceived vulnerability of Chinese nurses and their preferences for caring for HIV-positive individuals: a cross-sectional survey

AIMS

The study was to assess HIV/AIDS knowledge, attitudes and perceived vulnerability with potential factors.

BACKGROUND

HIV/AIDS is a public health catastrophe in China. Nurses are expected to care for nurture, comfort and advocate for all patients regardless of their condition. However, in the area of HIV/AIDS, nurses suffer as a result of expectations put on them by their professional roles.

DESIGN

This was a descriptive, cross-sectional design that used a survey approach.

METHOD

Data were collected from Summer 2003-Winter 2004.

RESULTS

Nurses reported significant perceived severity of risk from occupational exposure. Many nurses were frequently exposed to being stuck by needles (86%) and being splashed by body fluids and more than half of them (59.7%) were concerned about contracting HIV/AIDS. Nurses who had experience of finger pricks worried about potentially contacting HIV and being unaware of it (odds ratio= 0.444, p = 0.004). Nurses demonstrated a lack of knowledge and training in infectious diseases which may be a result of the fact that the study location is not considered a 'concentrated area' for infectious disease transmission; therefore, the need for the infectious diseases training has not been considered urgent.

CONCLUSIONS

A well-designed educational programme on occupational hazards and risk behaviour should be implemented to educate nurses in suburban cities and the general public. Hospital administrators should implement on-site continuing education on HIV/AIDS throughout China. Armed with better knowledge of both transmission routes and precautions, nurses can protect themselves while providing care to patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses in China urgently need psychosocial and physical supports from families, friends, communities and their working environments while combating HIV epidemic. With good support system, nurses will better educate patients and their family members on how to prevent transmission not only of HIV/AIDS but of a wide range of other infectious diseases as well.

Knowledge and attitudes of Jordanian nurses towards patients with HIV/AIDS: findings from a nationwide survey

This study explored the knowledge and attitudes of Jordanian nurses toward patients with HIV/AIDS, particularly in regards to their sources of information and education. This survey utilized a cross-sectional design. A self-administered questionnaire developed by Eckstein was used in collecting the data. A total of 922 nurses completed the questionnaire. Overall, Jordanian nurses expressed negative attitudes toward patients with HIV/AIDS, and their level of HIV/AIDS knowledge was weak. Weak knowledge level was recorded among nurses in the following subsections: agent and immunology; course and manifestation; transmission and incidence; and precaution and prevention. Only in one subsection (risk group), did nurses show a good level of knowledge about HIV/AIDS. More than two-thirds of nurses (84%) refused to provide care to patients who tested positive for HIV/AIDS. Most of the nurse participants believed that currently provided HIV/AIDS information resources were inadequate (81.4 %). The majority of nurses were interested in support groups for staff nurses (96.5%). The major source of HIV/AIDS information obtained by Jordanian nurses was through Internet web sites (52.7%). The majority of nurses (96.2%) ranked their fear of getting AIDS from their nursing practice as overwhelming. The total attitude of participants towards patients with HIV/AIDS in all five subsections (i.e., fear of contagion, social stigma, fatal outcome of the disease, direct care, and education and counseling) was negative (84.3%). Accurate knowledge about HIV/AIDS along with an in-depth understanding of patients? needs can help alleviate much of the fear, anxiety, and stigma associated with caring for patients with HIV/AIDS.

The impact of an education intervention to change nurses' HIV-related knowledge and attitudes in Lithuania: a randomized controlled trial

The purpose of this study was to describe the effect of an intervention program on nurses' HIV-related knowledge and attitudes in Lithuania. The program focused on HIV epidemiology, transmission, coinfections, treatment and care, risk contacts, and moral and ethical dilemmas. It was designed to increase nurses' knowledge and positive attitudes concerning HIV. The study used a randomized controlled trial design with two experimental groups ([EG]; EG1, n = 63, EG2, n= 63) and one control group (n= 59) in three Lithuanian hospitals. Data were collected using a questionnaire developed by Held (1993). The questionnaire included questions about participant demographic characteristics, knowledge, and attitudes toward those living with HIV. The education intervention, which combined a 2-day workshop and written materials, had a positive effect on the knowledge levels of nurses. However, written materials alone failed to improve nurses' knowledge or change their attitudes.

Nursing and midwife students' willingness to provide care to patients with HIV/AIDS--a comparative study in Finland, Estonia and Lithuania

This article presents results on nursing and midwife students' willingness to care for patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). An international cross-sectional survey design was used and the data were collected from educational institutions in Finland (N=169), Estonia (N=132) and Lithuania (N=170) between autumn 2005 and spring 2006. Participants (N=471) were nursing and midwife students training to be RN, public health nurses or midwives. A modified version of a scale developed by Duppert et al. (1994) was applied to measure willingness to care for patients with HIV/AIDS. The study found a general willingness on the part of students to provide care for patients with HIV/AIDS. However, nursing and midwife students willingness varied between countries and was also related to specific nursing interventions. Factors associated with students willingness also varied within each country, depending on nurses' age, nursing experience (Finland), positive attitudes to treating patients with HIV/AIDS in general (Finland, Estonia), and previous experience in taking care of a patient with HIV/AIDS (Lithuania). It is important to develop strategies for nursing vulnerable patient populations and international nursing curricula to identify prejudicial thinking and intolerance towards patients with HIV/AIDS.

Consequences of drug abuse and HIV/AIDS in China: recommendations for integrated care of HIV-infected drug users

Drug abuse is a complicated social phenomenon rather than a neural disease. It especially fuels the HIV/AIDS epidemic. Researchers have shown interest in HIV-infected drug users as the socially and medically marginalized population, but they did not provide good enough care. Based on published English and Chinese journal articles and official reports, this integrated literature review summarizes the epidemic of drug abuse and HIV/AIDS, and comments on the clinical and psychosocial consequences, and harm reduction measures in China. Officially registered drug users have reached more than 1 million recently. A little under half of the people living with HIV/AIDS are injection drug users, as they transmit the disease through needle sharing and unprotected sexual behavior. The main consequences of drug abuse and HIV/AIDS included high prevalence of hepatitis viruses and tuberculosis co-infections, severe mental problems and extreme poverty. Even health professionals hold discriminative attitude toward drug users because of condemnation of drug abuse behavior and fear of HIV infection. Although interventions for drug addiction and harm reduction have been scaled up quickly, such as methadone maintenance treatment and needle syringe programs, the measures should be further revised, and the effectiveness needs to be evaluated appropriately. To enhance HIV-infected drug users' quality of life and the utility of medical services, improving health care providers' attitude is the first step. Then securing good quality of integrated medical care services with multidisciplinary cooperation will be essential.

The impact of HIV education on the lives of Ugandan nurses and nurse-midwives

In this ethnography, I explored the impact of an HIV/AIDS education program on the lives of 24 Ugandan nurses and nurse-midwives. Nurses who previously had viewed themselves simply as providers of advice and sympathy now saw themselves as more holistic, collaborative caregivers. They voiced an increased awareness of their role as leaders and advocates in the community with respect to policy. The education program had positive and synergistic effects on the nurses' professional practice, communication and problem-solving skills, confidence, and engagement in political and social change activities.

Help-seeking in a context of AIDS stigma: understanding the healthcare needs of people with HIV/AIDS in China

Despite the rapid increase of HIV infection cases in China, the majority of this population have not yet accessed AIDS-related healthcare services. Most current research in China focuses on HIV prevention and disease control, and pays inadequate attention to the barriers facing HIV-infected individuals in accessing and adhering with healthcare services. This article, as part of a research project on the illness experiences of people with HIV/AIDS in China, aimed to explore these individuals' healthcare experiences, shedding light on the gaps between their needs and existing healthcare services. Data for this qualitative study were collected through individual in-depth interviews with 21 HIV-infected adults in China. The results of data analysis suggest that these individuals' healthcare experiences were greatly affected by social discrimination and the limitations of healthcare resources. While AIDS stigma has reduced the social resources available for this population, HIV-related health institutions were perceived by them as an indispensable source of social support. It is concluded that healthcare institutions, as one of the few places in which HIV-infected people are willing to disclose their HIV positive status, should incorporate social care into healthcare service development and delivery so as to facilitate this population's accessing healthcare services and to address their unmet needs that go beyond the conventional scope of health care. Improving the visibility of people with HIV/AIDS in health care will also have a long-term impact on their own well-being and on HIV prevention in China.

HIV knowledge improvement among nurses in India: using a train-the-trainer program

Nurses play a major role in the health care delivery system; therefore, education of nurses is critical to successful prevention programs for persons with HIV. Little is known about nurses' knowledge of HIV in India. The purpose of this study was to determine the effects of a nurse-led train-the-trainer HIV education program on improving the HIV knowledge of nurses. A group of senior nurses (N = 10), were responsible for training a cohort of 10 nurses each, totaling 100 nurses. The 2-day training program included HIV epidemiology and etiology, infection control, psychosocial support, counseling, modes of transmission, natural history of the disease, symptoms of early and late disease, diagnostic testing, and legal and ethical issues. Pre- and posttest scores were calculated using a self-administered structured questionnaire that measured HIV-related knowledge in terms of cognitive and transmission knowledge. Paired t-tests indicated that both measures of HIV knowledge improved significantly from pretest to posttest.

Exploring knowledge and skills on HIV in student nurses and midwives

A cross-sectional survey design using a self-administered questionnaire was sent to a sample of 62 final-year student nurses and midwives to describe their knowledge of, skills related to, and attitudes towards, human immunodeficiency virus/acquired immune deficiency syndrome. Out of the 47 respondents who return the questionnaire, only 53% stated that they had received class instruction on the topic and 63.8% claimed to have increased their knowledge mainly from reading professional journals. Although only 32% said that they had cared for a patient or knew of a family member or another person with the disease, 91% indicated that they were willing to care for such patients. Overall, the respondents demonstrated positive attitudes towards this group of patients and a good level of knowledge about the subject, although some gaps were evident. However, a large majority stated that their skills to cater for the physical and psychological needs of this group of patients were deficient and would like further training.

"If you get AIDS... you have to endure it alone": understanding the social constructions of HIV/AIDS in China

Recent AIDS research has documented the widespread discrimination toward people living with HIV/AIDS (PLWHA) in China. General ignorance and misconceptions about this disease have been identified as the two primary reasons for this prejudice. Yet, little attention has been paid to social constructions of HIV/AIDS in the Chinese context and to the processes by which such constructions are experienced, understood, reacted to, and, perhaps, reconstructed through social and interpersonal interactions. Based on a qualitative study of Chinese PLWHA's illness experiences, this paper explores how HIV/AIDS, as a social construct, is understood by these individuals in the context of their daily encounters. It is discovered that, despite their knowledge of HIV/AIDS, PLWHA's perceptions about and responses to this disease are greatly influenced by their experiences of interacting with others (e.g., their families, friends, and health workers). The conflicts between individuals' mastery of knowledge pertaining to, and their overreactions in practice toward, HIV-infected bodies suggest that AIDS education should not be limited to the dissemination of knowledge per se, but that the interpersonal or interactive dimensions of discrimination and efforts to combat it must also be taken into account.