Research initiatives to help combat the HIV/AIDS epidemic were the focus of three sessions presented in July at the 22nd International Nursing Research Congress of the Honor Society of Nursing, Sigma Theta Tau International.
This research can enhance the care of patients with HIV and provide data on which we can base policy and guidelines, said Inge Corless, RN, PhD, moderator of the HIV sessions and a professor at MGH Institute of Health Professions in Boston.
Although the number of new HIV infections has declined globally, it is increasing in some countries, and more than 33 million people worldwide live with HIV infection, according to the World Health Organization.
The congress HIV sessions, which Corless called cutting-edge research, focused on global perspectives, health promotion initiatives and collaborative initiatives for patients with HIV or AIDS.
Culturally specific HIV prevention
A research project aimed at preventing HIV infection in low-income women in Chile stressed the importance of a culturally targeted design. Called Mano a Mano-Mujer, or Hand to Hand-for Women, the program sought to decrease Chilean womens rising share of HIV cases, which nearly doubled between 1986 and 2009.
Women do not see themselves as being at risk, said lead investigator Rosina Cianelli, RN, MS, MPH, PhD, FAAN, associate professor, University of Miami School of Nursing and Health Studies, Coral Gables, Fla.
Yet women are vulnerable, partly because of traditional gender roles. These roles are expressed through machismo (machoism) and marianismo, which is female acceptance that men will engage in high-risk sexual behaviors, said Cianelli, who is originally from Chile.
A pilot study by Cianelli showed that to be effective among Chilean women, an HIV prevention campaign must address these cultural barriers and should have nurses teach it, rather than peers. Women really trust nurses and follow what nurses tell them to do, she said.
The new study therefore implemented a nurse-instructed intervention, which recruited women from Santiago, Chile, who were ages 18 to 49 and reported having sexual activity within the past six months. Nearly 500 women enrolled in the study: 244 in the intervention group and 252 women in the control group. The intervention group received six educational sessions on HIV, which covered risk-reduction behaviors, such as use of condoms (including female condoms) and communicating with partners about safer sex practices. Both groups underwent assessment before and three months after the study regarding their HIV knowledge, attitudes and behaviors.
The control group received no education until after completing the study assessment.
Compared with controls, women who received the intervention had significantly improved HIV knowledge, attitudes toward people living with HIV, intentions to reduce HIV risk behaviors and self-efficacy (confidence in ability) to engage in risk-reduction practices, Cianelli reported. An increase in condom use was not statistically significant, but more women reported being abstinent after the intervention, she said. Because Chile is predominantly Catholic and a Catholic university collaborated on the study, Cianelli said the program also discussed abstinence.
The program had wide-reaching benefits beyond HIV prevention, she said. Some women returned to school; some left abusive relationships.
As part of another international nursing research team, Patrice Nicholas, RN, MPH, DNSc, ANP, examined the prevalence and self-management of peripheral neuropathy symptoms in 80 adults with HIV infection in South Africa. Nicholas, director of Global Health and Academic Partnerships at Bostons Brigham and Womens Hospital and professor at MGH Institute of Health Professions, was a Fulbright Scholar at the University of KwaZulu-Natal in Durban, South Africa.
Of the study population, nearly 62% had peripheral neuropathy, a common complication of both HIV and antiretroviral therapy. More than 25% rated their pain as 10 on a 0 to 10 scale, Nicholas reported.
Medications such as gabapentin and tricyclic antidepressants, which can make quality of life much better for these patients, are not readily available in South Africa, she said.
Furthermore, few participants reported effective self-care. Those who did perform self-care to alleviate pain tried rest, massage and walking more often. The study calls out for more therapeutic interventions for treating HIV neuropathy in South Africa and the U.S., she said.
This research, Nicholas continued, should encourage nurses everywhere to assess HIV-infected patients for peripheral neuropathy, which often goes unevaluated.
Stigma and compliance barriers
Two studies focused on HIV-related stigma. Aubrey Florom-Smith, RN, BSN, a graduate assistant at the University of Miamis nursing school, presented the results of one of these studies. From a literature review, Florom-Smith found stigma is a universal experience for HIV-infected individuals that may result in negative health outcomes.
Corless, the moderator, called stigma an important topic in HIV discussions. Stigma may affect patient compliance, and it may make people reluctant to find out if they have HIV infection or to tell their families they are infected, she said. People are afraid of being ostracized and may not do the things they need to do to maintain their health.
Unfortunately, nurses may not recognize their own stigmatizing beliefs or discriminatory behaviors toward HIV-infected patients, according to an abstract by Natalia Villegas, RN, MSN, a University of Miami doctoral student. Villegas, Cianelli and colleagues found community nurses and other healthcare workers in Santiago, Chile, had stigmatizing attitudes toward people living with HIV, or they broke patient confidentiality to inform other nurses about patients HIV status. Its important for nurses to be aware of stigma as we interact with patients, to listen to their concerns and to offer support and resources, Corless said.
Nurses also should promote resilience to coping with HIV by identifying patients motivation factors, according to another study co-authored by Florom-Smith.
In other research presented at the meeting, Jodi Simpson, RN, DNP, NPP, FNP, of Kings County Hospital Center, Brooklyn, N.Y., identified barriers to adherence to highly active antiretroviral therapy among patients with severe mental illness and HIV or AIDS. A retrospective chart review at a New York HIV-mental health clinic showed barriers to compliance included male gender, multiple substance abuse, living alone and having only a high school education. In her abstract, Simpson wrote of the need for [a]standard guideline and resource tool to improve treatment and medication adherence in this population.