Caring for those with HIV/AIDS: nurses must continually strive to ensure the care they offer people living with HIV/AIDS is non-judgemental.

MAY 12 is International Nurses' Day. The theme this year is "Nurses caring for all: Fighting AIDS stigma". Is there still a stigma associated with a diagnosis of HIV/AIDS? Are health care workers hesitant to provide care for patients with HIV/AIDS? Should there be any perceived distinction between caring for those with HIV or any other blood-borne virus?

To the end of last year, 772 individuals have been notified in New Zealand as having developed AIDS. A total of 1887 individuals have been diagnosed as being infected with HIV. (1) There will also be those in the community with undiagnosed HIV infection and other blood-borne viruses. In comparison to most countries, the overall known incidence of HIV/AIDS infection in New Zealand is very low.

Over the last decade there has been a significant increase in health care workers' knowledge about the HIV virus, transmission routes, prevention factors and treatment options. Adhering to Standard Precautions during the care of all patients regardless of their diagnosis, and having needle/sharps safety practices as normal practice, are very effective in preventing occupationally acquired HIV. (2)

The New Zealand AIDS Epidemiology Group has been collecting statistics on HIV/AIDS infections in New Zealand since 1985. The group says there have been no known cases of health care workers acquiring HIV from occupational exposure within New Zealand. It is reassuring to know our current infection control practices work and that health care workers can safely provide care for individuals infected with HIV, AIDS and other blood-borne viruses.

A number of studies and surveys have been undertaken in a number of countries over the last two decades, looking at the attitudes of nurses towards AIDS-related illnesses. A small survey was undertaken in New Zealand and published in 1990. (3) One hundred and thirty two nurses responded to a variety of questions related to their attitudes on occupational risk, patient care and related matters. Eighty seven percent expressed the desire to be informed when their patients were known to be HIV positive. Ninety six percent of responses expressed the view that patients with HIV/ AIDS were entitled to the same care as any other patient, but only 66 percent indicated they would approach caring for a person with HIV/AIDS no differently from any other patient. There appeared to be a difference in the perception of what was the right thing to do and actual practice.

A study was undertaken in Sweden of nursing staff, assistant nurses and nursing students, to see if there was a difference in the attitudes of nurses in caring for HIV-infected and homosexual HIV-infected patients. They also wanted to measure the nurses' fear of contracting HIV and to assess whether nurses would wish to refrain from providing care to HIV-infected patients. The data was collected 1999 and 2000 and was published in 2003. (4) The numbers included in the study were not large and some limitations were noted.

The authors found that, in general, both nursing staff and nursing students had empathetic attitudes towards both HIV-infected and homosexual HIV-infected patients. There were, however, a minority of respondents who expressed condemnatory attitudes towards those with HIV. Generally, the fear of HIV contagion was low. Despite this, 26-36 percent of those studied would still refrain from caring for HIV-infected patients if that possibility existed. The reasons for this were not able to be explored.

These survey results show there is still work to be done to enhance knowledge at all levels of nursing about HIV/AIDS. One of the students in the Swedish study commented: "You feel insecure until education makes you secure." Having experienced nurses who were not prejudiced as role models was noted as being important to promote both the quality of care offered to HIV-positive patients, and the mutual sense of wellbeing among patients and nurses.

Some of the Swedish findings are reflected in the anecdotal reports from health care workers in New Zealand. Modern nursing demands that we do not discriminate on the grounds of race, creed, sex and religion in our patients/clients.

The National Committee of NZNO's Division of Infection Control Nurses believes:

* patients/clients with H IV are entitled to unbiased, consistent nursing/ health care, regardless of how and when they acquired HIV;

* health care workers have the right to personal protective equipment provided by their employer that is readily available in clinical areas, so Standard Precautions can be routinely adhered to;

* health care workers should be responsible and adhere to standard precautions and have safe needle/ sharps practices;

* health care workers have the right to timely and consistent followup if they sustain a needle/sharps injury or blood and body fluid exposure.

* health care workers have the right to ongoing education to continue to enhance knowledge on HIV/AIDS.

Nurses caring for all--let's continue fighting AIDS stigma.

REFERENCES

(1) AIDS Epidemiology Group, (2003) AIDS New Zealand; Issue 51, February.

(2) Garner, J. S. (1996) Overview of isolation systems, in Olmsted R (Ed). APIC Infection Control and Applied Epidemiology: Principals and Practice. Mosby: Baltimore.

(3) Wills, D. J. (1990) A survey of nurses' attitudes to AIDS-related issues. New Zealand Nursing Forum; 18: 4, 7-9.

(4) Rondahl, G., Innala, S. and Carlsson, M. (2003) Nursing staff and nursing students' attitudes towards HIV-infected and homosexual HIV-infected patients in Sweden and the wish to refrain from nursing. Journal of Advanced Nursing; 41: 5, 454-461.

--Karen Davis, RCpN, BHSc, CIC, is a nurse clinician, infectioncontrol nursing for Lakes District Health Board, based in Rotorua. She is chair of NZNO's Division of Infection Control Nurses.