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Factors influencing anxiety concerning HIV/AIDS in rehabilitation workers.

Media attention aimed at dissemination of information regarding the nature of HIV/AIDS may actually increase homophobic attitudes and anxiety concerning this disease and those persons affected. The purpose of this research was to examine factors that influence the anxiety of rehabilitation workers in providing services to persons with HIV/AIDS. Measurements obtained utilizing Spielberger's State/Trait Anxiety inventory showed that the only factors that influenced state anxiety levels were age and the amount of previous contact with persons with HIV/AIDS or homosexuals. Suggestions for training based on the profile of participants are also provided.

Media attention of issues such as HIV/AIDS often causes a corresponding focus from the public. The media attention associated with HIV/AIDS has been aimed at dissemination of information regarding the nature of the disease and prevention methods which often has had the unintended consequence of increasing homophobic attitudes (Magruder, Whitbeck, & Ishii-Kuntz, 1993). Correlational studies that have examined attitudes toward AIDS found that individuals who hold anti-homosexual attitudes are more likely to support repressive measures against people with AIDS (LePoire, Sigelman, Sigelman, & Kenski, 1990; Price & Hsu, 1990; Stipp & Kerr, 1989). Association of the disease with sexual orientation appears to have increased levels of intolerance towards homosexuals. For example, reported rates of hate crimes directed toward gays and lesbians in the San Francisco Bay Area have doubled since 1990 (Magruder, Whitbeck, & Ishii-Kuntz, 1993).

Rehabilitation workers have and are currently dealing with individuals from some of the subgroups effected by the human immunodeficiency virus. They work with people who are accustomed to discrimination as a way of life. The questions that could be asked include: (a) Are rehabilitation workers different in their anxieties concerning individuals with HIV/AIDS? (b) What elements affect the anxiety of rehabilitation workers? and (c) What, if anything, decreases or increases anxiety in rehabilitation workers concerning persons with HIV/AIDS?


The purpose of this research was to determine what demographic variables influenced anxiety concerning HIV/AIDS in rehabilitation workers. Research of this nature will assist agencies in determination of training priorities for employees at all levels. There are some workers who may need more intensive interventions than others.

Literature Review

The number of persons who are HIV positive continues to increase despite educational efforts aimed at lifestyles and behavior changes. These changes involve behaviors that historically have had little public discussion and are behaviors that many individuals find offensive. As the number of individuals with HIV/AIDS grows, so will the need to provide services to these people. An extensive review of the rehabilitation literature over the past five years, conducted by hand and by computer search, revealed that little has been written concerning rehabilitation workers and their reactions to persons with HIV/AIDS. One article (All & Fried, 1994) addressed the psychosocial issues of HIV/AIDS that affect rehabilitation and Hunt (1995), investigated the level of HIV/AIDS training conducted in rehabilitation counseling programs. Hunt (1995) additionally, documented the lack of research on HIV/AIDS in rehabilitation publications over the past ten years. Useful information and research was found in health care, counseling, psychology, and social work journals.

Anxiety about AIDS is not limited to the general public. Workers in human service fields are worried about their vulnerability to the disease. This fear continues despite well-designed studies that demonstrate the relatively low risk of patient/human service worker exposure when universal precautions and other risk reduction behaviors are employed (Reeder, Hamblet, Killen, King, & Uruburu; 1994).

Initially, HIV disease presented in members of socially stigmatized groups and was surrounded by mystery and death (Meisenhelder & LaCharite, 1989). HIV/AIDS has elicited emotional and prejudicial responses from human service workers (Cole & Slocumb, 1993). Pre-existing stigma and prejudicial beliefs have contributed to the formation of attitudes toward persons with HIV/AIDS and the disease itself (Cole & Slocumb, 1993; Herek & Glunt, 1988; Siminoff, Erlen, Lidz, 1991). Most of these reactions have been associated with the major subgroups afflicted by the disease: gay men, drug users, racial minorities, or outsiders in general. Persons with HIV/AIDS come from subgroups who previously have had low rates of contact with human service workers. Consequently, there has been little need for these workers to deal with their attitudes about these groups.

Samuel and Boyle (1989) addressed the issue of attitudes in social workers and this can be extended to rehabilitation workers. The possession of more information was correlated with the possession of more positive attitudes. Additionally, higher information scores were correlated with lower self-rated anxiety and younger age (35 years of age or younger). Behavior scores were also correlated with more contact with family and friends who were homosexual. The study results were similar to other studies that supported the ideas of general fear about AIDS and anti-gay attitudes being significantly and negatively correlated with knowledge.

Positive behavior scores have been found to be related to having an association with a person with AIDS (family or friend), expressed confidence in medical information, being nonreligious, previous attendance at an AIDS in-service program, and being homosexual (Henry, Campbell, & Willenbring, 1990). Additionally. occupational therapy personnel were found to fear carrying the virus home and fear contracting the virus in routine care situations. A positive relationship was found between actually providing care for a person with AIDS and both volunteering to care and a willingness to care for persons with HIV/AIDS (Atchinson, Beard, & Lester, 1990).

Surveys conducted in 1985 and 1987 (Seltzer, 1993) were aimed at assessing whether the correlates with attitudes toward AIDS change over time. The sampling frame for these two surveys included all telephone residences in the 50 states. Only individuals 18 years or older were surveyed (1985, n=2,308; 1987, n=2,095). Questions were used to examine support for repression of persons with AIDS, knowledge of transmittal of HIV by casual contact, attitudes toward homosexuality, personal concern concerning AIDS, and demographic and attitudinal variables. Results demonstrated that respondents were more likely in 1987 to support tattoos for people with AIDS and to support outlawing sexual activity for people who test positive for HIV. Individuals supporting these types of labeling were more likely to be anti-homosexual, less educated, and more likely to believe that AIDS could be transmitted by casual contact. Men were more likely than women to hold repressive attitudes. Respondents were more likely in 1987 to state that they would try to make friends with someone who had the disease. Individuals over the age of 50 were more likely to believe in casual transmission than their younger counterparts. Individuals over the age of 50 had the lowest level of personal concern in 1985 and this level of concern was further reduced in 1987.


A quasi-experimental research design was originally chosen for this investigation, since an experimental design with a control group was not feasible or practical. Initially, a repeated measures design was to be utilized but, due to the fact that initial anxiety was in the low range, a simple pre-test/post-test design resulted. Spielberger's State/Trait Anxiety Inventory (STAI) was chosen to measure pre and post presentation anxiety (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983).

The State-trait Anxiety Inventory and the corresponding version for children have been used more frequently in research than any other anxiety measure. It consist of 40 brief items, 20 that assess how an individual feels at a particular moment in time, and 20 items that assess,how one feels most of the time. Scores can range from 20, indicating low anxiety, to 80, indicating high anxiety. The validity of the STAI rests on the respondent's understanding that he or she must report feelings at this particular moment and how he or she generally feels. It is recommended that the A-state scale be given first. The A-state scale is more sensitive to the conditions under which it is administered. Test-retest reliability is reported to be .73 to .86 for the A-trait scale and as situational sensitive as .16 to .54 for the A-state scale. Internal consistency provides a more meaningful index of reliability and was evaluated by alpha coefficient measures. A-state coefficients were .90 for working adults, students, and military recruits (Berger & Owen, 1987; Dreger, 1978; Spielberger et al., 1983).

The educational presentation was designed to be presented in a three-hour format. The same content was presented to four different groups of various rehabilitation workers at four different locations, all of whom were employed by a state rehabilitation agency in the Rocky Mountain area. Research has suggested that longer programs may be better than short programs in addressing biases and changing attitudes (Cooke, 1988; Dorman, Collins, & Brey. 1990: Royse & Birge, 1987, van Servellen, Lewis, & Leake, 1988). A three hour block was the only time that could be allotted to the in-service training. Presenters utilized lecture, audiovisual materials and small group discussions for presentation of the information. The researcher was always the administrator of the data collection instrument.

The educational program consisted of two distinct segments, with fifteen minutes at the end of each segment for questions. The first segment was two hours of information centering around workplace issues and HIV/AIDS. The second segment lasting forty-five minutes consisted of a person with HIV/AIDS describing what it is like to live with this disease, thus, allowing the participants to acquire knowledge about and discuss what it is like to live with this particular disease. It also allowed participants to understand the affect the disease has on the person's daily life and his/her plans for the future.

The research question was designed to analyze what variables had greater effects on the anxiety of rehabilitation workers, not the content of the educational presentation. The recommendations found in the literature on program length, content and teaching strategies were utilized in the presentations to the greatest degree possible with the time constraints imposed. It is recognized that short one time educational offerings may not be the optimal manner to provide HIV/AIDS education (Dorman et al., 1990). It has been suggested that HIV/AIDS information should be incorporated into existing curriculum, courses, practicum experiences, and training seminars (Diaz & Kelly, 1991; Hunt, 1995).

Research Question

What variables influenced and/or reduced anxiety concerning HIV/AIDS in rehabilitation workers

The independent variable was the educational program. The dependent variable consisted of scores obtained after subtracting the pre-state anxiety scores from the post-state anxiety scores. Researchers have consistently reported a decrease in the anxiety of health care workers with increased education about HIV/AIDS. The use of a pre-test/post-test design threatened internal validity. Threats to validity included: 1) weakness in cause and effect inferences, due to possible competing explanatory causes, 2) maturation of the sample; 3) and the fact that collecting opinions and attitudes may change them. Short, one time offerings may not be sufficient to influence anxiety concerning HIV/AIDS. The responses given might be influenced by collecting them immediately after the presentation. The external validity of the research was also limited. Results can truly only be generalized to the sample. There was no reason to believe that rehabilitation workers in the Rocky Mountain area were dissimilar to workers in states with the approximate same incidence of HIV disease. Any differences that exist should cause the results to be cautiously generalized to the target population (rehabilitation workers).

Description of Sample

The sample for this study consisted of employees of a state (public) rehabilitation agency in the Rocky Mountain region. All rehabilitation workers in the agency assigned to attend the educational presentation were asked, but not required, to participate in the research study. Only two individuals declined participating in the research study. Demographic information was collected to look at: job title, level of education, previous hours of HIV/AIDS education, religious preference, age, gender, previous personal or professional contact with a homosexual, and previous personal or professional contact with a person with HIV/AIDS.


Two particular areas of the literature have been supported by this research study. These areas are the effects of age and contact with persons who either have HIV/AIDS or are homosexual. Table 1 provides a demographic profile of the participants in the areas of job title, level of education, previous hours of HIV/AIDS education, religious preference, gender, age and previous contact with a person with HIV/AIDS, and previous contact with a homosexual.

Table 1 Summary Statistics for Demographic Data

 N = 81
Adm/Superv 15 18.5
 Counselor 45 55.6
 Clerical 7 8.6
 Other 14 17.3
 Missing Data 7 8.6
 Associate 5 6.2
 Bachelors 16 19.6
 Masters 53 65.4
 0-3 29 35.7
 4-6 27 33.3
 7-10 16 19.8
 11-13 3 3.7
 14-20 4 4.9
 21+ 2 2.5
 None 27 33.3
 Catholic 11 13.6
 Methodist 8 9.9
 Lutheran 3 3.7
 Baptist 5 6.2
 Episcopalian 3 3.7
 Other 24 29.6
 Male 25 30.9
 Female 56 69.1
 Missing Data 7 8.6
 20-30 3 3.6
 31-40 24 29.6
 41-50 38 46.7
 51-60 8 8.5
 61+ 1 2.4
Previous Contact with a
Person with HIV/AIDS 65 80.2
Previous Contact with a
Homosexual 74 92.5

The only factors in this study that related to reduced anxiety were age, previous contact with persons with HIV/AIDS, and previous contact with persons who were homosexual. Dependent t-test showed that the educational presentation had no effect on the post-presentation measurement of state anxiety (t=1.23, p[is greater than]0.22) partly due to the fact that pre-measures of anxiety (mean=36.01) indicated low levels of anxiety. Participants in this study had a high percentage of contact with persons with HIV/AIDS and persons who are homosexual (80.2% and 93%, respectively).

Results (paired t-test) reinforced that younger individuals were less anxious on the pre-test and the post-test for anxiety. The individuals who gained the most were the older participants (t= 20.49, age and the difference variable). Paired t-tests of the amount of previous contact with a person with HIV/AIDS (t = -32.07) and previous contact with a homosexual (t = -31.8 1) found that contact influenced anxiety. Individuals who had previous contact with a person with HIV/AIDS were less anxious both before and after the presentation. Amount of previous education concerning HIV/AIDS had no influence on anxiety.


It cannot be assumed that the impact of training seminars is the same for everyone. The manner in which individuals processed the information given in training sessions depended on their attitudes, self-rated risk of acquiring the virus, motivation, and prior experience with the issues and individuals involved (Samuel & Boyle, 1989). Educational presentations need to provide contact with persons with HIV/AIDS (Henry, Campbell, & Willenbring, 1990; Samuel & Boyle, 1989). Older workers may need more educational seminars than younger individuals since they are more likely to believe in casual transmission and, frequently, had less opportunity to interact with persons with HIV/AIDS (Seltzer, 1993). An important aspect of this research deals with how to spend training funds. Needs assessments of training priorities should include how much, if any, contact the participants have had with persons with HIV/AIDS or homosexuals. In settings where workers are older and have had little contact with this population, training must include the opportunity to interact with these two groups of individuals. In settings where workers are younger and/or have had personal or professional contacts with homosexuals or persons with HIV/AIDS, the presentations may be better aimed at providing information about case management. This case management needs to include types of treatment modalities, ADA issues, job re-training opportunities, future employment, and independent living options. Training for both older and younger rehabilitation workers must include supporting the rehabilitation workers' uncertainties about the disease, the individuals effected, and opportunities to discuss their own fears and concerns that come with dealing with the incurable nature of the disease.


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Atchinson, B., Beard, B., & Lester, L. (1990). Occupational personnel and AIDS: Attitudes, knowledge, and fears. The American Journal of Occupational therapy, 44(3), 212-217.

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Henry, K., Campbell, S., & Willenbring, K. (1990). A cross-sectional analysis of variables impacting on AIDS-related knowledge, attitudes, and behaviors among employees of a Minnesota teaching hospital. AIDS Education and Prevention, 2(1), 36-47.

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LePoire, B. Sigelman, C., Sigelman, L., & Kenski, H. (1990). Who wants to quarantine persons with AIDS? Patterns of support for California's proposition 64. Social Science Quarterly, 71, 239-249.

Magruder, B., Whitbeck, L., & Ishii-kuntz, M. (1993). The relationship between Aids-related information Sources and homophobic attitudes: A comparison of Two Models. Journal of Homosexuality, 25(4), 47-67.

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Seltzer, R. (1993). AIDS, homosexuality, public opinion, and changing correlates over time. Journal of Homosexuality, 26(1), 85-97.

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Van Servellen, G., Lewis, C., & Leake, , B. (1988). Nurses' responses to the AIDS crisis: Implications for continuing education programs. The Journal of Continuing Education in Nursing, 19(1), 4-8.
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Author:Fried, Juliet H.
Publication:The Journal of Rehabilitation
Date:Oct 1, 1996
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