Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC)

Determinants of Workforce Preparedness during Pandemics Among Healthcare Workers at the U.S. Department of Veterans Affairs

OBJECTIVE

An infectious disease outbreak can place a significant burden on healthcare systems, however, our understanding of the broader healthcare workforce's preparedness during a pandemic is limited. This study examines factors that influence perceived workforce preparedness at the U.S. Department of Veterans Affairs (VA) during a pandemic.

METHODS

The VA Preparedness Survey was a random, anonymous, web-based survey fielded nationwide October to December 2018. Multivariate statistical analyses examined the effects of study relevant factors (sociodemographic, work-related, general health, and household-related characteristics of VA employees) on perceptions of workforce preparedness, including institutional readiness and understanding of individual roles during a pandemic.

RESULTS

Four thousand and twenty-six VA employees responded. Overall, 55% were confident in their VA medical facility's ability to respond; 49% understood their role; and 68% reported their role to be important during a pandemic. After controlling for study-relevant factors, household preparedness, having plans that address the health care needs of family members, and higher self-reported health status were associated with all 3 workforce preparedness variables. Clinical staff (compared to non-clinical staff) were less likely (OR:0.80, 95% CI:0.68-0.94, P < .01) to have confidence in their medical facility's ability to respond but more likely (OR:1.77, 95% CI:1.49-2.10, P < .001) to believe their role was important. Employees who have been at the VA longer (OR:1.07, 95% CI:1.01-1.14, P < .05) or have experienced a disaster while working at the VA (OR:1.29, 95% CI:1.04-1.59, P < .05) were more likely to understand their role during a pandemic.

CONCLUSION

The findings from this study suggest the need for identifying ways to increase VA employees' confidence in their medical facility's ability to respond to a pandemic; develop trainings to improve understanding of their different yet critical roles, for both clinical and non-clinical staff, during a pandemic; create different workforce trainings for newly hired employees; and identify ways to improve household preparedness for a pandemic outbreak.

The role of risk perception in willingness to respond to the 2014-2016 West African Ebola outbreak: a qualitative study of international health care workers

Background

The 2014–2016 West Africa Ebola Virus Disease (EVD) outbreak was an unprecedented public health event, and in addition to claiming over 11,000 lives, it resulted in the deaths of more healthcare workers than any outbreak in recent history. While a cadre of willing and able health workers is essential for an effective epidemic response, health workforce capacity in times of crisis may be significantly impacted by how risks are perceived by health staff. This study aimed to explore how risk perceptions influenced healthcare workers’ willingness to respond during this outbreak.

Methods

Through in-depth interviews with 11 front-line international health care workers who chose to respond to the West Africa outbreak, this qualitative study explores how perceptions of risk developed and subsequently mediated the decision to respond to the outbreak. Data was thematically organized using NVivo 10.

Results

We found that numerous individual and social-level factors played a role in modifying risk perception in health workers. Institutional trust emerged as a key risk attenuator, as did past experience, self-efficacy, duty of care, humanitarian ethos, and cognitive heuristics. Feelings of risk were amplified by infections of co-workers, and risk perceptions of family members and the public, which were mainly informed by media reports, also hampered willingness to respond in some cases.

Conclusions

Understanding the risk perceptions of health workers, institutions, and the public, while complex and interdependent, are each crucial to understand for an effective public health response to epidemics, and as such should be taken into consideration in future program planning and research.

Health workers perceptions and attitude about Ghana's preparedness towards preventing, containing, and managing Ebola Virus Disease

BACKGROUND

Ebola virus is highly infectious and the disease can be very fatal. The World Health Organization has declared the 2014-2015 Ebola Virus Disease outbreak a Public Health Emergency of International Concern. In response to this, preparations were made in various health facilities and entry points across Ghana. This study explored health workers perceptions, and attitude about Ghana's preparedness towards preventing and containing Ebola Virus Disease.

METHODS

We conducted a qualitative study in five (5) of the ten (10) regions in Ghana. Five focus group discussions (N = 44) were conducted among nurses; one in each region. In addition, ten (10) health workers (2 in each region) who are members of regional Ebola Virus Disease task force were recruited and interviewed. In the Greater Accra, Volta and Western regions that have ports, six (6) port health officials: two in each of these regions were also interviewed. The interviews were recorded digitally and transcribed verbatim. Thematic content analysis was used to analyze the transcripts with the aid of NVivo 10 software.

RESULTS

The results of this study showed that Ghanaian health workers perceived the screening at various ports as important and ongoing but felt that the screenings at in-land ports were being undermined by the use of unapproved routes. Training of health workers was also being carried out in all the regions, however, there was a general perception among 33 out of 44 nurses that majority of health workers have not received training on Ebola Virus Disease prevention and management. Logistical challenges were also reported as some health facilities did not have adequate Personal Protective Equipment. In facilities where equipment was available, they were stored in places which are not easily accessible to health workers at all times of the day. Human resource preparation was also perceived to be a challenge as health workers (38/44 of nurses) generally expressed fear and unwillingness to work in Ebola treatment centres in the event of an outbreak in Ghana.

CONCLUSIONS

Our study concludes that preparatory work for Ebola Virus Disease prevention and containment in Ghana is perceived as inadequate by health workers. Ghana needs to strengthen preparation in the area of training of health workers, provision and accessibility of Personal Protective Equipment and incentives for health workers to better position her to contain and manage any Ebola Virus Disease outbreak.

Concerns, attitudes, and practices of orthopaedic surgeons towards management of patients with HIV/AIDS in Nigeria

The increasing number of people living with HIV/AIDS is causing concern among surgeons over risk of occupationally acquired HIV infection. This may influence their attitude to such patients. The purpose of this study was to develop a cross-sectional survey of orthopaedic surgeons to assess their concerns, attitudes, and practices towards management of HIV-positive patients in Nigeria. All respondents were males, 55 (73.3%) of them indicated concern over the risk of occupational acquisition of HIV infection and 37 (49.3%) had examined or operated on at least one HIV/AIDS patient. Sixty (79.9%) were willing to be tested for HIV and 51 (67.9%) were previously tested. Fifty-seven (75.9%) would order preoperative HIV screening of high risk patients, and 67 (89.3%) would operate on HIV-positive patients. Most orthopaedic surgeons in Nigeria would operate on HIV-positive patients.

Attitudes toward gay men and lesbians and related factors among nurses in Southern Taiwan

OBJECTIVES

The aims of this study were to explore different dimensions of the attitudes toward gay men and lesbians among nurses in southern Taiwan and to examine the association between attitudes and intention to provide care to homosexual individuals. The factors related to attitudes towards gay men and lesbians by nurses were also examined.

METHODS

In total, 1824 nurses from a medical centre and two regional teaching hospitals in southern Taiwan were recruited into this study. We used the Attitudes Toward Homosexuality Questionnaire (ATHQ) to examine four-dimensional concepts toward homosexuality among nurses. The association of attitudes with the intention of taking care of homosexual patients was examined. Correlations of attitudes toward homosexuality with demographic and occupational data, sexual orientation, knowledge about homosexuality, and experiences of having contact with gay men and lesbians were examined using a stepwise multiple linear regression.

RESULTS

Participants had the most negative attitude toward homosexuality in the 'contact' and 'stereotypes' dimensions, followed by the 'morality' dimension and then the 'condemnation/tolerance' dimension. Nurses with more negative attitudes toward homosexuality had lower intentions of taking care of patients with a homosexual orientation. Nurses who had friends or relatives with a homosexual orientation, had a higher educational degree, and had provided care to homosexual patients were more likely to have positive attitudes toward homosexuality. In contrast, nurses who had worked for a longer period, labelled themselves as being absolutely heterosexual, and were religious were more likely to have negative attitudes toward homosexuality.

CONCLUSIONS

The factors related to attitudes toward homosexuality identified in this study have to be taken into consideration when intervening for nurses' attitudes toward gay men and lesbians.

Evaluation of inpatient clinical training in AIDS care

BACKGROUND

Studies of outpatient clinical training in AIDS care have shown positive effects on residents' knowledge, attitudes and intentions. In this study, residents' knowledge, attitudes and intentions regarding the care of HIV-infected patients were used as outcome measures to evaluate the effectiveness of a 1-month residency training in an AIDS inpatient unit.

METHODS

From April 2000 through April 2001, 33 internal medicine residents completed pretest-posttest questionnaires evaluating changes in their knowledge, attitudes and intention to care for HIV-infected patients. Of these 33 residents, 25 participated in a posttest interview, reflecting on their learning experience during the 1-month clinical rotation.

RESULTS

At the posttest, residents were significantly more accurate in assessing HIV-associated risk (p < 0.001), and were significantly more knowledgeable about the necessary protective equipment to prevent HIV transmission (p < 0.01). Residents were significantly less concerned about the risk of infection (p < 0.01) and interpersonal concerns (p < 0.05). Residents' reluctance to care for HIV-infected patients was significantly lower (p < 0.05), as was their tendency to avoid invasive procedures or treatment of HIV-infected patients (p < 0.001). Residents designated after their training were more likely to practice universal precautions and less likely to be afraid and to stereotype HIV-infected patients. They also reported gaining insight into HIV diseases and patients' multifaceted needs, and appreciating the importance of teamwork in AIDS care.

CONCLUSION

A 1-month AIDS residency training can effectively enhance residents' HIV-related knowledge, attitudes and intention to care for patients infected with HIV.

Survey research: a primer for hand surgery

Survey research is an important and commonly used research tool. The findings of survey research help set national practice guidelines and guide health care policy decision making. The process of survey design and administration is rigorous, complex, and involved. The Journal of Hand Surgery contains on average 3 articles involving surveys per issue. This report serves as a reference for readers of the many survey articles published in this journal. It also provides a guide for hand surgeons or others interested in how to conduct survey research.

Emotional and behavioral consequences of bioterrorism: planning a public health response

Millions of dollars have been spent improving the public health system's bioterrorism response capabilities. Yet relatively little attention has been paid to precisely how the public will respond to bioterrorism and how emotional and behavioral responses might complicate an otherwise successful response. This article synthesizes the available evidence about the likely emotional and behavioral consequences of bioterrorism to suggest what decision makers can do now to improve that response. It examines the emotional and behavioral impact of previous "bioterrorism-like" events and summarizes interviews with experts who have responded to such events or conducted research on the effects of community-wide disasters. The article concludes by reflecting on the evidence and experts' perspectives to suggest actions to be taken now and future policy and research priorities.

Epidemiology of needlestick and sharp injuries at a university hospital in a developing country: a 3-year prospective study at the Jordan University Hospital, 1993 through 1995

OBJECTIVE

To study the epidemiology of needlestick and sharp injuries in a university hospital in a developing country, Jordan.

METHODS

A prospective study was undertaken of all needlestick and sharp injuries among workers at the Jordan University Hospital between 1993 and 1995. Health care workers were asked to report in person to the infection-control team to verify the incident and to respond to a questionnaire. Blood was obtained from patients and health care workers immediately and from the health care workers 6 months later for hepatitis B virus, hepatitis C virus, and HIV testing.

RESULTS

During the 3-year period, 248 health care workers had needlestick and sharp injuries. Of these, 34.6% were staff nurses, 19%, environmental workers, 15.7%, interns, 11.7%, residents, 8.5%, practical nurses, and 6% were technicians. The incidence density was highest for the interns followed by staff nurses and environmental workers. Of incidents, 22.6% occurred during blood drawing, 11.3% during placing intravenous lines, 8.5% during administration of medication, 11% during recapping the needle, 10.5% during needle disposal, 12.5% during garbage collection, and 5% were caused by a neglected needle. Only 117 patients were identified; 36 of 62 of these had positive results for hepatitis B surface antigen, and 8 of 13 for hepatitis C virus.

CONCLUSION

Needlestick and sharp injuries occur frequently in developing countries. Safer disposal facilities and routine hepatitis B vaccine should be adopted.

Primary care physicians and barriers to providing care to persons with HIV/AIDS

Primary care physicians play an increasingly important role in the care of persons with HIV/AIDS due to the rising number and changing geographic distribution of persons infected with HIV/AIDS. The study explored the relationship between barriers to health services and the experience and willingness of primary care physicians to care for persons with HIV/AIDS. The study was based on a random survey of primary care physicians in South Carolina. The results indicate that although primary care physicians' willingness to treat persons with HIV/AIDS is significantly associated with many self-reported barriers (i.e., financial, structural, knowledge, and attitudinal), their HIV/AID care experience was most significantly correlated with self-reported knowledge that overrides financial and structural barriers. The results emphasize the importance of programs and policy initiatives aimed at enhancing the primary care physicians' knowledge level and improving their attitudes related to HIV/AIDS.

Rural physicians: a survey analysis of HIV/AIDS patient management

Primary care physicians in South Carolina were asked about their knowledge, attitudes, beliefs, and services provided to HIV/AIDS patients. The study focused on conditions under which physicians would provide additional services in an effort to develop more effective state policies regarding HIV/AIDS. There was a 66 percent (597/900) response rate. This analysis focuses on a group of 338 physicians that identified themselves as rural (nonurban) physicians. Of the rural physicians responding, 42 percent had not treated a case of HIV/AIDS during the last year and 52 percent had seen only 1 to 9 patients. They identified lack of specialty back-up support, likelihood of losing patients, legal and ethical issues, and lack of community services as the primary barriers to service. Gaps in rural physician knowledge included when to refer HIV/AIDS cases to specialists and information on legal and ethical issues. They, like their urban colleagues, would provide additional services to HIV/AIDS patients with specialty back-up (57 percent), better community and social services support (54 percent), additional training (48 percent), and limited liability (47 percent). The authors conclude that policy changes addressing these areas in the broader contexts of rural health issues would expand access to care for persons with HIV infection in rural states.

HIV and the work intentions of public health nurses

Studies have examined the association between attitudes about the human immunodeficiency virus (HIV) and nurses' willingness or intentions to work with infected persons. However, the relationship between these intentions and perceived concern from nurses' family and friends, or factors of professional nursing experience is relatively unexplored. An anonymous questionnaire was completed by 311 public health nurses from areas with high and low prevalence of acquired immunodeficiency syndrome (AIDS) in North Carolina. Multiple regression analysis showed that nurses had stronger intentions to work with HIV-infected clients if they had more favorable attitudes about the disease, perceived significant others [corrected] to be supportive of such work, had stronger professional ties to public health, and had worked fewer years in public health. In addition, nurses from low AIDS-prevalence areas had stronger intentions to work with these clients if they had professional nursing care experience with them. These findings are consistent with the Theory of Reasoned Action, but also identify professional nursing experience as independently associated with behavioral intentions. This suggests that attitudinal, normative, and professional experiences are all important in examining nurses' intentions to work with clients infected with HIV.

Respiratory care practitioners' attitudes toward patients with AIDS

OBJECTIVE

To assess attitudes of respiratory care practitioners about AIDS and patients with AIDS.

DESIGN

A questionnaire that explored attitudes about AIDS was disseminated throughout southern New Jersey. Identity of individual responders was protected carefully.

RESULTS

One hundred fifty-nine responses were received. The majority of responders favored identification of patients with AIDS, segregation of those patients into AIDS wards, and then avoidance of the AIDS wards. There was some bias against patients with known high-risk behaviors (especially drug abuse), but once a patient had AIDS the fear of getting AIDS was the only factor that correlated (p = 0.001) with the desire to avoid AIDS patients. Thirty-nine percent of responders said that they used universal precautions less than 90 percent of the time, and no factor (including fear of AIDS and markers of education) predicted which therapists did not consistently use them.

CONCLUSIONS

The desire to avoid AIDS represents a rational desire not to become infected with the HIV virus. This study documents an identify-and-avoid philosophy in lieu of careful use of universal precautions. Educational efforts need to emphasize that the use of precautions represents the only truly effective means of preventing infection with the AIDS virus and other communicable diseases.

Homophobia and attitudes toward gay men and lesbians by psychiatric nurses

Stereotypic and stigmatic attitudes toward homosexuality may interfere both directly and indirectly with the care provided to gay and lesbian patients. The purpose of this study was to measure attitudes toward gays and lesbians and assess homophobia among psychiatric nurses. The demographic characteristics of education, religious identification, and knowledge of gays and lesbians had positive affects on attitudes and homophobia. The Attitudes Towards Gays and Lesbians Scale (ATGLS) developed by the researcher specifically for this study assessed cognitive attitudes and the Index of Homophobia (IHP), developed by Hudson and Ricketts (1980), measured homophobia, the affective response to gays and lesbians.

HIV-related knowledge and attitudes among medical students in China

A modified version of the 'WHO/KABP Questionnaire for Students' was administered to 302 students at a medical university in China. The instrument included items to assess the students' demographic background, knowledge of AIDS/HIV, attitudes about AIDS, as well as towards people infected with HIV, those groups commonly labelled as 'high risk' and toward sources of information. The average score on the knowledge scale was 80% correct. There was a substantial disparity in knowledge between how HIV is transmitted and how HIV is not transmitted--90% of the former items were answered correctly, while only 72% of the latter were answered correctly. Over 40% of the sample blamed prostitutes for AIDS in China, whereas 22% blamed drug addicts and 6% blamed homosexuals. Two-thirds of the sample indicated that they thought people with AIDS got what they deserve. About one-third of the sample supported quarantine measures as well as keeping infected students out of classrooms. Nearly half of the sample indicated that they did not trust any of the official sources of health information we asked about and 27% said that they thought the government was concealing information about AIDS.

The influence of perceived risk of exposure to human immunodeficiency virus on medical students' planned specialty choices

The purpose of this report is to determine the influence of the acquired immunodeficiency syndrome (AIDS) epidemic on medical students' training and career plans through a prospective, anonymous self-administered survey of 10 Likert-scaled (1 strongly agree to 5 strongly disagree) responses to statements assessing attitude toward patients with human immunodeficiency virus (HIV), adequacy of knowledge and experience with HIV, and influence of HIV on career choices. The study was done at a major AIDS referral university teaching hospital. The participants were first- through fourth-year medical students in spring 1990. A 72% (of 451 students) response revealed that both surgery and emergency medicine were perceived as high risk of exposure specialties. Students indicated an overall willingness to care for HIV-positive patients (mean, 2.54) and a general adequacy of knowledge and experience (mean 2.54). The AIDS epidemic has had little influence for training, future career, and practice locations (mean, 4.06). Responses differed by class year. The later class years were more willing to care for HIV patients (P < .001) and indicated more knowledge and experience with HIV (P < .001). Influence on career, training and practice location choices were without class trend. In contrast to some studies, this group of medical students had relatively positive attitudes toward patients with HIV and were not particularly influenced by the AIDS epidemic regarding career choices.

NURSING CARE CHALLENGES: Homosexual Psychiatric Patients

1. Stereotypes of homosexual behavior may negatively affect the nursing care for homosexual patients. Nurses must closely examine their attitudes toward homosexuals. To be able to provide quality care to homosexual patients, nurses must feel comfortable and fully aware of their own attitudes toward sexuality and homosexuality. 2. Nurses stand in a unique position to foster acceptance of homosexuality by assuming the advocacy role and addressing the stereotypes regarding homosexuality for both individual clients and the community. 3. Nurses need to provide an atmosphere of acceptance for homosexual patients by creating an environment where sexuality can be discussed in nonthreatening ways.

Occupational exposure to human immunodeficiency virus and hepatitis B virus: a comparative analysis of risk

OBJECTIVE

To estimate the occupational risk from infection with the human immunodeficiency virus (HIV) in terms of loss of (quality-adjusted) life expectancy, and to compare that risk to those posed by other hazards faced by health care workers.

DESIGN

Decision-analytic model.

RESULTS

For a 30-year-old female health care worker (unvaccinated for hepatitis B virus [HBV]), the loss of life expectancy from a needlestick from a symptomatic HIV-positive (HIV+) patient is 39 days (range, 17 to 93 days), as compared with a loss of 17 days from a needlestick from a patient who is hepatitis-B-surface-antigen-positive (HBsAg+), and 38 days from a needlestick from a patient who is hepatitis-B-e-antigen-positive (HBeAg+). When morbidity is included in the analysis of risk (through calculation of the quality-adjusted loss of life expectancy), the risk from both HBV and HIV increases. The quality-adjusted loss of life expectancy due to a needlestick exposure from a symptomatic HIV+ patient is 45 days (range, 20 to 108 days), as compared with a quality-adjusted loss of life expectancy of 48 days from a needlestick from an HBsAg+ patient, and 109 days from a needlestick from a patient who is known to be HBeAg+. By comparison, a cross-country automobile trip is associated with a loss of life expectancy of approximately 1 day. The 45- to 50-day loss of quality-adjusted life expectancy from percutaneous exposures to HIV and HBV is approximately the same magnitude as the gain in life expectancy from 10 years of annual screening for breast cancer with mammography and physical examination.

CONCLUSIONS

The risk associated with percutaneous exposures to symptomatic HIV+ patients is comparable to other risks that health care workers have faced knowingly and have accepted in the recent past. However, the loss of quality-adjusted life expectancy associated with a needlestick exposure is significant. Identification of cost-effective methods that increase the safety of medical personnel but also ensure full access to high-quality care for HIV+ patients should be a high priority.

Homophobia among psychiatric residents, family practice residents and psychiatric faculty

As the number of AIDS cases has continued to increase, psychiatric research has focused on the victims of this disease. Little has been written about the caregivers and the impact that their attitudes have on patients. There have been a few studies measuring attitudes of health care providers to homosexuals and AIDS patients, but to the best of our knowledge, none have looked at the attitudes of psychiatrists or residents in psychiatry. Psychiatric residents, family practice residents and psychiatric faculty in a medium-sized Canadian medical school completed a questionnaire measuring attitudes toward homosexuals. We report on the results of this questionnaire and comment on the impact of the attitudes of health care professionals on the quality of patient care.

Concern about AIDS among hospital physicians, nurses and social workers

In this study, the authors examine the worry and discomfort experienced by direct care health professionals in treating AIDS patients and how their profession, attitudes, knowledge, experience and demographic characteristics influence their emotional reaction to those patients. The research focuses on experienced emotion as distinct from expressed emotion, as an important factor in explaining health behaviors among professionals. To address these issues 536 health care professionals comprising 132 physicians, 378 nurses and 26 social workers employed at a University teaching hospital in Chicago were surveyed. The findings suggest that health care workers' emotional reactions to HIV depend on the type of patient interaction. We found for all three professions, as the invasiveness of contact increased, the level of worry and amount of discomfort also increased. Nurses however, on the whole were the most adversely affected by their patient contacts. We conclude that emotional reactions in the workplace cannot be explained by cognitions, beliefs and attitudes alone. This study suggests that work roles, work assignments, and professional authority contribute to emotional reactions to patients with AIDS.

Behavioral change in longitudinal studies: adoption of condom use by homosexual/bisexual men

We compared reporting serial cross-sectional prevalence of sexual behavior over time, to reporting individual patterns of behavioral change in a cohort of homosexual men at a six-month interval. Aggregate prevalence rates underestimated the magnitude of change to safer practices, and failed to provide information on relapse to less safe practices. We conclude that it is important to report data based on individual fluctuations in behavior for the evaluation of change over time.

AIDS as a paradigm of human behavior in disease : impact and implications of a course

A new required psychiatry course for first-year medical students linked the urgent need for acquired immune deficiency syndrome (AIDS) education with the traditional goal of teaching the biopsychosocial model of illness. The course, "Human Behavior in Disease: AIDS as Paradigm," used HIV/AIDS to demonstrate principles of all life-threatening diseases. Formal evaluations of the course's impact indicated that it significantly reduced students' prejudices and increased positive attitudes regarding AIDS patients. The students' ratings of the course indicated that the AIDS paradigm was understood and valued. Our experience suggests that preclinical psychiatry courses can play an important role in the medical educational response to AIDS, while, at the same time, achieving their traditional curricular goals.

The AIDS-related experiences and practices of primary care physicians in Los Angeles: 1984-89

Telephone interviews of random samples of Los Angeles primary care physicians in 1984, 1986, and 1989 obtained information about their AIDS-related practice experiences, and sexual history taking. Data from mid-1989 reveal almost 74 percent have worked up at least one patient for AIDS or HIV infection in the past six months and 39.5 percent are caring for at least one patient with AIDS or AIDS-related complex. Self-reported use of appropriate sexual history questions has improved substantially over this five-year period.

[The attitude of hospital personnel to AIDS]

Caregivers of 13 hospital services in Switzerland--confronted at various degrees with the aids problem--have been interviewed. The study indicates that hospital caregivers still strongly fear an HIV infection through professional contacts. At the same time they have difficulties to balance correctly risks at work against risks in their private lives. The attitudes of caregivers might negatively influence patient care. They could, however, be modified by a better management of aids related information in hospitals.

AIDS and homosexuality: a longitudinal study of knowledge and attitude change among rural nurses

With no effective medical treatment or vaccine for acquired immunodeficiency syndrome (AIDS) available now or in the near future, nursing can make the most difference by providing emotional support and physical care for people with AIDS and their families. One of the least understood areas in providing such care is the feelings nurses have toward persons with AIDS, especially in rural areas. This study measured changes in knowledge and attitude toward AIDS and homosexuality before, immediately after, and three months after an all-day AIDS workshop for nurses. The program provided current knowledge about transmission of the human immune virus and risk behaviors, and addressed personal feelings regarding fear of caring for persons with AIDS as well as negative feelings associated with homosexuality. Results revealed significant positive changes in knowledge and attitudes three months later. Participants also became significantly less fearful and more willing to care for persons with AIDS. Feelings of fearfulness and willingness to care for people with AIDS were associated not with knowledge differences but with differences in attitudes toward the disease and homosexuality. Therefore, this program's affective component was more closely associated with precursors to behavior change than was cognitive education. As the education needs of rural and community nurses increase, programs specific to them must continue to be developed and studied. Future research must also explore and evaluate actual nursing care of AIDS patients in relation to education program objectives.

Work-related fear of AIDS and social-desirability response bias

The focus of the current research was on development of a short scale to measure work-related fear of AIDS for use in field research and on assessment of the extent to which its ability to predict managers' intentions to discriminate were free of social-desirability response-bias effects. Based upon a sample of 198 managers from southern US manufacturing, service, and government organizations, the study yielded a 5-item scale with particularly strong test-retest reliability of .88 and internal consistency indicated by Cronbach alpha of .92. While initial evidence was promising regarding predictive validity, social desirability was correlated with both fear of AIDS and one of the criterion variables but accounted for very little common variance. Techniques suggested by Ganster, Hennessey, and Luthans (1983) to detect social desirability response bias were employed and did not yield moderator, spurious, or suppression effects. Supplementary analysis showed that respondents in manufacturing exhibit significantly stronger fear of AIDS than either service or government managers. Significant but weak correlations of -.16 and -.20 were found between fear of AIDS and subject's sex and education. Males and the less well educated tend to express greater fear of AIDS. Implications are discussed regarding research and practice in management.

AIDS prevention in primary care clinics: testing the market

To assess attitudes toward educational programs about AIDS, 540 patients and 36 of their medical providers in primary care clinics were systematically sampled to ascertain what age groups should be exposed to a pamphlet entitled "Am I at Risk for AIDS?", as well as what was acceptable content for posters and pamphlets placed in clinic waiting rooms. Although fewer than 10% of patients and providers opposed asking both teenagers and adults to read a pamphlet listing risk groups and practices, 24% of patients and 51% of providers opposed exposing children to the pamphlets. Only 6% of patients and none of the providers opposed all posters about AIDS, but 30% of patients and 44% of providers opposed posters listing risk groups, and opposition was even greater to posters describing "safe sex." Regarding pamphlets acceptable for clinic waiting rooms, resistance among patients and providers was common (greater than 25%) only when sexual practices were specifically mentioned. Although 89% of patients stated they had never been asked about their sexual orientations by a doctor or nurse, 34% of providers stated that they "always" or "often" so inquire. In the primary care clinics surveyed, a wide variety of educational interventions about AIDS could be implemented with little opposition.