A recent article in the journal AIDS Patient Care and
STDs reports on the surprising reactions of some health-care
personnel when they must treat or care for a person with the human
immunodeficiency virus (HIV) - which has been known for 25 years.
Examples include doctors who would not visit a patient's hospital
room, neurologists who avoid looking patients in the eye, and
ambulance personnel who madly threw bloodied gloves into the street
after learning the injured patient carried the virus.
These instances of stigmatic events are described in the study
conducted by Lance S Rintamaki of the University at Buffalo and
colleagues. The study participants report several of these events,
which include a wide variety of health-care personnel. "Clinicians
should have the training and common sense to avoid a lot of these
behaviors, but perhaps we shouldn't be surprised when hearing about
nonclinical staff caught up in these events. They're likely relying on
the same stereotypes and misinformation about HIV that are commonplace
among the general public, which may lead them to act in fearful and
stigmatizing ways toward HIV-positive patients," says Rintamaki.
It is known that HIV patients spend a lot of time with health-care
providers in order to treat and manage the disease. If patients are
stigmatized, it can be discouraging. In studies, patients have noted
that the most significant social and psychological challenge of having
HIV is dealing with stigma.
The existing literature regarding health-care providers and HIV stigma
focuses on doctors or nurses and reports on their self-reported
attitudes, rather than the experiences of the patients who are affected
by these doctors and nurses, notes Rintamaki. However, the few studies
that have reported on the frequency of stigmatic evens do not describe
the specific behavior of the events. This is the gap that Rintamaki and
colleagues wanted to fill.
Rintamaki and colleagues began the study by recruiting a convenience
sample (one readily available) of 50 people who were in the infectious
disease units of three Veterans Administration hospitals in the Midwest
United States. In two focus groups, eight participants elaborated on
their experiences with stigmatizing behavior in health-care settings.
The authors then combined these data with one-on-one recorded interview
with the other 42 volunteers.
The interviews were carefully transcribed and coded according to the
type of stigmatizing behavior that the participants experienced most
often while around health-care personnel. The categories include:
Lack of eye contact
Assuming physical distance
Using disdainful voice tone or inflection
Asking confrontational questions
Showing irritation, anger, nervousness, fear or panic
Taking excessive precautions
Scaring, mocking, blaming or ignoring patients
Providing substandard care or denying care
Being generally abusive.
It is important to note that while many participants reported only
positive experiences with health-care personnel, others gave accounts
of stigma with several providers in several health-care settings.
Rintamaki and colleagues recount one story of a neurologist looked the
patient in the eye so few times that the patient could not describe the
doctor's face. Another anecdote reports a nurse who told the patient
with disdain, "You have AIDS," in a very "callous and cold" way. "There
was no feeling. It's almost like a stone-faced warden or something. No
concern," reported the patient.
Other stigmatizing experiences included providers who showed judgmental
and panicky behavior when learning of a patient's status - doctors who
"hermetically seal" themselves before meeting with patients, and
patients being told they were going to die.
Some of the study participants said that the health-care providers
blamed them for their condition. A phlebotomist (someone who draws
blood), who was having trouble finding a vein form which to draw blood,
admonished one patient: "If you hadn't done this to yourself,
we wouldn't have to be going through this!"
"This study reveals that patients are sensitive to such behaviors,
indicating the need for all health-care personnel to be mindful of
their actions toward these patients," Rintamaki reports.
"Given patients' sensitivity to any indication of bias or
discrimination, it's likely that even well-intentioned health-care
personnel sometimes engage in behaviors that are interpreted negatively
by their patients. The findings from this study give health-care
personnel additional insights on what to avoid, or if certain protocols
are standard procedure, what to explain further. These approaches might
help to prevent misunderstandings and hard feelings."
Additional researchers on the study were Allison Scott and Kama A.
Kosenko, Ph.D., from the University of Illinois at Urbana-Campaign in
Urbana, Ill., and Robin E. Jensen, Ph.D., from Purdue University in
West Lafayette, Ind.
The study was supported by a Veterans Administration Health Services
Research and Development training grant
The University at Buffalo is a premier research-intensive public
university, a flagship institution in the State University of New York
system and its largest and most comprehensive campus. UB's more than
28,000 students pursue their academic interests through more than 300
undergraduate, graduate and professional degree programs. Founded in
1846, the University at Buffalo is a member of the Association of
American Universities. buffalo.edu
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: Peter M Crosta