AIDS education in Tanzania: promoting risk reduction among primary school children

OBJECTIVES: The purpose of this study was to test the effects of an education program in Tanzania designed to reduce children's risk of human immunodeficiency virus (HIV) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome (AIDS). METHODS: A randomized controlled community trial including baseline and 12-month follow-up surveys was employed. Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and randomly assigned to intervention (n = 6) or comparison (n = 12) conditions. Of the 1063 sixth-grade students (average age: 13.6 years) who participated at baseline, 814 participated in the follow-up survey. RESULTS: At follow-up, statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication, AIDS knowledge, attitudes toward people with AIDS, and subjective norms and behavioral intentions toward having sexual intercourse. A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year (7% vs 17%). CONCLUSIONS: It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children.     

Correlation between history of contact with people living with HIV/AIDS (PWAs) and tolerant attitudes toward HIV/AIDS and PWAs in rural Thailand

This study examines the hypothesis that people who have more contact with PWAs (people living with AIDS) are more tolerant than those who have no contact with them. Four provinces with different incidence of AIDS in 4 different regions of Thailand were selected. Structured questionnaire interviews were conducted with village people, asking about their history of contact with PWAs, and knowledge and attitudes toward HIV/AIDS and PWAs (n = 434). An 'Attitude Score', which indicates an accepting attitude (or tolerance) toward HIV/AIDS and PWAs, was developed using the results of the questionnaire on attitudes. Six factors: sex, education, age, province, knowledge, and history of contact with PWAs were positively correlated with the Attitude Score. After a multiple regression analysis, contact with PWAs was significantly associated with Attitude Score. This study is one of the first analytical studies conducted in a non-Western country to show that people's tolerant attitudes towards HIV/AIDS and PWAs are positively related to their history of contact with HIV/AIDS and PWAs. This findings should have important implications for future educational programmes and preventative intervention.     

HIV/AIDS related knowledge, attitudes, and preventive behavior of pregnant Korean women

OBJECTIVE: To assess HIV-AIDS-related knowledge, attitudes, and preventive behavior of pregnant Korean women before designing patient and public education programs. DESIGN: Pre-experimental cross-sectional survey. POPULATION, SAMPLE, SETTING, YEARS: Convenience sample of 409 women at six prenatal clinics in Seoul, Korea, in 1993. OUTCOME MEASURES: HIV-AIDS-related knowledge, attitudes, and preventive behavior. METHODS: Self-administered questionnaires. FINDINGS: The women described high levels of knowledge about HIV and AIDS risk factors but less knowledge about transmission of the virus, as well as attitudes of rejection toward unrelated people with HIV/AIDS; 16% provided condoms for their husband's use in extramarital sex, the primary risk behavior. CONCLUSIONS: Korean women are at risk for heterosexual transmission of HIV despite knowledge of risk factors. CLINICAL IMPLICATIONS: Korean education programs for women should focus on modes of heterosexual transmission, care of individuals with HIV or AIDS, self-assessment of HIV-AIDS risk, and self protection.     

A liver-specific isoform of the betaine/GABA transporter in the rat: cDNA sequence and organ distribution

This paper discusses the findings of a quantitative study of nurses' willingness to care for patients with AIDS. It identifies several factors that enable nurses to confront the fear of AIDS nursing and to turn fear into compassion, and negative attitudes into positive ones. These factors include professional values, organizational support, group identity, patients' responses, spirituality, family and friends with AIDS, knowledge about AIDS, and the importance of personal choice. The value of these factors are further supported through personal statements made by nurses on AIDS-dedicated units as they express their feelings, thoughts, and positive experiences and expectations regarding AIDS nursing.     

Willingness to provide care and treatment for patients with HIV/AIDS

This paper is derived from the findings of a larger study which examines nurses' and doctors' attitudes towards mainstreaming of hospital inpatient services for individuals with HIV/AIDS in general hospital wards. The aim of this paper is to discuss the factors which influence nurses' and doctors' willingness to provide care and treatment for patients with HIV/AIDS. Two methods of study are used in this research--a survey questionnaire and semi-structured interviews. The findings of this study provide several themes about the positive attributes associated with caring for and treating patients with HIV/AIDS. These include: that caring for and treating is personally and professionally rewarding; the need to be non-judgemental and accepting of others; that previous work or social experience is related to willingness to work with patients; the influence of family and colleague support in the work environment; and having a duty of care.     

Nurses' attitudes about acquired immunodeficiency syndrome care: what research tells us

With the mounting incidence of human immunodeficiency virus infection not projected to peak until a decade into the next century, the question of nurses' willingness to engage in acquired immunodeficiency syndrome (AIDS) care remains important. Published data, however, do not support the frequently cited view that positive attitudes are exceptional. This analysis suggests reasons for misperceptions and also cautions that a continued focus on attitudes may not be useful unless we validate their influence on nursing action in clinical situations. Researchers must ask not only what differentiates the willing from the unwilling but also what alters the extent of nurses' willingness to engage. Even more important may be what influences how nurses engage, that is, what knowledge and skills they need to provide compassionate, effective care. The salience of these questions is especially apparent when we recognize how consistent the finding of positive AIDS-care attitudes has been through the last decade's plethora of studies. Without overlooking negative attitudes about, and some nurses' reluctance to participate in, AIDS care, research at this time should perhaps start with the premise that nurses want to nurse, and then focus on what they need to learn--cognitively, affectively, and technically--to do so competently and comfortably. In other words, the essential question is: What do nurses need to learn?     

School nursing in the 21st century: prediction and readiness

The complex health and education needs of today's students are prompting schools to develop more responsive school health programs. School nurses' preparation for roles in these emerging programs requires both a vision of future practice and a clear recognition of present skill levels. This study compared the vision of practice in the twenty-first century held by school nurses in a rural, mid-plains state with the vision of a national expert school nurse panel. The findings have implications for role evolution and educational preparation.     

Transformation techniques for the fibula of the mandible

Parents of elementary school children in rural east-central Texas were surveyed about their attitudes toward and knowledge of Comprehensive School Health Education. Data indicated widespread support for health education compared to other subject areas. Parents felt alcohol and other drugs, nutrition, and first aid were the most important topics to be covered in elementary school, while sexuality, cancer, and stress were the least important. Parents were most comfortable discussing alcohol and other drugs, family life, and growth and development with their children and least comfortable discussing exercise, cancer, and sexuality. Implications for school health programs are discussed.     

Evaluation of an interdisciplinary training program in palliative care: addressing the needs of rural and northern communities

Our study was a pilot test of an interdisciplinary training program in palliative care to improve the quality of care to terminally ill cancer and AIDS patients in rural and northern communities in Manitoba. The program involved two weeks of intense palliative care training for nurses, social workers, physicians, and volunteers. Four teams were trained during a six-month period. A repeated measures design was used to assess the effectiveness of the program. Results indicated that health professionals' knowledge about care of the dying, care of individuals with HIV/AIDS, and attitudes toward care of the dying improved upon completion of the training program and remained improved three months following the program. Improvements in use of medications, increased attention to family care, increased discussion of DNR orders, and increased consultation related to symptom management were evident following the training program. The parallel training program for volunteers was also judged to be effective.     

Do physicians discuss HIV and AIDS with patients? A survey of physician practices

HIV and AIDS continue to be major concerns to the health care community and the world around them. Preventive efforts and education have been the focus of the fight against AIDS thus far. By the year 2000, 75% of physicians are expected to conduct risk-reduction counseling for patients regularly. Previous studies show that a smaller percentage "routinely" follow this recommendation. The purpose of our study was to assess with what percentage of patients physicians discuss several HIV/ AIDS-related topics, what percentage of their patients are considered at risk for infection, and how comfortable the physicians are with their knowledge level and discussing the subject matter. We sent surveys to the last five graduating classes from St. Louis University School of Medicine and to 169 physician preceptors in the community. The survey asked about patients considered at risk, physician comfort level with HIV/ AIDS, the percentage of patients they discuss various HIV/AIDS topics with, and his or her preparedness for these discussions. Total responses were 464 (53.7%) representing all areas of medicine. Most of the physicians (72.9%) consider 0-25% of their patients at risk for HIV/AIDS. Eighty-one percent claim they are moderately or very comfortable discussing the material with patients and more than 90% feel they have at least adequate knowledge. Most of the respondents discuss the HIV/ AIDS topics with 0-25% of patients. Recent medical school graduates and primary care physicians are more comfortable with HIV/AIDS and discuss the surveyed topics with a higher percentage of patients.     

Attitudes of medical students to HIV and AIDS

OBJECTIVE--To assess the knowledge and attitudes of medical students to HIV/AIDS and whether attitudes correlate with knowledge and clinical experience. To determine if students felt adequately prepared to deal with medical and psychological aspects of HIV/AIDS. SUBJECTS AND METHODS--The subjects consisted of 190 London and 99 Cambridge medical students at the end of their genitourinary medicine attachment, plus 230 Cambridge medical students at the end of their second pre-clinical year. Between March 1991 and February 1992 all were asked to complete an anonymous questionnaire, covering factual knowledge and attitudes towards HIV/AIDS. MAIN RESULTS--Cambridge genitourinary medicine students, despite spending less time studying HIV infection than their London counterparts gave more correct answers to the factual questions, although this difference did not reach significance (52.4% vs. 47.5%, p = 0.14). One third of students believed that many health care workers were at high risk of acquiring HIV at work and one fifth thought doctors should have the right to refuse to treat people with HIV. Fourteen percent of Cambridge genitourinary medicine students indicated that most British people with HIV have only themselves to blame, by comparison with 4% of London students (p = 0.003). Thirty-nine per cent of Cambridge genitourinary medicine students expressed reluctance to care for someone with AIDS by comparison with 10% of London students (p = 0.0001). CONCLUSIONS--It is important that medical educators convey accurate information about HIV, including the actual risks posed by occupational exposure and try to ensure that medical students spend sufficient time seeing patients with HIV/AIDS during their training.     

Prognostic value of dipyridamole thallium-201 screening to minimize perioperative cardiac complications in diabetics undergoing kidney or kidney-pancreas transplantation

A survey of knowledge, attitude and practice (KAP) regarding human immunodeficiency virus infection was performed on 899 students from 3 government-administered high schools located in the Bangkok Metropolitan area. Initially, all students completed a written questionnaire (pre-test) regarding HIV/AIDS. Following this, they attended a slide lecture presentation given by a specialist physician. The same test questionnaire was then completed by the same students six weeks (post-test) later for comparison of their previous KAP. The subjects composed of male to female ratio equal to that of the median age 15-16 years old. Sixty-seven per cent of the subjects were living with their parents, 16.3 per cent with relatives and 15 per cent with friends. Ninety nine per cent of the subjects had received information on HIV/AIDS before enrollment to this study. The source of knowledge ranged from television (89.1%), teachers (81.6%), pamphlets (80.2%), newspapers (75%), radio (55%), health care workers (53.4%), friends (38.6%) and only 32.5 per cent from their parents. The subjects' knowledge about HIV/AIDS and risk factors in the post-test questionnaire was significantly increased (P < 0.001) from the pre-test status. However, their attitudes to an HIV infected person were not significantly changed in the post-test questionnaire: only the "attending school" question showed significantly (P < 0.05) increased numbers of agreement. Similarly, the attitudes and practices to prevent HIV infection were not significantly (P > 0.05) different between pre-test and post-test questionnaires. The result of this study is to recommend regular school-based programs of education to increase awareness of preventive strategies for HIV/AIDS and sexually transmitted diseases.     

Long-term peritoneal dialysis before transplantation and intra-abdominal infection after simultaneous pancreas-kidney transplantations

OBJECTIVE: To examine the attitudes and knowledge of health care professionals regarding human immunodeficiency virus (HIV) infection in countries with a varying prevalence of HIV infection to assist in the development of acquired immunodeficiency syndrome (AIDS) educational programs. DESIGN: Anonymous questionnaire with four sections: demographics, attitudes, knowledge, and an open-ended question investigating feelings about the potential impact that HIV infection may have on respondents' practices. PARTICIPANTS: Final-year medical students, house staff, and attending physicians at teaching hospitals in India, Thailand, Canada, and the United States. RESULTS: From January to October 1992, 819 health care professionals completed the questionnaire: 340 from India, 196 from Canada, 155 from the United States, and 128 from Thailand. The percentage of respondents who had previous contact with patients with HIV/AIDS varied from 30% to 98%; it was lowest in India, followed by Thailand and then Canada, and highest in the United States. Percentages of respondents uncomfortable performing a physical examination on a patient with HIV/AIDS were 24%, 25%, 9%, and 4%, respectively. Mean HIV/AIDS knowledge scores were 83%, 84%, 92%, and 93%, respectively. Most respondents correctly identified modes of transmission of HIV infection. Only 67% of Indian health care professionals understood the concept of a false-negative screening serologic test, compared with 98% of Canadian health care professionals. In Canada and the United States, only 78% and 76%, respectively, understood the concept of a false-positive screening serologic test. Awareness of an asymptomatic stage of HIV infection ranged from 32% in India to 74% in Canada. Despite their concerns of becoming infected, health care professionals in countries with a lower prevalence of HIV infection reported a strong ethical duty to care for these patients. CONCLUSIONS: Level of comfort in caring for HIV-infected patients and HIV/AIDS knowledge scores varied directly with the amount of previous contact with these patients. Disturbing numbers of health care professionals from all four countries did not understand the potential problems of the enzyme-linked immunosorbent assay serologic test and a significant percentage were unaware of the asymptomatic stage of HIV infection. There is a universal need for increased education of health care professionals about HIV infection and AIDS.     

Antiretroviral therapy for pediatric and adolescent HIV

As the number of children infected in the HIV epidemic increases, the school nurse can play an important role in ensuring that these children receive comprehensive health care. Compliance with following an immunization program for HIV-infected children is a potential problem for various reasons. Many of these children come from homes where the mother also has HIV/AIDS. She is likely to be involved in keeping her family together, caring for her own health needs, and meeting financial and social needs of her family. Access to health care may be limited. The majority of vaccines administered within the first few months of life are parenteral and consist of inactivated antigens. Children or infants who are immunosuppressed may be unable to respond to the immunogen, thus rendering them susceptible to many infectious diseases. Heterosexual transmission and pregnancy compound the problems of HIV/AIDS (Flynn, 1994). Compliance following an immunization schedule becomes a greater challenge when working with the adolescent population. Parents may not understand that the risk of receiving vaccine, MMR for example, is less than the risk of severe complications associated with the diseases themselves. Coordination of care between the child, parent, and school district personnel is imperative to minimize the risk of further health-related problems of the HIV-infected child. Encouraging regular immunizations can decrease the child's susceptibility to infection, and administering medications properly can enhance the benefits of the drug therapy. An excellent resource for answering questions of school nurses related to HIV/AIDS is the National Pediatric and Family HIV Resource Center; contact Elaine Gross, R.N., M.S. at 1-800-362-0071.     

Australian and South African undergraduates' HIV-related knowledge, attitudes, and behaviors

To understand safe sex behavior in two countries which have been differentially affected by the HIV/AIDS epidemic, the present study compared the AIDS-related knowledge, attitudes, and behaviors of 920 heterosexual undergraduate students in Australia and 228 heterosexual undergraduate students in South Africa. South African students were found to have significantly less knowledge about HIV/AIDS, and significantly less favorable attitudes toward safe sex behavior than their Australian counterparts. They were also more likely to report that they have avoided various groups of people for fear of contracting AIDS. Experience from Australia over the period 1986-1995 suggests that significant improvements in the AIDS-related knowledge, attitudes, and behaviors of South African undergraduates are achievable.     

A study of hospital nurses' attitudes toward continuing education in Kaohsiung City, Taiwan

The purpose of this study was to investigate hospital nurses' attitudes toward continuing education. Continuing education was defined as non-credit organized educational programs designed for nurses by hospitals, nursing institutions, or other related organizations to maintain or improve professional competence. It included "in-service education", "on-the-job training", and other synonymous educational activities. Six hundred and seventy-four randomly selected hospital nurses in Kaohsiung City participated in this study. The data was collected by delivering a 34-statement questionnaire through the directors of nursing. Cronbach's Alpha Coefficient was applied to determine the reliability with a value of 0.79. Factor analysis and a group of experts' suggestions were applied to determine the validity. Frequency distribution, Analysis of Variance, Scheffe' test, and Multiple Regression Analysis were conducted to analyze the research questions. The level of significance was set at 0.05 or less. The results indicated that the majority of nurses (92.65%) hold positive attitudes toward continuing education (M = 86.32). Nurses' attitudes toward continuing education were related to selected personal and professional characteristics, and hospital policies regarding continuing education. To maintain nurses' positive attitudes and to develop positive attitudes for those who hold negative attitudes, some strategies for continuing education should be considered by nursing administrators.     

Nurse anesthetists'' perspectives on improving the anesthesia care of culturally diverse patients

This report of a 1995 survey presents data regarding nurses' attitudes and beliefs about assisted suicide in AIDS. The authors surveyed 428 nurses working at facilities serving AIDS patients in the San Francisco Bay Area, using an anonymous, self-administered questionnaire. They received 215 responses (50%). There was a high level of agreement with statements that place assisted suicide in the context of humane action to relieve suffering. An AIDS diagnosis did not change respondents' attitudes toward assisted suicide, although many nurses said that the relentless suffering and specific nature of the AIDS epidemic did influence their thinking.     

Domestic violence: examining nurses' and doctors' management, attitudes and knowledge in an accident and emergency setting

Despite the increasing awareness of the important role that Accident and Emergency (A&E) personnel have in the diagnosis and management of domestic violence victims, there is limited knowledge about the nurses' or doctors' knowledge of or attitudes to domestic violence in Australian health care settings. In addition nursing and medical staff still receive very little training in working with domestic violence victims. This study was conducted to examine the existing knowledge, attitudes to and management strategies for domestic violence victims among 111 nurses and doctors in two rural and two country hospitals. The findings indicate that A&E staff recognise the importance of their role in the identification and management of domestic violence victims. Despite this they do not have all the skills necessary to deal effectively with the problem or to be able to access local resources for assistance. Education programs should focus on direct questioning techniques, and recognition of risk factors and protocols to provide guidelines for police involvement.     

Energy expenditure in workers who install plastic and metal pipes for water supplies and sewage

Since 1985, many drug abuse treatment centers and health care providers have implemented special education programs for individuals who inject drugs. They focus primarily on increasing awareness of the threat of the human immunodeficiency virus (HIV) being spread through drug injection equipment and by sexual activities. As part of the Drug Abuse Treatment for AIDS-Risk Reduction (DATAR) project, the AIDS/HIV Risk Reduction Module was designed to meet these special intervention needs. This study examined program impact on 110 methadone treatment clients. Results indicated that for those in treatment less than 4 months, the AIDS intervention program enhanced specialized knowledge about AIDS, aided in the reduction of AIDS-risky behaviors, and enhanced attitudes toward achieving and maintaining abstinence from drug use. Thus, AIDS education and intervention programs appear to be effective and should be emphasized in the early phase of drug abuse treatment.     

Enhanced production of IL4 but not of IFN gamma and IL 10 by peripheral blood mononuclear cells from atopic children in response to CD2 plus CD28 stimulation

Because individuals with mental retardation have recently been identified as a group at-risk for developing HIV infection, HIV/AIDS training programs for service providers working with this population are critical. In this study an HIV/AIDS education program for family-based foster care providers was described and evaluated. The results indicate that although these service providers had some prior knowledge about HIV and AIDS, there were significant improvements in knowledge following the training. Implications of these findings for individuals with mental retardation were discussed.