Western health practitioners' view about African traditional health practitioners' treatment and care of people living with HIV/AIDS

African traditional health practitioners are an important source of health care for many South Africans. Thus, they are a health resource in this society. However, the integration of traditional health practitioners into the mainstream of health care is a complex process. Various factors contribute to this complexity, including the skepticism and reservation with which some western health practitioners view traditional health practitioners. This paper highlights the perceived strengths and weaknesses of the traditional healing system for people living with HIV/AIDS, as perceived by western health practitioners. The use of traditional practitioners as a choice of health care is attributed to both the strengths and weaknesses of this system of health care. The strength of the traditional healing system is in its sharing of the worldview and belief system of its users, it being an alternative to an inefficient western health care system (official system), privacy and absence of time limitations per consultation, treating patients psychologically, and scientifically unexplained physiological relief of the symptoms of specific illnesses. The perceived weaknesses of the traditional healing system include harmful treatment regimens, especially for people living with HIV/AIDS; prolonging the seeking of appropriate health care when traditional remedies fail to produce the desired effect; destroying interpersonal relationships of people living with HIV/AIDS through witchcraft accusations; psychological torment caused by the belief that HIV/AIDS can be cured by traditional remedies/intervention; and increasing the workload of western practitioners who are requested by patients to conduct multiple HIV tests after undergoing various traditional treatment regimens to cure HIV/AIDS. It is recommended that traditional practitioners be encouraged to adapt harmful traditional healing practices to the benefit of their patients in a non-judgemental and non-critical manner. In addition, joint workshops should be conducted with traditional and western practitioners to demystify traditional healing practices.     

Nurses' health education program in India increases HIV knowledge and reduces fear.

Few health care facilities are adequately prepared to manage and care for HIV/AIDS patients in India. Nurses play a critical role in patient care but are often ill-equipped to deal with their own fears of occupational risk and handle the clinical aspects of HIV/AIDS care, leading to stigma and discrimination toward HIV-positive patients. The authors examine the impact of a 4-day HIV/AIDS health education program on knowledge and attitudes of nurses in a government hospital. This education program was developed using a training of trainers model and qualitative research. A total of 21 master trainers underwent 6 days of training and began training of 552 hospital nurses (in 2004-2005). Using a pretest-posttest design, the authors assessed changes in knowledge and attitudes of 371 trained nurses. Significant improvements were seen in nurses' HIV/AIDS knowledge in all areas including care, treatment, and issues of confidentiality and consent. Fear of interaction with people living with HIV/AIDS was reduced significantly. The short course was successful in increasing nurses' knowledge in all aspects. There is great potential to expand this stigma-reduction intervention to other public and private hospitals.     

云南省红河州某哈尼族聚居地区人群艾滋病病毒感染状况及危险因素认知调查分析

目的了解红河州哈尼族聚居地区人群艾滋病病毒(HIV)感染状况、艾滋病相关知识知晓情况及面临的危险因素,为在该人群中开展艾滋病防治工作提供科学依据。方法对15～49岁哈尼族人群进行问卷调查,收集社会人口学、艾滋病相关知识、性行为等信息;采集7 ml静脉血检测HIV、梅毒螺旋体和Ⅱ型单纯疱疹病毒感染。结果 1001名哈尼族村民中有小学及小学以下文化程度者占61.0%;仅有32.8%的村民听说过艾滋病,3种艾滋病传播途径的正确回答率34.2%,日常生活是否传播艾滋病的正确回答率为9.8%,有关艾滋病传播途径的问题正确回答率18.2%,艾滋病相关知识全部正确回答率8.8%。41.7%的村民有外出务工史,71.4%的村民外出务工期间有过配偶外性伴。HIV阳性率0.6%,梅毒阳性率2.9%,Ⅱ型单纯疱疹阳性率43.7%。结论哈尼族村民受教育程度低下,艾滋病防治知识整体知晓率低,获得艾滋病相关知识的途径有限、普遍存在多性伴习俗,外出务工者是哈尼族聚居地区传播艾滋病的主要桥梁人群。制定针对哈尼族人群预防艾滋病传播健康教育和防治干预措施十分必要。     

HIV & AIDS in older adults

Many Americans mistakenly believe that older adults are not at risk for HIV/AIDS. Older people do not perceive themselves to be at risk for HIV infection, either. In reality, approximately 10% of AIDS cases are among people older than 50. Many health care providers lack an awareness of the risk of HIV/AIDS in the elderly population, and as a result, many older people with these conditions are misdiagnosed with other ailments. Major manifestations of HIV/AIDS in elderly adults include Pneumocystis carinii pneumonia, herpes zoster, tuberculosis, cytomegalovirus, oral thrush, Mycobacterium avium complex, and HIV dementia. Elderly HIV-positive women have special health concerns, such as cervical cancer. Nurses and nurse practitioners can heighten their colleagues' awareness of the existence of HIV/AIDS in the elderly population and educate their older patients on HIV/AIDS. Furthermore, information about sexuality and sexual practices of older adults should be incorporated into all health science curricula. Additional research is needed to determine the extent of the problem and how health care providers can best serve their older patients' needs.     

Primary care and specialty care in the age of HAART

The advent of complex highly active antiretroviral therapy (HAART) brings to light the issue of whether people with HIV infection or AIDS should be managed by a primary care physician or by an HIV specialist. There is no HIV specialist per se, however, experience can increase the skills needed to treat this disease. Experience is defined as having treated between 5 and 20 patients living with HIV. Primary care physicians have historically developed skills in treating chronic multisystem diseases, but HIV has gained a new complexity with the battery of antiretroviral medications available. Primary care physicians must now learn about viral dynamics and resistance, viral load measurements, and the specifics of each available drug. In addition, educating patients to comply with their regimens requires counseling skills, knowledge of adverse effects management, and managing lifestyle issues. Consulting with experienced practitioners on various aspects of HIV infection and AIDS is useful and the network of medical consultants should always be strengthened. All patients deserve to be treated by a physician with current skills in providing antiretroviral therapy, as well as by a committed primary care physician.     

Acquired immunodeficiency syndrome: knowledge and attitudes of nurses in Northern Ireland

The number of people suffering from conditions associated with HIV infection is growing steadily. These people require care from nurses who should be well trained to undertake all the various aspects of nursing care. Surveys have indicated that health professionals associate AIDS with minority groups such as homosexuals, drug-abusers and prostitutes. Incidents of sub-optimal nursing care of AIDS patients, or suspected AIDS patients belonging to these minority groups, have been well documented. Surveys have revealed much ignorance and confusion among the general public as well as among health professionals with regard to this controversial syndrome. This study aimed to measure nurses' knowledge and attitudes towards homosexuals, drug-abusers and prostitutes, who through their lifestyle are at increased risk for HIV infection. Questionnaires were distributed to a random sample of 800 nurses in Northern Ireland. The sample was stratified by several demographic variables. A response rate of almost 60% was achieved. Nurses appeared to have a moderate knowledge of issues related to HIV infection, but there were large gaps in their knowledge of the terminology used in HIV infection. Nurses were not extremely worried about AIDS itself. However, homosexuals, prostitutes and drug-abusers were seen to be at least partly responsible for their own illness. Implications for nursing care and for nurse education are discussed.     

The burden of secrecy among South African adolescents orphaned By HIV and AIDS

HIV thrives in an atmosphere of silence and secrecy. The stigma, real or feared, of HIV/AIDS is often a barrier to support and care that adolescent orphans need. The purpose of this article is to describe the burden of silence borne by adolescents orphaned by HIV and AIDS. A phenomenological study using photography and photo-elicitation was done among orphaned adolescents. Fifteen adolescents orphaned by HIV and AIDS, living in an urban area of South Africa, participated in the study. Participants photographed objects, such as graveyards, hearses, and a room where a parent committed suicide. These photographed objects were grouped as symbols of death. Nature and people also were photographed. Photo-elicitation revealed the psychosocial impact that results from the secrecy about parental cause of death. Implications for mental health practitioners are also discussed.     

Specialist or generic community nursing care for HIV/AIDS patients?

Improved management of HIV-related illness means that patients spend over 80% of their time in non-institutional settings Most community-based health care in the United Kingdom is provided by primary health care teams general practitioners and community nurses, with support from social workers However, in many areas specialist HIV services have assumed responsibility for the care of HIV/AIDS patients, and primary health care teams have only played a marginal role Our study examined patterns of community nursing for HIV/AIDS patients in one regional health authority, North-East Thames (NETRHA) Interviews with 77 people in seven health districts included community nurse managers, clinical nurse specialists (CNS) HIV/AIDS and palliative care nurses The appropriateness of different nursing models was assessed, taking into account the changing epidemiological and demographic profile of the disease, the influence of dedicated HIV funding, and the effect of recent British National Health Service reforms Three models of care have developed in NETRHA specialist HIV teams, individual CNS HIV/AIDS acting as a resource to generic staff, and care given by generic community nurses Our work suggests that both generic community nurses and patients benefit from specialist input, and that this should be provided using CNSs HIV/AIDS in an advisory and facilitative capacity     

The Burden of Secrecy Among South African Adolescents Orphaned By HIV And AIDS

HIV thrives in an atmosphere of silence and secrecy. The stigma, real or feared, of HIV/AIDS is often a barrier to support and care that adolescent orphans need. The purpose of this article is to describe the burden of silence borne by adolescents orphaned by HIV and AIDS. A phenomenological study using photography and photo-elicitation was done among orphaned adolescents. Fifteen adolescents orphaned by HIV and AIDS, living in an urban area of South Africa, participated in the study. Participants photographed objects, such as graveyards, hearses, and a room where a parent committed suicide. These photographed objects were grouped as symbols of death. Nature and people also were photographed. Photo-elicitation revealed the psychosocial impact that results from the secrecy about parental cause of death. Implications for mental health practitioners are also discussed.     

Rural nursing students' knowledge, attitudes, and beliefs about HIV/AIDS: a research brief.

The purpose of this study was to explore rural student nurses' knowledge, attitudes, and beliefs about caring for people with HIV/AIDS. The results from this study were consistent with other past studies where judgmental attitudes toward patients with HIV/AIDS were demonstrated. Data indicate that nursing students' attitudes, beliefs, and knowledge about HIV/AIDS have not changed over the past decade. Based on these findings, many implications for nurse educators exist. Nurse educators need to examine approaches to teaching about HIV/AIDS that can increase knowledge and influence the actual treatment of individuals who have this disease. In addition, the focus for rural nursing programs should be on increasing the understanding of the impact of HIV/AIDS on rural communities and to help project future needs for HIV/AIDS-related services.     

Opinions and self-reported health status of Italians seeking homeopathic treatment

The use of homeopathy is increasing worldwide. This multi-centre cross-sectional study aims to describe the opinions and self-reported health status of a sample of Italian people seeking homeopathic care. A self-administered questionnaire including socio-demographic characteristics, knowledge and opinions about homeopathy, personal experience with homeopathy, and, self-reported health status (SF-12), was administered to a sample of people who had sought homeopathy. Of a possible 1229 individuals invited to participate, 1223 did so. The majority of the participants were female, young (mean age 42 years), well educated (mean 13 years of education). The reason for seeking care was for either physical or emotional conditions. Most participants had fair to good knowledge of homeopathy, and the self-experienced effect (subjective judgment on efficacy) was good regardless of the type of health condition reported. The Physical Component Summary (PCS-12) scores were similar to the general Italian population, but the Mental Component Summary (MCS-12) scores were lower in all relevant strata examined. This study provides information on the characteristics of people seeking homeopathic care, in particular the results of the SF-12 self-reported health status evaluation.     

Degree of comfort in providing care to PWAs: effect of a workshop for baccalaureate nursing students.

A low-incidence area of HIV/AIDS was the site for this study, which examined baccalaureate nursing students' degree of comfort in providing basic nursing care to people with AIDS (PWAs), and determined the effect of a National Institutes of Health (NIH)-sponsored one-day workshop on HIV/AIDS on this degree of comfort. The pretest-posttest study revealed no statistically significant decrease after the workshop in the amount of discomfort associated with providing basic nursing care to PWAs. However, there were changes in the ranking of nursing procedures following the workshop. Included is a discussion of the workshop's effect on students' comfort level and implications for nurse educators. Ideas for related studies in the area of HIV health care are explored.     

Working complementary therapies into mainstream health care

Complementary and alternative medicine (CAM) is speculative and practitioners and policy makers question its validity in the care of people within the NHS. However, increasing numbers of people are using private CAM therapists to address their health needs. This has consequences in terms of cost to the patient, of using CAM instead of traditional health care, and for policy makers and educators raises questions of competency, regulation and research to validate its efficacy. This article provides a personal account of a nurse educator's discovery of homeopathy as a complementary therapy, its impact upon health status, training undertaken and action taken as a result. It outlines the potential use of CAM as a holistic approach that embraces the interprofessional framework and suggests CAM practitioner inclusion within mainstream healthcare provision. The article emphasizes the need for further quantitative and qualitative research of CAM treatment.     

基于社区的HIV/AIDS患者心理支持模式的研究

目的探讨基于社区HIV/AIDS患者心理支持模式。方法建立以社区为基础,由心理学专家、社区志愿者、社区医生、社区护士、患者家属等组成的心理支持团队,通过心理咨询、健康教育、反歧视宣传、同伴交流等活动,为HIV/AIDS患者提供心理关爱和情感支持。结果基于社区的心理支持模式,能有效地帮助HIV/AIDS患者走出心理困境、降低焦虑抑郁程度、提高生活满意度。采用患者单一条目自我评分法,心理支持前后焦虑抑郁和生活满意度的差异有统计学意义(P0.01)。结论建立以社区为基础的心理支持模式有着传统心理支持不可比拟的优势,对充分发挥社区在艾滋病防治方面的功能及动员社会力量控制艾滋病的传播有重要的现实意义。     

HIV Primary Care Curriculum Improves HIV Knowledge,Confidence and Attitudes

To meet the goals of the National HIV/AIDS Strategy and the need for a human immunodeficiency virus (HIV)-competent primary care workforce, education and training of nurse practitioners are critical. The University of California, San Francisco School of Nursing developed and implemented an HIV primary care curriculum and evaluated this curriculum for a graduating cohort of 55 students. Results show gains in students’ HIV knowledge and confidence in providing basic HIV care and improvements in attitudes toward people living with HIV. We have been able to show that HIV content can be successfully integrated into a nurse practitioner generalist curriculum.     

The clinical management of patients with HIV infection and AIDS.

The clinician is faced with a number of problems when treating patients infected with the human immunodeficiency (HIV) virus. Firstly, there is a lack of accurate data on the numbers of people infected by the HIV virus and uncertainty as to the natural history of the infection. This limits the ability to plan health care strategies for the future. Secondly, it is difficult to encompass detailed knowledge of the variety of illnesses which occur in patients with HIV infection and AIDS and the even broader range of therapies and outcomes reported in the literature. Thirdly, the clinician has to keep pace with the rapidly changing nature of the models for HIV pathogenesis and possible therapeutic interventions. However, despite these gaping holes in our knowledge, the main message of this clinical review is that a general awareness of the wide spectrum of conditions associated with HIV infection, coupled with a well organised, multidisciplinary and pragmatic approach, will provide the patients with the best chance of being correctly diagnosed and treated. Furthermore, it must be remembered that, while seeking scientific knowledge and experimenting for a cure, AIDS remains a universally fatal condition. It is essential that palliative care is available alongside and within facilities which are providing potentially curative clinical drug trials. It is equally vital that the patients be given autonomy in deciding which of these aspects of care they choose at any time. Such an approach, and the experience of caring for patients with HIV infection who pass from apparent health to fatal disease, will continue to test the skills and reserves of physicians well into the next century.     

临床护生艾滋病知识、态度与护理意愿的研究

目的了解护理实习学生艾滋病知识、态度、护理意愿度其相关性。方法采用问卷方法对68名护理实习生进行现况调查。结果护生的艾滋病知识均分为13．7分，对职业感染、不可能传播HIV的途径等知识回答正确率低。态度均分为0．89分，86．8％护生的态度分为正分，表示同情和支持艾滋病病人。但对因静脉吸毒、性乱、同性恋染上艾滋病者持歧视态度。护理意愿均分为77．7分，有25％的护生表示不愿意为艾滋病病人提供护理。相关分析表明艾滋病知识、态度、护理意愿之间呈显著性相关关系。结论护生艾滋病知识掌握不够全面。对艾滋病病人护理意愿低。本文为此提出相应对策．     

THE CLINICAL MANAGEMENT OF PATIENTS WITH HIV INFECTION AND AIDS

SUMMARY The clinician is faced with a number of problems when treating patients infected with the human immunodeficiency (HIV) virus. Firstly, there is a lack of accurate data on the numbers of people infected by the HIV virus and uncertainty as to the natural history of the infection. This limits the ability to plan health care strategies for the future. Secondly, it is difficult to encompass detailed knowledge of the variety of illnesses which occur in patients with HIV infection and AIDS and the even broader range of therapies and outcomes reported in the literature. Thirdly, the clinician has to keep pace with the rapidly changing nature of the models for HIV pathogenesis and possible therapeutic interventions. However, despite these gaping holes in our knowledge, the main message of this clinical review is that a general awareness of the wide spectrum of conditions associated with HIV infection, coupled with a well organised, multidisciplinary and pragmatic approach, will provide the patients with the best chance of being correctly diagnosed and treated. Furthermore, it must be remembered that, while seeking scientific knowledge and experimenting for a cure, AIDS remains a universally fatal condition. It is essential that palliative care is available alongside and within facilities which are providing potentially curative clinical drug trials. It is equally vital that the patients be given autonomy in deciding which of these aspects of care they choose at any time. Such an approach, and the experience of caring for patients with HIV infection who pass from apparent health to fatal disease, will continue to test the skills and reserves of physicians well into the next century.