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. http://www.buffalo.edu
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Written by: Peter M Crosta