HIV/AIDS is a condition that is caused by an attack on the immune system by the human immunodeficiency virus. Tyler-Viola et al., (2014) state that the conditions lead to the deterioration of the immune system, leading to an eventuality regarded as the “acquired immunodeficiency syndrome” (AIDS). Globally the disease is estimated to have caused the deaths of around twenty-five million. The condition does not have any known cure or even a vaccine to protect against the infection with the virus. Most transmissions cases are credited to unprotected intercourse, injection drugs as well as pregnancy. The fact that HIV/AIDS is highly preventable, there continue to be multiple infections annually to the number of persons living with HIV/AIDS also rising.
HIV/AIDS is important to the nursing profession given the manner in which the condition has impacted the practice of nursing. The emergence of the global issue of HIV/AIDS is important to nursing given the expansion in the role of nurses to include the provision of antiretroviral therapy. During the onset of nursing practice, antiretroviral therapy was not part of nursing practice. The manner in which infection control is carried out in nursing has also been impacted by the emergence of HIV/AIDS. The disease is highly infectious and as such nurses in practice are required to be more on the lookout to avoid acquiring the infection. The emergence of HIV/AIDS has also made the awareness of needle pricks to be more pronounced in nursing care.
HIV/AIDS has impacted the view of both professional nursing practice as well as the social outlook of matters of all the related issues. In terms of the description of HIV/AIDS, there is not much discrepancy between what is known in the USA versus what the description adopted by the rest of the world. The reason behind the lack of any significant difference is as a result of the agenda of defining HIV/AIDS being based on causal factors. However, there are various misconceptions in the view of HIV/AIDS in the USA, especially regarding the association of the condition with certain persons in the community (Tyler-Viola et al., 2014). In most cases, HIV/AIDS is associated with gay persons as well as most immigrants and persons of minority communities. The association of the condition to persons of a certain sexual orientation has led to calls for restricting gay persons from donating blood.
The view of HIV/AIDS is relatively different in Botswana, where the condition is largely viewed as a national epidemic (Kip, Ehlers & Van Der Wal, 2009). Despite the acknowledgment of the widespread nature of the condition, there are still several factors that inhibit the view of the condition. Some mythical beliefs hold that the disease is caused by some dark forces and as such taking preventative measures do not have a role in preventing infection. The increased disease burden has led most local healthcare practitioners to make efforts towards understanding how to manage HIV/AIDS as there is a high likelihood that a nurse will interact with a positive patient during practice. Kip et al. (2009), also argues that the attitude towards infection control has also been influenced significantly by the increase in the set up of needle prick response systems.
Study 1: Nursing research Study in the USA
Tyler-Viola, L., Corless, I., Webel, A., Reid, P., Sullivan, K. & Nichols, P. (2014). Predictors of medication adherence among HIV-Positive women in North America. Journal of Obstetric, Gynecologic and Neonatal Nursing, 43 (2), 168- 178.
The study was aimed at exploring the relationship between several factors that determine adherence to HIV medication that is commonly referred to as antiretroviral (ARVs). The focus of the study was on the existing relationship between the context and environmental factors affecting adherence to antiretroviral therapy. The study specifically reviewed these factors among women living with HIV intending to enable guaranteeing care improvement for the HIV-positive women.
The participants of the study included a sample of 383 women, which was drawn from a population of 2,182 persons who are living with HIV. The study participants were recruited in sixteen different clinics that cater to HIV-positive patients across North America. Some of the study participants were also drawn from related HIV-Service organizations that are engaged in HIV-related activities in North America (Tyler-Viola et al., 2014).
The study design was descriptive with each center serving as an individual data entity. After seeking the consent of the participants, the researchers administered questionnaires that contained both open-ended and closed questions. The questionnaires were used to collect both descriptive and multivariate data which was used to examine the adherence to ARVs as reported by the participants.
According to the study, the age of the patients is positively correlated with adherence to the ARV medication with the older patients demonstrating increased adherence as compared to the younger patients. The level of engagement with the healthcare provider also had a positive correlation with the reported adherence to ARV treatment. Patients who experienced reduced stigma had relatively reduced symptoms of depression emanating from their condition that had a positive influence on their adherence to therapy.
Study 2: Nursing Research Study (Non-USA)
Kip, E., Ehlers, V. & Van Der Wal, D. (2009). Patients’ adherence to antiretroviral therapy in Botswana. Journal of Nursing Scholarship, 41 (2), 149–157.
The study purposed to evaluate the factors that had a role in determining the ability of patients to comply with the antiretroviral regimen in four different clinics located in Botswana (Kip et al., 2009).
The participants constituted 400 patients who were drawn from the total population of patients who attended the four clinics that manage mainly HIV-positive patients.
The study design that was employed by the researchers was a quantitative-descriptive design. The researchers collected data through the use of structured interviews that were carried out after seeking the consent of the participants. The data was later analyzed using the Statistical Package for Social Sciences (SPSS) version number 13. The authors also carried out the Chi-square and p-value tests to ascertain the relationship of different variables included in the study.
The study found out that HIV-positive patients in Botswana failed to adhere to the recommended therapy due to factors that could be categorized as patient-centered and service-centered. Under patient-centered barriers, adherence was reduced by the lack of enough knowledge about the importance of the therapy and the disease process. The service-centered barriers that reduced the adherence levels included the attitude of nurses as well as other health workers towards HIV-positive patients. The level of knowledge about HIV /AIDS among nurses was also important in determining the adherence level.
Talam, N., Gatongi, P., Rotich, J. & Kimaiyo, S. (2008). Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients attending HIV/AIDS Clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya. East African Journal of Public Health, 5 (2), 74-78.
The study purposed to evaluate the factors that determine the ability of patients attending the HIV/AIDS clinic at Moi Teaching and Referral Hospital to comply with the antiretroviral drug therapy.
The study participants constituted 384 HIV/AIDS patients attending the clinic and had attained the legal adult age of eighteen years at the time of the study.
The study employed a purposive sampling method to identify the participants. The data was collected from the patients as well as key informants using interviewer-administered questionnaires and self-administered questionnaires respectively (Talam, Gatongi, Rotich & Kimaiyo, 2008). The analysis of the data was carried out using SPPS version 10.0 while carrying out Chi-square tests and significance tests.
The study results indicate that the primary factor that affects adherence is related to patients being away from their homes and as such unable to access their preferred clinics. The engagement of patients in other economic activities, as well as forgetfulness, also contributed to the reduction in the adherence levels.
Nsimba, S., Irunde, H. & Comoro, C. (2010). Barriers to ARV adherence among HIV/AIDS positive persons taking antiretroviral therapy in two Tanzanian regions 8-12 months after program initiation. Journal of AIDS & Clinical Research, 1 (3).
The study aimed at evaluating the adherence levels of antiretroviral therapy among HIV-positive patients in two Tanzanian regions. The study also aimed at evaluating the factors that influence the adherence to the provided antiretroviral therapy in the two regions.
The participants of the study included 207 ARV users drawn from the Dar es Salaam and Arusha regions of Tanzania. The participants also included health staff as well as other key informants.
The data collection was carried out through observations, exit interviews, and focus group discussions. The researchers also carried out pharmacy stock checks in different healthcare facilities in the region.
The study findings indicate that the patient adherence level was affected by both institutional and individual factors. Patients cited factors such as the long wait time, transport costs, and drug side effects as the major barriers to adherence (Nsimba, Irunde & Comoro, 2010). The patients also cited the stigma emanating from untrained nurses, the overload of healthcare staff as well as lack of privacy during consultations as the deterrents towards adherence to therapy.
Patient adherence to the prescribed treatment regimen is critical in ensuring that the war against disease is successful. As such, the adherence of HIV-positive patients to the provided antiretroviral therapy is essential. The adherence of patients to antiretroviral therapy is hampered by various factors that are classified as patient-centered or service-centered. It is important for the patients to be assisted to overcome the barriers to the provision of more information about antiretroviral therapy. Increasing the level of awareness among the healthcare workers will contribute towards reducing the stigmatization of HIV-positive patients. It is important that enough resources are provided so that barriers such as the long wait time at the clinic as well as the delay in the provision of results are eliminated.
Kip, E., Ehlers, V., & Van Der Wal, D. (2009). Patients’ adherence to antiretroviral therapy in Botswana. Journal of Nursing Scholarship, 41(2), 149–157.
Nsimba, S., Irunde, H., & Comoro, C. (2010). Barriers to ARV adherence among HIV/AIDS positive persons taking antiretroviral therapy in two Tanzanian regions 8-12 months after program initiation. Journal of AIDS & Clinical Research, 1(3).
Talam, N., Gatongi, P., Rotich, J., & Kimaiyo, S. (2008). Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients attending HIV/AIDS Clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya. East African Journal of Public Health, 5(2), 74-78.
Tyler-Viola, L., Corless, I., Webel, A., Reid, P., Sullivan, K., & Nichols, P. (2014). Predictors of Medication Adherence Among HIV-Positive Women in North America. Journal of Obstetric, Gynecologic and Neonatal Nursing, 43(2), 168- 178.