In this, the second decade of the worldwide AIDS crisis, HIV continues to take advantage of disenfranchised and vulnerable groups. Throughout the 80s in the U.S., HIV affected primarily white, gay men; there were, of course, the "innocent victims," those who did not acquire the disease through socially unacceptable practices. The disease is now ravaging other groups, with disproportionate increases in incidence among heterosexual women of color. It has become increasingly evident that significant co-factors in in the HIV epidemic include racism, poverty, violence, and child abuse.
Nearly everyday I witness evidence of another related epidemic - that of prejudice toward groups who have or are at risk for AIDS; the women who are participants in a study being conducted by one of my doctoral students (Salveson, in progress), with their stories of social isolation and fear of disclosure that at times becomes overwhelming as they live out their Uves with AIDS; my activist friend who publicly fights for AIDS prevention programs and privately reels from the most recent homophobic attack; the well-educated man sitting next to me at a scholarship awards dinner, suggesting quarantine for people infected with the virus. The political rhetoric of the day seems to reflect open season on vulnerable groups, disparaging "welfare moms," pregnant teens, drug users, immigrants and gays with a venom unbefitting public discourse in a democratic society.
So this issue of JNE is both timely and provocative. Patricia Gray and her colleagues remind us that homophobia and heterosexism reside deeply within all of us, surfacing in our interactions with colleagues and students, Leasure and associates provide startling evidence of stigmatizing attitudes toward persons with AIDS, at least among a sample of students at a midwestern university. The study revealed that nursing students' attitudes are related to mode of transmission, with persons who contract AIDS through either homosexual or heterosexual transmission being considered less deserving of care than those who contracted the disease through maternal transmission or blood transfusion. The findings of this study suggest that periodic assessment of student attitudes toward persons with AIDS would help faculty craft relevant educational experiences. Wiley and associates have developed a tool for this purpose, providing preliminary data on its reliability scad validity.
Teaching approaches aimed at modifying students' attitudes toward persons with AIDS are suggested by Cerny and associates and Patsdaughter. Inquiry-based learning, as described by faculty at the University of Hawaii, provides students with the opportunity to openly explore their prejudices and stereotypes about persons with AIDS, examining the effect of these attitudes on their decision-making. Patsdaughter models compassion and concern through involvement of both faculty and students in a community AIDS walk.
Public policy guided by moral conservatism mitigates against effective AIDS education and prevention programs (Des Jarlais, Padian, & Winkelstein, 1994). Nokes provides a wonderful example of how nursing students can be involved in significant prevention programs, delivering AIDS education to a campus community, where no doubt is a population of individuals at high risk.
Discrimination against people infected with HIV, or at risk for it, indirectly but powerfully affects their quality of life, their ability to participate in self-care and the ability to change high-risk behavior. Prejudice limits the possibility of our developing sensitive and effective AIDS prevention programs targeted toward high-risk groups. As nurse educators, we have the obligation to work with our students in eliminating prejudice. In the midst of the most significant health crisis of our times, we have the moral obligation to act.
- Des Jarlais, D.C., Padian, N.S., & Winkelstein, W. (1994). Targeted HTV-prevention programs. The New England Journal of Medicine, 33(21), 1451-1453.
- Salveson, C. (In progress). TAe lived experience of women infected with HJV. Unpublished doctoral dissertation, Oregon Health Sciences University, School of Nursing, Portland, Oregon.