An Adult Who Have Been Diagnosed With HIV Perceive
HOW DOES AN ADULT WHO HAVE BEEN DIAGNOSED WITH HIV PERCEIVE THEIR CARE FROM HEALTH AND SOCIAL CARE PROFESSIONALS?
Abstract
HIV infections have increased over the years in the United States. Several patients are trying to find ways to live with the condition. Adults diagnosed with HIV face difficulties related to acceptance in the healthcare sector an issue that raised a lot of concerns (Adimora et al., 2021). The research focuses to evaluate the perception of an adult diagnosed with HIV regarding the care from health and social care professionals. Significantly, the advent of antiretroviral therapy shifted the status of HIV from fatal to a chronic medical condition. There have been significant improvements regarding the management of HIV patients due to increase life expectancy and the quality of life. Nevertheless, adults diagnosed with HIV remains to feel the burden of the condition because it leads to social and psychological problems (Dalton et al., 2019).
How does an adult who have been diagnosed with HIV perceive their care from health and social care professionals?
1.0 Introduction
According to Dalton et al. (2019), adults diagnosed with HIV face difficulties related to acceptance in the healthcare sector an issue that raised a lot of concerns. Studies show that healthcare professionals health professionals are complacent and adamant when it comes to assisting adults diagnosed with HIV attributing to discriminatory practices. According to statistics, 26.2% of cases of stigma are recorded in hospitals, and an additional 28.8% in dentist's offices (Adimora et al., 2021). In their effort to contact their general practitioner, cases of stigmatization recorded were 19. %. The research focuses to evaluate the perception of an adult diagnosed with HIV regarding the care from health and social care professionals. The survey study involved 262 participants to assess the negative and positive interactions with healthcare providers.
The study specifically focused on individuals living in the United States. Importantly, the adults living with HIV talked about their negative experiences with healthcare professionals (Calabrese et al., 2019). Some of the notable experiences involved awkward interactions, rude treatment, irrelevant questions together with blame, pity unnecessary referrals, delayed treatments among other issues. Positive interactions were also reported despite the negative treatments from the professionals in the health sector. Dalton et al. (2019) highlights that the positive interaction encompassed equal treatment, social support provision, and confidentiality regarding their health records. There is a gap regarding how adults living with HIV perceive their care from health and social care professionals. The incidences of negative interactions should be improved to reduce the increasing case of stigma among individuals living with HIV (Adimora et al., 2021).
1.1 Statement of the Problem
HIV infections have increased over the years in the United States. Several patients are trying to find ways to live with the condition. However, attaining these goals is becoming a problem due to increased cases of stigmatization affecting HIV patients. The issues forced the adults diagnosed with HIV to develop different perceptions towards the care they receive from health and social care professionals.
1.2 Research Objectives
This research focuses on the perception of adults diagnosed with HIV on the care they receive from health and social care professionals. The research will play a fundamental role in understanding the positive and negative interactions between HIV patients and health and social care professionals. Significantly, the study factors in both qualitative and quantitative methodology.
1.3 Research Questions
- What are the major contributing factors to stigmatization experienced by adults diagnosed with HIV?
- What are the contributing factors to negative and positive interactions between HIV patients and healthcare professionals?
- What approaches can be put in place to change the perception of adults diagnosed with HIV towards the health and social care professionals?
2.0 Literature Review
Adimora et al. (2021) points out that the advent of antiretroviral therapy shifted the status of HIV from fatal to a chronic medical condition. There have been significant improvements regarding the management of HIV patients due to increase life expectancy and the quality of life (Adimora et al., 2021). Nevertheless, adults diagnosed with HIV remain to feel the burden of the condition because it leads to social and psychological problems. Specifically, individuals are faced with issues associated with stigma, an issue that devaluates the identity of people suffering from HIV. Stigma originates from social interactions which predominantly exercise issues aligned with social inequalities (Calabrese et al., 2019).in most cases, the thought of HIV infection is unbearable because it causes anxiety citing the association of the condition death and moral judgments originating from the society.
Calabrese et al. (2019) argues that adults living with HIV are always linked to behaviors violating the social norms including homosexuality, commercial sex work not forgetting intravenous drug use. Consequently, these individuals experience episodes of stigmatization which leads to negative perceptions regarding care from health and social care professionals (Adimora et al., 2021). Studies show that healthcare professionals health professionals are complacent and adamant when it comes to assisting adults diagnosed with HIV attributing to discriminatory practices.
According to statistics, 26.2% of cases of stigma are recorded in hospitals, and an additional 28.8% in dentist's offices. In their effort to contact their general practitioner, cases of stigmatization recorded were 19. % (Adimora et al., 2021). Hence, most adults diagnosed with HIV have a negative perception about the care they receive from health and social care professionals due to the stigmatization they go through while getting services. According to Calabrese et al. (2019), stigma related to HIV contributes to incidences of testing and treatment delays, poor healthcare services together with reluctance towards acquiring healthcare services. Additionally, stigma has a damaging effect on the psychology of adults diagnosed with HIV since they come across healthcare providers who discriminate against their condition (Calabrese et al., 2019).
Eaton et al. (2017) emphasizes that HIV-related stigma contributes to decreased patient satisfaction, psychological distress not forgetting the incidences of low self-esteem and unwillingness to stay healthy. Despite the negativity associated with these interactions, there have been positive outcomes when adults diagnosed with HIV interact with health and social care professionals (Calabrese et al., 2019). Positive interactions increase treatment adherence subsequently creasing the quality of life of these patients. The thoughts were shared by Mayer et al. (2021) who added that adults diagnosed with HIV should feel accepted when getting treatment in healthcare institutions. The approach increases the reliance of these patients on health and social care professionals. Consequently, the adults diagnosed with HIV will develop the need to acquire healthcare services (Mayer et al., 2021).
Dalton et al. (2019) further explains that HIV testing is usually offered by general practitioners and STI clinics in the United States. Some GPs charge the tests to take care of the risk policy. However, most tests conducted at the STI clinics are not charged. An adult diagnosed with HIV gets referrals to acquire specialized HIV care from an HIV nurse and internist. According to Eaton et al. (2017), the patients are required to make visitations to their healthcare providers regularly as they maintain contact with the general practitioners and other healthcare providers to address issues aligned with the HIV infection (Mayer et al., 2021). Specifically, the internists focus on the medical aspects of the condition. On the other hand, nurses are mandated to provide psychological support to increase treatment adherence. The nurses also act as the link between the internists and the other healthcare professionals including GPs and social workers (Calabrese et al., 2019).
3.0 Methodology
A cross-sectional survey was conducted to help with the determination of the incidence of negative interactions between the adults diagnosed with HIV and the healthcare providers. The findings explored the perspectives of the HIV patients through a qualitative interview study. The interview incorporated a general inductive strategy coupled with thematic analysis.
3.1 Survey
The study made use of 262 participants out of the 342 recruited adults who were diagnosed with HIV. Informed consent was provided to allow the participants to answer the interview questions. Specifically, the questions targeted the incidence of negative interactions between the HIV patients and the nurses, doctors, dentists together with other healthcare providers like pharmacists, physiotherapists, support staff, and home care. The negative interactions included in the interview originated from the literature regarding the stigma associated with HIV infection in a healthcare setting. Additional information on the negative interactions was acquired from focus groups from people living with HIV and HIV practitioners.
Notably, the participants were asked if the healthcare professionals provide support to adults diagnosed with HIV. Additional questions touched on the reason behind avoiding seeking healthcare services, an issue which has been attributed to the negative interactions between patients and healthcare providers. Furthermore, the research incorporated demographic data which encompassed age, gender, educational achievement plus ethnicity, sexual orientation, and family composition. Information touching on characteristics of HIV was also factored in including the transmission mode, treatment status together with health status, and the visible symptoms. The participants in the study composed of 120 women and 142 men aged between 23 to 74 years. 60% of these participants had bachelor's degrees. An extra 25.9% had a high school diploma coupled with some knowledge on vocational training. Moreover, 13.1% of these participants had basic knowledge from high school or none. Significantly, the education achievements of three participants were missing. Most of the HIV infections were predominantly acquired through sexual intercourse.
3.2 Interviews
The interviews took an interesting approach because they were semi-structured and involved a face-to-face interaction. The participants made decisions regarding the location of the interview, an approach that necessitated the need to visit the individuals in their homes. Using interviews to conduct research provided a platform to document information on every adult diagnosed with HIV, unlike group discussions. Significantly, conversations related to HIV are usually sensitive, hence using focus groups to collect data can increase the case of stigmatization among HIV patients. Interviews also create opportunities to address certain behaviors which go against the social norms including commercial sex work. Moreover, it is difficult to get in touch with HIV patients because no one wants to open up about their HIV status, therefore conducting interviews at a specific time and a location is a feasible approach compared to group discussions. All the interviews took place through informed consent and structured protocols to avoid inconveniences coupled with violation of privacy.
The research purposely recruited the adults diagnosed with HIV through HIV healthcare providers working in United States hospitals, and other agencies including the CDC, National Institute of Health, and the Office of Global Affairs. Notably, the research employed inclusion criteria to involve the adults diagnosed with HIV. The participants were also part of the United States healthcare system. Moreover, the study deliberately included an equal number of adults diagnosed with HIV in urban centers plus those staying in the outskirts of the urban centers. The predominant objective of the interview was to establish the perception of adults diagnosed with HIV towards care from health and social care professionals. The time frame of the interviews was approximately 1 hour.
The gadgets used to record the interviews were digital voice recorder together with transcribed verbatim. The initiative to process data was facilitated using Microsoft Office Excel. The transcripts were carefully assessed to correspond with recordings. The approach specifically identified themes and categories to assign text fragments in excel. The development of categories and subcategories occurred through coding. Subsequently, the approach eases ways to document the categories and any changes arising from in the documentation since decisions took place through annotations and memos. Moreover, the research took a step to compare the preliminary findings with empirical literature associated with HIV and healthcare. The ethical approval was issued by the Institutional Review Board (IRB). Additionally, the participants were only given gifts to commend them for their participation since there was no monetary compensation.
4.0 Results
4.1 Quantitative findings: Interaction prevalence rates and care avoidance
Approximately 59.6% of the participants encountered at least one issue related to negative interactions. Specifically, 33% of the adult diagnosed with HIV reported at least one kind of negative interaction. Another 20% came across two cases of negative interactions during their association with the health and social care professional. Only a few participants talked about three negative interactions. The remaining individuals experienced several problems while interacting with the healthcare professionals. Nevertheless, 76.3% of the participants discussed the sympathy and support they received from health and social care professionals which are positive interactions. According to the results generated from the research, 11.8% of adults diagnosed with HIV were reluctant to access healthcare services due to the recorded cases of negative interactions.
4.2 Qualitative findings: Negative experiences with health care
The interview involving the adults diagnosed with HIV indicated several cases of negative interactions with health experts. The contributing factor to these issues is pinned on the healthcare organization in the United States. For instance, a general practitioner has to refer the patients to specialized physicians. Additionally, very limited time is allocated to adults diagnosed with HIV not forgetting the need for physicians to reduce the costs incurred in the healthcare sector. Adding to this, there are issues associated with stigma because several protective measures have been put in place to handle HIV patients across the country. However, it is very difficult to link the negative interaction experienced by HIV patients to stigmatization.
Awkward interactions and inappropriate behavior
Awkward social interactions formed part of the negative interactions between adults diagnosed with HIV with healthcare providers. It is very uncomfortable for healthcare to act surprised because a patient is suffering from HIV. This reaction contributes to the low self-esteem experienced by patients. Moreover, some health and social care professionals ask adults diagnosed with HIV irrelevant questions. For example, it is awkward to ask an HIV patient about her status. Some participants complained that they have to explain their HIV status every time they go the healthcare facilities yet the institutions have their health records. Patients with other conditions like diabetes, hypertension among other chronic conditions do not get questions related to how they acquired the disease. According to the participants, they get rude treatment from the health experts, an issue attributed to their HIV condition. A portion of the individuals participating in the study talked about adults diagnosed with HIV and the feeling that the healthcare experts are blaming them for their condition.
Excessive precautions and differential treatment
Participants argued about the excessive measures and protocols put in place to handle HIV patients. For instance, some healthcare professionals will put on two pairs of gloves before handling the adult diagnosed with HIV. These behaviors are observable among dentists and orthodontists. Additionally, health experts boo HIV patients early in the morning or late in the evening to give room for though sterilization of instruments.
Compromised Care
The participants also aired the concerns regarding the reluctance by health and social care professionals suffering from HIV. This behavior the objectives and goals of healthcare institutions that focus on the provision of quality services to patients. One participant narrated how a physiotherapist decided to seek the opinion of the director in a health sector to avoid contracting the disease. Some HIV patients were deliberately referred to the internists for issues that were not associated with HIV. Due to incompetence, the internists resort to referring the HIV patients back to the physician and this becomes a repetitive cycle. Compromised care exercised by health experts also involves a late diagnosis of an adult diagnosed with HIV for any condition affecting their health. Furthermore, some participants stressed the internists who concentrated on the use of antiretroviral medications even if the HIV patient was in urgent need of treatment. Delayed treatment can negatively impact HIV patients since the individuals have a fragile immune system. In some cases, participants always remind the health and social care professionals about the contraindications of medication used to treat HIV to help the experts differentiate them from other medications used to treat other conditions. This is an act of complacency and adamancy which compromises the goals and objectives of healthcare institutions. Moreover, some of the healthcare providers fail to give sufficient support to help the patients deal with their HIV condition. They overlook the consequences of contracting HIV. Subsequently, the adult diagnosed with HIV are forced to navigate ways to deal with their complicated condition.
Confidentiality Concerns
Protection of confidentiality is very essential because it makes patients feel safe. Unfortunately, confidentiality breaches have raised concerns among the adults diagnosed with HIV. These unprofessional acts are attributed to carelessness from the health and social care professionals (Dalton et al., 2019). Some health experts tend use the information related to a patient for selfish gains within the institutions. One notable incidence of breached confidentiality involves a nurse stick notes n charts suggesting an individual is HIV positive. It is very painful for patients to make queues and come across a file regarding their health status. Some participants believe that they have to consent to the release of the electronic patient files to GPs, dentists among other staff members within an institution.
On the contrary, some of the healthcare professionals provide health records of adults diagnosed with HIV to receptionists. Subsequently, every person visiting a particular will know the HIV status of patients. The information should be limited to specific healthcare professionals attending to the individuals suffering from HIV. Also, the participants discussed confidentiality concerns happening at the pharmacy section. For example, pharmacists tend to package medication in the presence of other customers. No patient wants another person to know what they are suffering from apart from the health experts.
4.3 Qualitative findings: Positive interactions in health care
Positive interactions exist between patients diagnosed with HIV and health and social care professionals. Specifically, the positive interactions outweighed the negative interactions. For instance, praised the health experts for providing equal treatment, extra attention, and social support not forgetting their ability to value HIV patients and reduced cases of confidentiality breaches.
Equal Treatment
A large portion of the participants commended the health experts or providing equal care in the facilities. For instance, the lab specialists handling the blood samples specifically analyzed the tests without asking unnecessary questions. The physicians, GPs together with the dentists and pharmacists also performed their duties without discriminating the adults diagnosed with HIV. The health specialists are not surprised with the status of the patients.
Extra Attention
The participants are happy with the extra attention they receive due to their HIV condition. A large portion of health and social care professionals got involved and concern due to the unique condition of HIV patients especially if the patients are hospitalized. For instance, an internist will make a follow-up to ensure a patient is safe through the provision of advice and opinion regarding the way forward for an HIV patient. Specialists including dentists, hygienists, and surgeons among other health experts paid extra attention to adults diagnosed with HIV.
Valuing the Patient
Other participants documented the respect they get from healthcare professionals because they value HIV patients. Health and social care professionals work effortlessly to maintain the well-being of HIV patients. Importantly, they dedicated adequate time to listen to the complaints raised by adults diagnosed with HIV which is a sign of respect and value to the patients. The patients are usually allowed to visit their healthcare providers whenever a need arises. Competent and committee health professionals do not attribute all the healthcare problems to HIV.
Social Support
According to a portion of the participants, the healthcare professionals provide social support to the adults diagnosed with HIV patients. Therefore, HIV patients feel free to discuss any issue affecting them to face their struggles in life with confidence. Some of the nurses specifically offer support to the patients and the families together with the friends of people diagnosed with HIV. Social support plays a fundamental role to help HIV patients cope with negative reactions after diagnosis. The approach reduces the incidences of stigmatization because adults diagnosed with HIV get to meet health experts who feel positive about their condition (Calabrese et al., 2019).
Assurances Regarding Confidentiality
One last positive interaction between individuals diagnosed with HIV and health and social care professionals relates to the protection of their confidentiality. The health specialist ensures that the information related to the HIV status of a patient remains discrete. The information is only accessed by a few authorized individuals approved by the HIV patient. Some healthcare institutions have strict policies regarding confidentiality breaches and this includes penalties and termination of a contract for any health professional violating the policies (Calabrese et al., 2019).
5.0 Discussion
The methods used to conduct the research explicitly show that adults diagnosed with HIV in the United States perceive health and social care professionals differently. The argument is explained in the occurrence of positive and negative interactions. However, the positive interactions do not rule out the existing gap regarding healthcare provisions due to incidences of negative interactions (Dalton et al., 2019). A wide range of negative experiences was highlighted by the adults diagnosed with HIV. Significantly, several healthcare providers argue that HIV cases are normal in this century subsequently making issues like stigmatization a problem of the past (Eaton et al., 2017). Some HIV patients feel that the health and social care professionals ignore them intentionally. They specifically complained about confidentiality breach, an issue which has been disputed the complaint citing that unofficial disclosure of patient information to colleagues to facilitate the provision of healthcare services. Eaton et al. (2017) highlights that the approach helps the colleagues to take necessary precautions while handling HIV patients.
One way to explain the gap existing related to healthcare provision to adults diagnosed with HIV involves the stigma consciousness affecting the patients (Johnson et al., 2019). Most patients HIV patients believe in stereotypic individuals in the healthcare sector and they have termed this behavior as a discriminatory act against adults diagnosed with HIV. However, Parish et al. (2018) argues that the perception developed by the patients is countered by several health experts arguing that negative attitudes exhibited by health workers towards adults diagnosed with HIV are due to stress and emotional exhaustion at work. People should not interpret it as a lack of willingness to take care of HIV patients (Calabrese et al., 2019). Therefore, prejudice is the last thing coming into the minds of health and social care professionals when they see an adult diagnosed with HIV (Parish et al., 2018).
On the contrary, health professionals are determined to provide quality services to HIV patients as they protect themselves from the disease (Parish et al., 2018). The stigmatizing behaviors of experts addressed by adults diagnosed with HIV are due to a lack of knowledge and experience from the patients and healthcare professionals. Significantly, issues of negative interactions frequently occurred in low prevalence areas, an issue attributed to limited interaction between the HIV patients and healthcare providers. Fauk et al. (2019) explained that inadequate training, limited expertise in HIV condition combined with lack of experience in treating adults diagnosed with HIV were the contributing factors to the negative interactions observed in the research.
Johnson et al. (2019) emphasizes that the incidence of positive interactions outweighed the negative interactions. Imperatively, the provision of quality healthcare services is fundamental because it increases adherence and engagement in care. Therefore, a prudent approach should be put in place to improve the interactions between adults diagnosed with HIV and health and social care professionals (Morgan et al., 2019). For instance, multi-level and multi-faceted interventions will go a long way to come up with theory and evidence-based approaches to help the targeted end-users. Specifically, parallel interventions should be developed to target adults diagnosed with HIV and health and social care professionals (Fauk et al., 2019). There should be initiatives in place to empower HIV patients, consequently helping them to establish resilience against negative interactions. The patients must know their rights coupled with obligations in the healthcare centers, an approach that will help them identify the health professionals violating those rights. In the long run, they will have the power to take appropriate action to punish the healthcare providers engaging in the perceived discriminatory acts (Gesesew et al., 2017).
Moreover, HIV patients experiencing negative interactions will also become resilient through the incorporation of the coping skills which act as buffers against the negativity associated with those interactions. The interview conducted on the participants shows that most healthcare is professional and this is observable through the social support and empathy they exercise towards adults diagnosed with HIV. For clarity, empathy and social support play a crucial role to increase positive interactions, subsequently reducing the incidence of stigmatization of HIV patients (Fauk et al., 2019). Therefore, interventions providing opportunities to exercise empathy, reduce misinformation, and transforming stereotypes will help to improve the quality of services received by adults diagnosed with HIV in the healthcare sector.
According to Fauk et al. (2019), supportive structural conditions exist in healthcare institutions across the United States. For instance, updated national legislation touching on treatment protocols is available to help HIV patients access the healthcare providers. Adding to this, nondiscriminatory policies are acting to reduce the cases of mistreatments which results in the stigmatization of HIV patients. Conclusively, the implementation of effective protocols and interventions to help HIV patients access quality healthcare services will change their perception towards the care they receive from health and social care professionals (Gesesew et al., 2017).
6.0 Conclusion
The paper highlights that adults diagnosed with HIV face difficulties related to acceptance in the healthcare sector an issue that raised a lot of concerns. Studies show that healthcare professionals health professionals are complacent and adamant when it comes to assisting adults diagnosed with HIV attributing to discriminatory practices. According to statistics, 26.2% of cases of stigma are recorded in hospitals, and an additional 28.8% in dentist's offices. In their effort to contact their general practitioner, cases of stigmatization recorded were 19. %. There is an issue of HIV-related stigma which contributes to decreased patient satisfaction, psychological distress not forgetting the incidences of low self-esteem and unwillingness to stay healthy. Despite the negativity associated with these interactions, there have been positive outcomes when adults diagnosed with HIV interact with health and social care professionals. Positive interactions increase treatment adherence subsequently creasing the quality of life of these patients. The paper concludes the topic by addressing ways to increase the positive interactions to change the perception of adults diagnosed with HIV towards health and social care professionals.
7.0 References
Adimora, A. A., Ramirez, C., Poteat, T., Archin, N. M., Averitt, D., Auerbach, J. D., ... & Gandhi, M. (2021). HIV and women in the USA: what we know and where to go from here. The Lancet.
Calabrese, S. K., Tekeste, M., Mayer, K. H., Magnus, M., Krakower, D. S., Kershaw, T. S., ... & Dovidio, J. F. (2019). Considering stigma in the provision of HIV pre-exposure prophylaxis: Reflections from current prescribers. AIDS patient care and STDs, 33(2), 79-88.
Dalton, L., Rapa, E., Ziebland, S., Rochat, T., Kelly, B., Hanington, L., ... & Richter, L. (2019). Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent. The Lancet, 393(10176), 1164-1176.
Eaton, A. D., Craig, S. L., & Wallace, R. (2017). The intersecting cognitive and aging needs of HIV-positive older adults: implications for social work practice. Social work in health care, 56(8), 733-747.
Fauk, N. K., Merry, M. S., Putra, S., Sigilipoe, M. A., Crutzen, R., & Mwanri, L. (2019). Perceptions among transgender women of factors associated with the access to HIV/AIDS-related health services in Yogyakarta, Indonesia. PloS one, 14(8), e0221013.
Gesesew, H. A., Tesfay Gebremedhin, A., Demissie, T. D., Kerie, M. W., Sudhakar, M., & Mwanri, L. (2017). Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis. PloS one, 12(3), e0173928.
Johnson Shen, M., Freeman, R., Karpiak, S., Brennan-Ing, M., Seidel, L., & Siegler, E. L. (2019). The intersectionality of stigmas among key populations of older adults affected by HIV: a thematic analysis. Clinical gerontologist, 42(2), 137-149.
Mayer, K. H., Nelson, L., Hightow-Weidman, L., Mimiaga, M. J., Mena, L., Reisner, S., ... & Sullivan, P. S. (2021). The persistent and evolving HIV epidemic in American men who have sex with men. The Lancet.
Morgan, E. E., Woods, S. P., Iudicello, J. E., Grant, I., Villalobos, J., & HIV Neurobehavioral Research Program (HNRP) Group. (2019). Poor self-efficacy for healthcare provider interactions among individuals with HIV-associated neurocognitive disorders. Journal of clinical psychology in medical settings, 26(1), 13-24.
Parish, C. L., Siegel, K., Liguori, T., Abel, S. N., Pollack, H. A., Pereyra, M. R., & Metsch, L. R. (2018). HIV testing in the dental setting: perspectives and practices of experienced dental professionals. AIDS care, 30(3), 347-352.
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