Nurses’ experiences of stigma in HIV and AIDS care in Jamaica

Objective: To explore how multilayered dimensions of stigma influence nurses provision of nursing care to patients and families living with HIV/AIDS. Methods: A cross-sectional survey was done among 201 frontline nurses, midwives and nurse managers working in the public health care system in Westmoreland, St. James, Trelawny, Kingston & St. Andrew, St. Catherine and St. Thomas. Stigma was measured using the validated HIV/AIDS Stigma Instrument for Nurses. Qualitative data were collected in a purposive sample of 20 nurses and midwives using a semi structured interview guide. Interviews were audio taped and transcribed verbatim coded and thematically analyzed. Results: Quantitative data revealed low levels of stigma against patients with HIV/AIDS. Nurses frequently reported occurrences of subtle stigmatization of patients such as making patients with HIV last to be cared for 48 (23.9%), shouting at or scolding patients with HIV/AIDS 46 (22.4%) and generally giving poor quality care 42 (22.8%). A small proportion, 20 (9.7%) of respondents also reported that nurses who care for patients with HIV/AIDS were stigmatized, particularly nurses who work in hospitals rather than health centres Qualitative interviews with nurses and midwives revealed that stigma and discrimination was a major factor that influenced nurses’ ability to provide care for patients living with HIV. Fear of stigma and discrimination also influenced patients’ decision to disclose their HIV status, which in turn influenced nurses’ ability to provide care. Conclusion: Stigma associated with HIV/AIDS hinders nurses from providing the best possible nursing care to patients and demonstrates a need for continuing education. Key Words: Stigma, Nurses; Nursing Care, HIV/AIDS