Agung Waluyo Fakultas Ilmu Keperawatan Universitas Indonesia

Transcription

1 Agung Waluyo Fakultas Ilmu Keperawatan Universitas Indonesia

2 In only six years, total HIV and AIDS cases increased six-fold. From 4,159 in 2003, to 26,632 by, 2009 The total number of PLWH in Indonesia in 2010 is estimated to be 371,800, and by 2014 the estimated number will increase to 541,700 people (MoH, 2008).

3 HIV stigma key factors fueling the spread of HIV. Nurses are potential leaders to reduce stigma. A study reported that Indonesian nurses and other health professionals stigmatized PLWH. Religion, religiosity linked to stigma. Indonesia is an excellent setting for this study.

4 To determine the extent to which Indonesian nurses individual stigma attitudes to HIV are affected by: background AIDS care factors HIV knowledge religious factors

5 Background Age Gender Monthly income Working experience Educational Background AIDS Care Factors HIV and AIDS Care Training Perceived Competence to Care for PLWH Perceived Workplace Stigma Individual Stigma Attitudes to HIV HIV Knowledge Religious Factors Religious identification Religiosity Hospital Religious Affiliation

6 What is the level of stigma of Indonesian nurses? What factors are associated with nurses stigma attitudes?

7 Design: a cross sectional correlation design Sample: combination of purposive and convenience sampling. Setting: 4 hospitals in Jakarta: General hospital (non-religious government) Islamic, Catholic, Protestant hospitals.

8 Characteristic Total (n=396) Islamic Hospital (n=100) Protestant Hospital (n=100) Catholic Hospital (n=96) General Hospital (n=100) F test Religion: Muslim (%) Protestant Catholic ***

9 Approval from UIC & UI Distribute flyers in 4 hospitals Recruited until 100 nurses/hospital Responded to researcher

10 HIV knowledge. HIV-KQ-18 questionnaire (Carey & Schroder, 2002). Religiosity. Beliefs & values measure developed by King, Speck & Thomas (2001). Perceived Workplace HIV Stigma. HASIN developed by Uys, Holzemer, et al. (2009) Individual Stigma Attitudes to HIV. Adopted from the NAAS (Preston et al., 1995; Preston et al., 1997).

11 All tools translated into Bahasa Indonesia All translated tools back-translated into English Back-translated version was compared with the original version

12 Prior Studies Variables (Factors) # of items Internal Consistency ( ) Current Study Variables (Factors) # of items Internal Consistency ( ) Religiosity Religiosity Nurse s Attitudes toward AIDS Homosexuality IDUs HIV Care Social-professional 41 Individual Stigma to HIV Attitudes to AIDS HIV and AIDS Care Perceived Workplace Stigma Perceived Workplace Stigma

13 Characteristics Mean/Percentage Had some training on HIV/AIDS 34.8% Age Mean: Working Experience Mean: Gender Female 89.0% Religion Islam Protestant Catholic Education Nursing Assistant Diploma Nursing BSN 53.5% 29.5% 17.0% 8.8% 73.2% 18.0%

14 Variables Training on HIV care Never (%) Ever, once or more Perceived competence: Yes (%) No or doubt Workplace Stigma Mean SD Range Percentage/Score 65.2% 34.8% 63.2% 36.8%

15 The nurses had an average HIV knowledge score of or equal to 69 out of 100

16 Variables Religiosity: Mean SD Range Religious identification Islam Protestant Catholic Percentage/Score % 29.5% 17.0%

17 The mean of Individual Stigma Attitude score was (maximum possible score of 120) standard deviation of with a range of

18 Variable Hospitals Religions Nurses Age Work experience Education Background Perceived Competence Individual Stigma to HIV 38.87*** 53.49*** 15.11*** 10.56*** 24.54*** 20.14***

19 Variable B SE B t p Background Educational AIDS Care Factors Perceived Competence to care PLWH Perceived Workplace Stigma Religious Factors Religion (Muslim) Hospital (The Catholic) Hospital (The Islamic) Religiosity This model accounted for 35.5% of individual stigma variance, (F (15, 320) = , p<0.001)

20 The level of Indonesian nurses Stigma to PLWH in this study appear to be higher than nurses in previous study in US. The current study mean score 3.27 out of 5, and previous study 2.98 out of 5. Lower HIV knowledge was significantly associated with higher individual stigma attitudes.

21 Religiosity was associated with individual stigma attitudes Religiosity differed significantly by religion & hospital religious affiliation The degree of religiosity affects stigma independently from type of religion or hospital affiliation. The nurses have higher levels of religiosity. Indonesia has a strong mosque community & religious leaders.

22 Religion. Catholic nurses and the Catholic hospital nurses had significantly lower stigma attitudes. Religion has two sides: cultural values that promote stigma, & the supporting compassionate service.

23 Hospital Religious Affiliation. The Catholic hospital had lower individual stigma attitudes toward PLWH. Hospital policy influences staff s stigma toward PLWH. With a sample of only four hospitals, it is difficult to determine whether it is the religions affiliation itself, that contributed to nurses stigma attitudes.

24 The Catholic hospital nurses had the highest mean score of HIV Knowledge had the highest percentage (29%) of BSN nurses had the 64% of nurses who have had training had the 87.5% of nurses perceived competent There was a supportive policy to HIV and AIDS care and treatment within the hospital

25 Strengths. This study has a large sample of nurses. All the measures in this study are translated & had high internal reliability This is one of few studies that examined religion, religiosity, & hospital religious affiliation and their influence on nurses stigma to HIV.

26 Limitations This is a cross sectional study. Participants were recruited only in four hospitals in Jakarta and has a high proportion of non-muslims & NOT REPRESENTATIVE of all nurses. The four hospitals reflect variation in a number of related factors in addition to religious affiliation. The study did not systematically obtain information on each hospital regarding organizational factors.

27 Although the religious factors had significant positive association to stigma attitudes, other changeable factors are also important. Other important factors include educational background, perceived competence for HIV care & a less stigmatizing environment

28 Future Research The measures in this study were culturally appropriate by the target population of Indonesian nurses, the measures can be used to all Indonesian nurses. This study will contribute to the development on concept of individual stigma attitudes to PLWH.

29 Nursing Education Training is needed before nurse caring for PLWH. The nursing education curriculum should include training regarding HIV and AIDS care Nursing students, should have clinical experience with PLWH and be given time to explore their own response and experience during clinical placement

30 Nursing Education The HIV and AIDS care training should include discussion appropriate of cultural and religious issues. Active learning strategies such as role playing have been found to be effective in changing attitudes and behavior.

31 Hospital and Ministry of Health Policy Hospitals and the Ministry of Health should have policies supporting HIV and AIDS care. The policy should clearly describe the type of prevention, care, and support toward PLWH. The policy needs to address how to solve financial problems of the PLWH related to accessing care.

32 Hospital and Ministry of Health Policy The policy should address the system of human resources management, including Screening nurses for stigmatizing attitudes Scheduling required continuing education Monitoring the quality of HIV and AIDS care This policy should be applied in every hospital in every part in Indonesia.

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