Cameroon & USA Research On HIV Related Stigma

HIV Related Stigma Survey Among Nursing Students In Cameroon Takes Off
James Achanyi-Fontem,
Cameroon Link
Dr. Neal Rosenburg of Goldfarb School of Nursing, Barnes Jewish College and Pr. Donna Taliaferro of the Washington University at St. Louis, USA started working in Douala, Cameroon on March 1, 2009 on a planned HIV-related stigma survey among nursing students in Cameroon.
During the academic working visit, Dr. Neal Rosenburg and Pr. Donna Taliaferro are visiting nursing colleges in Douala, Nkongsamba, Buea and Limbe to collect data on stigma among nursing students. The data will be analyzed and compared with a similar operation at the Washington University at St. Louis. An investigation on how to ameliorate on the care for HIV orphans will be conducted with the objective of encouraging nursing students in the USA to work out strategies for supporting orphans in Cameroon.
The visiting medical professionals give a conference at the Complexe Universitaire EFPSA, INSAM, ISSAS at Ndokoti, Douala on Friday, March 6 at 11h00. Audiences are accorded leaders of associations in Cameroon working for the improvement of the well being of HIV orphans the audiences aim at the exchange of experiences for research of areas of capacity building care delivery and support tothe vulnerable childred of Cameroon. The activities are conducted with the technical support of the University of Buea and Cameroon Link Human Assistance Programme in Douala.
Objectives
1. Identifies different aspects of experiences among culturally diverse populations of HIV positive individuals.
2. Understands circumstances affecting culturally appropriate care for HIV positive clients.
3. Analyzes the impact of perceptions among nursing students on global healthcare issues surrounding HIV nursing.
4. Describes the impact of associated stigma relating to nurses caring for HIV positive populations.
5. Explicates the intent to deliver quality patient care to HIV positive clients.
Stigma as a concept is associated with various societal and personal attributes and attitudes. The deficit of a clearly accepted definition contributes to the problematic nature of measuring the impact and outcomes of stigma in the research setting. A repetitive element in the definition of stigma is that of a mark, or a well defined stain on or associated with an individual. This proposes a stain on the individual’s character which may transcend to the interpersonal and societal levels. However, the common usages of the definition exclude a redundant usage of the term in the context of behavior, culture, and physical attributes that are also associated with stigma.
Historically, the Greeks utilized the term stigma in the context of a physical blemish designated to identify something morally curious about a member of society. In the Greek culture, the identifiable mark was cut or burned into the physical body. This form of representation clearly identified a marked individual within a particular societal text (Goffman, 1963). The dominant or unmarked members of society could easily differentiate themselves by being free from the mark or stain which suggested a violation of a code or a representation of societal status such as a slave or a criminal. Goffman (1963) has explained stigma in terms of a tainted or discounted individual. The negative connotations of these attributes equate to the differences between what society presumes in terms of common or acceptable characteristics of a person. The problematic nature of this definition arises as the attribute itself is not discrediting, rather it is the variance between the individual and the societal influence.
The contemporary usage of this concept relies heavily on the original meaning; however, today the individual’s stigmatizing identifier may indeed be invisible to the rest of society, such as with the case of the human immunodeficiency virus (HIV). According Goffman (1963), three abundantly different types of stigma exist. The first, he referred as abominations of the body that account for physical defects identified to an individual.
Next, he described the blemishes of individual character. These traits are possessed by weak individuals as well as individuals with unnatural desires. Lastly, he proposed tribal stigma. This category of individuals share unique characteristics acquired via lineage such as race, ethnicity, and religion. Stigma is present throughout all societies. The nature and harm of stigma are uniform; however, the degree and circumstances of stigma vary among societies and cultural groups. Regardless of the context, the concept of stigma produces destructive effects. Blame, shame, fear, personal injury, violence, and death account for potential effects of stigma. The potential for both physical and emotional damage to the individual underscores the importance of this concept. In addition, the efforts of changing the defining attitudes of stigma pose unique challenges. Many attitudes attached to contemporary stigma are deeply engrained in the societal norms, the familial values, and the cultural mores of an individual. The changing tapestry of the American society requires a shift in attention to that of multiculturism. Regarding multi-cultural groups, HIV, and stigma, Burrage & Rocchiociolli (2003) reported that the understanding of multiculturism and stigma within the context of interventions accessible to the various groups of people infected with HIV is paramount.
The act of discrimination against an individual or group discerned to be deviant, unacceptable, or inferior is enacted stigma (Scambler & Hopkins, 1986). The critical attribute of enacted stigma is prejudice. Prejudice is defined as “preconceived opinion that is not based on reason or actual experience” (Concise Oxford Dictionary, 2006, p. 697). An essential aspect of the phenomenon of prejudice includes a social orientation towards whole groups of people and/or towards individuals because of their association is a member of a particular group (Brown, 1995).
Methods for measuring this concept are available but restrictive. The outcomes of stigma are merely identified, questionnaires offer a rank-order aspect of the degree of certain pieces of stigma within select populations, and finally a limited number of studies have been published to determine other components or constructs involved with this complex concept. A workable instrument with proven reliability and validity would strengthen the studies on stigma as well as properly place this concept in the forefront of attention with an instrument that can be utilized across various populations and translated into many languages to gauge the scope and impact of stigma among nursing students.
Study Design
This cross sectional research design will be implemented among nursing students at the University of Douala, the University of Dschang in Cameroon, West Africa and Goldfarb School of Nursing at Barnes Jewish College in St. Louis, MO, USA. Nursing students enrolled in the eighth semester (last semester of nursing clinicals) will be sampled by convenience method. The nursing students will complete the HASI-NS (HIV/AIDS Stigma Instrument – Nursing Students). This researcher modified instrument is intended as a pilot implementation as it appears to be unused within the student nursing population. This instrument is a modified version on the HASI-N (HIV/AIDS Stigma Instrument – Nurse) developed Uys, Holzemer, Chirwa, Dlamini, Greeff, Kohi, et al. with supported funds from the NIH and the Fogarty International Center. This instrument utilizes 20 items concerning behaviors, communication, and perceptions addressed to
nursing students in the clinical setting. The data will be cleaned, coded and analyzed using SPSS v.16. The results of this study will acknowledge the perceptions of Cameroonian and American nursing students who provide patient care or will be faced with delivering patient care to the growing population of diverse HIV positive patients. The results of this study will be disseminated at national conferences as well as provide the framework for manuscript submission to peer-reviewed journals. Most notably, the data from this pilot study will begin the rigorous process of establishing reliability and validity within new instrument development with the intent to expand to larger studies gauging HIV related stigma among nursing students across both continents.
Nurses are an integral part of the global health care picture as we rapidly move into an era of multi-cultures, multi-languages, and multiple illnesses that reinforce the acts of stigma. Most notably, it is important to remember that nurses are not excluded from harboring and delivering the devastating acts of stigma. In increase in awareness and education will serve as the weapons of choice for nurses of the twenty-first century to combat the destructive forces of stigmatization. As nurse researchers, the nursing science will accelerate the process via methods devoted to exploring strategies at the intervention levels with an ultimate outcome of diminishing current levels of stigma while greatly ameliorating the quality of delivered nursing care when working with marginalized groups facing the many faces of stigma
Timeline
October -December, 2008: finalize HASI-NS instrument development/translation; IRB
approval; secure letters of research clearance from Mr. James Achanyi-Fontem,
Executive Director, Cameroon Link (NGO) and Cameroonian officials.
January – April, 2009: announce, recruit, survey, nursing students at the College of Nursing at the Goldfarb School of Nursing at Barnes Jewish College in St. Louis, MO, USA and the University of Douala and Dschang in Cameroon.
April – June, 2009: data management/analyze data in St. Louis, MO, USA.
June – August, 2009: dissemination of study findings.
References
Brown, R. (1995). Prejudice: Its social psychology. Oxford: Blackwell.
Burrage, J., & Rocchiociolli, J. (2003). HIV related stigma: Implications for multicultural nursing. Journal of Multicultural Nursing and Health, 9(1), 13-17.
Concise Oxford American dictionary, (2006). New York: Oxford Press.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
Scambler, G., & Hopkins, A. (1986). Being epileptic: Coming to terms with stigma. Sociology of Health and Illness, 8, 26-43.