Barbara J. Blake

A model of HIV disclosure: Disclosure and types of social relationships

Purpose: The purpose of this study was to assess perceptions of HIV positive (+) persons regarding disclosure of their serostatus to others with the goal of developing a model of HIV disclosure that could be used by healthcare providers (HCPs) in HIV prevention. Data sources: Data were collected through 13 focus groups from 104 HIV+ participants. The groups were formed based on three HIV risk exposure categories—men who have sex with men, high‐risk heterosexuals, and substance users. Conclusions: Data analysis revealed three themes: disclosure of one’s HIV+ serostatus depends on type of social relationships, fear, and stigma, with social relationships being the major theme. A model of HIV disclosure emerged from the data analysis of social relationships. In the model, social relationships were categorized as sexual and nonsexual, with varying degrees of HIV disclosure—depending on the social relationship with the person to whom one did or did not disclose. Results indicated that HIV is still a fearful and stigmatizing disease, and disclosure of HIV status is a complex phenomenon embedded in various types of social relationships. Implications for practice: Results of this study provide a “Model of HIV Disclosure” that can be utilized by nurse practitioners and other HCPs in clinical practice when providing treatment, counseling, and prevention education for HIV+ clients and for prevention education for HIV negative clients—especially for family, friends, sexual partners, and employers of HIV+ clients.

“Get Them While They’re Young”: Reflections of Young Gay Men Newly Diagnosed With HIV Infection

&NA; Thirty years into the epidemic, young men who have sex with men (YMSM) continue to be the largest at‐risk group for HIV infection in the United States. In this qualitative study, face‐to‐face confidential interviews were conducted with 10 recently diagnosed YMSM. The purpose of the study was to explore the factors that may have contributed to each young mans recent HIV diagnosis and to solicit his perspectives on the design and efficacy of existing HIV prevention programs. Content analysis of the interview data revealed four major themes: personal risks, lack of relevant education, accessing the Internet, and the need for mentors. The informants in this study recommended the formulation of age‐specific education interventions and the development of HIV prevention interventions that match the sophistication level and needs of todays gay youth to reduce the number of new HIV infections in YMSM.

Experiences of women in obtaining human immunodeficiency virus testing and healthcare services.

Purpose: Over a decade ago, the U.S. Public Health Service recommended routine human immunodeficiency virus (HIV) testing for pregnant women. Despite this recommendation, nearly 30% of pregnant women report not being tested. The purpose of this qualitative study was to describe personal experiences of women in obtaining HIV testing and healthcare services in east Texas. Data sources: A secondary data analysis was conducted using audiotapes and transcriptions from structured group interview data obtained from HIV‐positive and high‐risk negative women residing in east Texas (n = 64). Conclusions: Content analysis revealed three patterns: living with stigma; struggling to be healthy; and getting along, day by day. Additional findings indicated that women are more likely to access HIV testing if they are assured of confidentiality and women living with HIV are more likely to remain in the healthcare system if healthcare professionals are supportive, knowledgeable, and nonjudgmental. Implications for practice: Healthcare professionals must engage in self‐reflection to conscientiously uncover their true feelings related to caring for women with or at risk for HIV disease. Once providers acknowledge that their beliefs and values differ from their clients, they will be able to minimize personal biases that interfere with HIV testing and healthcare services.

Exploring Experiences and Perceptions of Older African American Males Aging With HIV in the Rural Southern United States.

The HIV (human immunodeficiency virus) epidemic in the United States remains a serious public health concern. Despite treatment and prevention efforts, approximately 50,000 new HIV cases are transmitted each year. Estimates indicate that 44% of all people diagnosed with HIV are living in the southern region of the United States. African Americans represent 13.2% of the United States population; however, 44% (19,540) of reported new HIV cases in 2014 were diagnosed within this ethnic group. The majority of cases were diagnosed in men (73%, 14,305). In the United States, it is estimated that 21% of adults living with HIV are 50 years or older. There exists limited data regarding how well African American men are aging with HIV disease. The purpose of this study was to explore the perceptions and experiences of older African American men living with HIV in rural Georgia. Data were collected from 35 older African American men living with HIV using focus groups and face-to-face personal interviews. Qualitative content analysis revealed six overlapping themes: (1) Stigma; (2) Doing Fine, Most of the Time; (3) Coping With Age-Related Diseases and HIV; (4) Self-Care; (5) Family Support; and (6) Access to Resources. The findings from this study provide new insights into the lives of rural HIV-infected African American men, expands our understanding of how they manage the disease, and why many return to or remain in rural communities.

Effects of Reiki With Music Compared to Music Only Among People Living With HIV

&NA; Persons living with HIV (PLWH) often seek complementary treatments to improve their overall health and well‐being. Reiki, an ancient healing practice, has been found to be effective in reducing symptoms of stress, anxiety, pain, and depression. The purpose of this pilot study was to evaluate the effectiveness of Reiki as a complementary treatment for PLWH. Using a two‐group mixed‐methods experimental design, 37 participants were randomized to either a 6‐week Reiki with Music Group or a Music Only Group. Self‐reported and physiologic measures were obtained at baseline, 6 weeks, and 10 weeks. Significant improvements in relief of pain and stress in those receiving RMG were found. At the 6‐week assessment, semi‐structured interviews were conducted with all participants. Qualitative findings indicated that Reiki and music therapy helped reduce stress, anxiety, and depression. Evidence‐based data regarding the effectiveness of Reiki will help nurses help patients better manage HIV‐related symptoms.

The value of certification in HIV/AIDS nursing revisited

Relf, Berger, Crespo-Fierro, Mallinson, and MillerHardwick (2004) published the initial work on certification in HIV/AIDS nursing. Their work provided a comprehensive summary of the scope of HIV/AIDS nursing practice, distinguished certification from licensure, detailed the need for nursing certification, described the benefits of certification, and discussed methods for championing certification among nurses in HIV care. Since that initial article 10 years ago, much has changed within the HIV pandemic, nursing profession, and context in which HIV nursing care occurs. Care for clients living with HIV has advanced as these changes evolved. Survival has increased relative to advances in medical care and treatment. Improved care and treatment options mean that clients with HIV disease are now aging. In fact, life expectancy of clients living with HIV infection is nearly equal to those who are not infected (May et al., 2006). Currently, 24% of clients living with HIV in the United States are ages 50 years or older (Centers for Disease Control and Prevention [CDC], 2008). However, aging clients with HIV infection have a host of physical and psychosocial care needs that need to be addressed (Davis & Zanjani, 2012). Unfortunately, some aspects of HIVinfection have not changed over the past 10 years. In the United States alone, nearly 50,000 new cases of HIV infection occur annually. Groups most affected by HIV include Black men and women, and men who have sex with men (CDC, 2011). Unfortunately, the advances in HIV care and treatment are overshadowed by the fact that HIV prevention strategies have not been largely successful in decreasing new cases of HIV infection among these vulnerable populations (Johnson et al., 2008). The complex care needs of persons with HIV infection combined with the lack of HIV prevention interventions indicate that nurses with specialized knowledge, skills, and competencies are needed to provide care to people at risk for HIV, as well as those already infected. The Association of Nurses in AIDS Care in conjunction with the HIV/AIDS Nursing Certification Board (HANCB) recommends certification in HIV/AIDS Nursing for nurses who provide primary, secondary, or tertiary HIV care. As of August 2013, 655 nurses have earned AIDS Certified Registered Nurse (ACRN) certification, and 56 advanced practices nurses have earned Advanced AIDS Certified Registered Nurse (AACRN) certification. However, despite encouragement from both of these organizations, many nurses chose not to seek certification in HIV/AIDS nursing. The purpose of this manuscript is to revisit the value of nursing certification in HIV care. By revisiting this issue and using available evidence to demonstrate that certification

Cinemeducation: teaching family assessment skills using full-length movies.

A thorough family assessment provides a foundation for the nursing process when working with families. Therefore, nurses, along with other health care providers must develop expertise in conducting family assessments to provide the best possible care within the community. This article describes an innovative educational strategy using movies to teach family assessment skills and puts forth recommendations for future research to provide evidence to support this teaching modality.

Learning to Age Successfully with HIV

When the HIV epidemic emerged in the 1980s, pharmacological treatment was not available and many individuals died from HIV or related complications. Introduction of effective antiretroviral therapy in the 1990s transitioned HIV from a death sentence to a chronic disease. Fortunately, people are now aging with HIV, but also developing other chronic illnesses. This chapter examines theories related to aging and discusses the physical and mental health issues associated with aging and HIV. Topics include cardiovascular disease, osteoporosis, non-AIDS defining cancers, diabetes, frailty, neurocognitive functioning, and depression. Incorporated into each chapter are recommendations on how individuals can age successfully while living with HIV.

Integrating Professional Apprentices Into an End-of-Life Course

Nursing education faces several challenges in providing quality and meaningful education. Providing such an education is most important in teaching end-of-life care, as nurses are pivotal in helping patients to achieve a good death. A good death is often based on physical comfort, preparation for death, and completion of social and emotional tasks. Many obstacles hinder a patients wishes about dying, including how nurses perceive their role in end-of-life care situations and knowing how to intervene on behalf of the patient. Therefore, nursing education needs to create meaningful and relevant learning experiences to enable future nurses to effectively care for the dying patient. To this endeavor, the Palliative and End-of-Life Care course described in this article integrated knowledge through the use of three professional apprenticeships: (a) acquiring and using knowledge and science (cognitive), (b) using clinical reasoning and skilled know-how (practice), and (c) ethical comportment and formation (moral reasoning).

Women’s Perceptions Of Facing HIV

58 Background: Despite dramatic reductions in human immunodeficiency virus (HIV) transmission in the United States, many women of childbearing age who are at risk for HIV or are HIV positive struggle to maintain health and quality of life. Many of these women encounter social, cultural, economic, and systematic barriers to care and, regrettably, healthcare providers who demonstrate insensitivity and non-caring. Purpose: The initial project was funded in 2002 to uncover client-level and systematic barriers to HIV testing and care for pregnant women and women of childbearing age who lived in east Texas, US. The purpose of this second phase of the study was to discover, describe, and analyze the experiences of these HIV positive or at risk women of childbearing age who received care in these areas. Method: The data for this interpretive phenomenological study were collected during one key informant and eight focus group interviews. Sixty-six women volunteered to participate. Audiotaped interviews were transcribed verbatim and the resultant texts were analyzed hermeneutically as outlined by Diekelmann and Allen (1989). Methodological rigor was approached through adherence to the trustworthiness criteria (Guba & Lincoln, 1989). Findings: Three constitutive patterns and several themes emerged from the data. Patterns and themes illuminated the commonalities experienced by participants and included perceptions of living with the stigma of HIV, struggling to stay healthy, and getting by “day-by-day.” Common barriers to receiving holistic care included lack of confidentiality, fear of the unknown, and non-caring interactions with healthcare providers. Conclusions: Findings from this study revealed ways in which nurses may enhance their understanding of the lived experiences of women who are positive or at risk for HIV. Implications for nurses also include suggestions for promoting caring, healing, and harmony within nurse practice environments. The discussion also includes strategies designed to diminish systematic barriers to care and to develop providerclient interactions that embody trust, nonjudgmental acceptance, and genuine caring. Women’s Perceptions Of Facing HIV