ABSTRACT
Background: Early in the HIV/AIDS epidemic, a large number of health care workers had negative attitudes toward persons infected with HIV, but a more positive shift has occurred in these attitudes over the past decade. However, recent information about attitudes of physician assistants (PAs) is missing.
Methodology: A nationwide randomized sample of 1,500 PAs was surveyed through the US mail. The AIDS Attitudes Scale (AAS) developed by Froman, Owen, and Daisy in 1992 was used for this purpose. The results were analyzed using descriptive, t test, and analysis of variance (ANOVA) statistics.
Results: A majority of respondents had high empathy, low avoidance, and positive general attitude scores. Respondents living in the South had the highest avoidance and lowest general attitude scores compared with those living in other regions (ANOVA, P < .05).
Conclusion: The results were consistent with similar current studies of health care workers, which demonstrated supportive attitudes towards persons with HIV/AIDS.
Deaths due to HIV/AIDS in the United States have declined in the past decade thanks to improved testing, availability of multidrug treatments, and preventive education. In addition, most management now takes place outside the hospital setting, so the number of clinicians managing HIV/AIDS patients has increased dramatically.1 Historically, negative attitudes towards persons living with HIV/AIDS have been documented among providers.1 The purpose of this study was to evaluate the current attitudes of PAs toward persons with HIV/AIDS, as they are a part of the heath care team caring for such patients and not widely studied in this regard.
Negative attitudes and perceived stigma towards persons living with HIV/AIDS have existed since the disease was recognized in 1981.2-10 Trends among studies showed that the majority of negative or nonsupportive attitudes were due to a lack of experience and education about persons living with HIV/AIDS and their management.2-10
In 1989, one-fourth of cardiac surgeons refused to operate on HIV-infected patients, regardless of the cause of infection. A majority would operate on an HIV-infected patient only if the procedure was urgent.9 Both the 1989 and a 1999 survey found that cardiac surgeons were more likely to perform surgery on a patient with hepatitis before performing surgery on an HIV-infected patient.9-10 Studies in the 1990s claimed that physicians felt that they were not appropriately educated about HIV/AIDS, that a perceived stigma from the public resulted if they managed persons with HIV/AIDS, and that they feared contracting the virus.2-4 Lack of education and experience among physicians were leading factors for referral or refusal of management.
In 1992, most physicians surveyed had not yet cared for an HIV-infected patient.3 However, during the same time, other physicians felt comfortable with their knowledge of prevention and diagnosis of HIV/AIDS but were not comfortable managing infected patients who came to their practices.4 Respondents in both studies felt inadequately trained and thus could not provide adequate management.3-4 Weinberger and colleagues reported that 40% of US physicians referred or refused new HIV/AIDS cases in 1992, even though the American Medical Association (AMA) considered this practice unethical.4 For those physicians willing to care for HIV/AIDS patients, 97% had problems hospitalizing their patients, and 95% had difficulties getting these patients home health care.3
While many health care workers during the 1990s had negative attitudes and remained skeptical about treating persons with HIV/AIDS, providing health care to HIV-infected patients could not be avoided.5 Sixty percent of US physicians surveyed were concerned with contagion.4 Throughout the 1990s, a majority of physicians felt that they and their staff were protected by universal precautions when working with homosexual or bisexual HIV-infected patients. Regardless of these precautions, however, they did not feel comfortable managing HIV-infected intravenous drug users (IVDU).2-4,11
By 1997, health care workers in general thought that HIV-infected patients deserved adequate treatment, but fewer than 50% wanted to provide that themselves.2 Sixteen years after the recognition of HIV, a perceived stigma remained among health care workers. This stigma likely influenced negative attitudes towards person living with HIV/AIDS.7
In 2000, physician assistants (PAs) and nurse practitioners (NPs) reported that, when they did refer HIV/AIDS patients, it was because of lack of experience and the availability of experts on HIV/AIDS to treat their patients. Eighty-two percent of these nonphysician clinicians would provide health care, while 18% would refer. They agreed that a stigma existed towards IVDUs who had contracted HIV but did not believe that these patients "deserved" to get HIV/AIDS. PAs and NPs expressed sympathy towards these patients, did not avoid treating them, and were not fearful of contagion.8