Article

HIV/AIDS and its impact on

student nurses
Ian Peate, Tarja Suominen, Maritta VaÈlimaÈki,
Christa Lohrmann and Ulla Muinonen

Ian Peate, RN This article describes components surrounding British nursing students' (n ˆ 138) knowledge
BEd(Hons), base, attitudes towards HIV/AIDS, homophobia level, willingness to care for individuals with
MA(Lond) Principal
Lecturer, University HIV/AIDS and attitudes to sexual risk behaviours. The data were collected by questionnaire
of Hertfordshire, and analysed by statistical methods. Out of the 33 knowledge questions, the mean value of
Division of Adult
Nursing & Health correct answers was 22.2 (Min 13, Max 29, SD 3.27). Students who had taken care of people
Sciences, College with AIDS and who were willing to take care of these people showed more positive attitudes
Lane, Hatfield,
Hertfordshire,
to the disease and people with AIDS. Older age and reluctance to care for a person with AIDS
AL10 9AB, were associated with a high level of homophobic attitudes. Students demonstrated a positive
United Kingdom.
approach to carrying out general nursing tasks for a person with HIV/AIDS. Having been
E-mail: i.peate@
herts.ac.uk asked to care or having cared for a patient with HIV/AIDS, and being single were associated
Tarja Suominen, with a higher level of willingness to care for these patients. Female sex, older age and having
PhD, RN, Senior
Researcher, Stakes, children were associated with more cautious attitudes to sexual risk behaviours. The results
Docent, University of underline the importance of providing education about HIV/AIDS and supporting student
Turku, Department
of Nursing, 20014 nurses who are afraid they might contract the disease in nursing tasks. & 2002 Published by
University of Turku, Elsevier Science Ltd
Finland.
E-mail: tasu@utu.fi
Maritta VaÈlimaÈki,
PhD, RN Senior
Assistant Professor
University of Introduction
Tampere, 33014; However, as Tierney (1995) has concluded in
Department of The UK HIV data set recorded 48,226 her review of the literature, nurses' knowledge,
Nursing, Tampere
reports of HIV infected individuals from the attitudes and education regarding HIV/AIDS
University Hospital,
University of beginning of AIDS reporting in 1982 to the is poor and they often feel fearful of AIDS.
Tampere, Finland. end of 2001 (HIV/STIs 2002). Since 1982, there They also tend to display negative attitudes
E-mail: numava@
have been 11,073 deaths from AIDS. towards people with HIV/AIDS (see also
uta.fi
Christa Lohrmann, Currently the HIV/AIDS infection is the Robinson 1998, VaÈlimaÈki et al. 1998). Given
Diplompflege- major cause of death in Britons aged the continuing increase in the number of HIV
paÈdagogin, RN
between 25 to 44 years, irrespective of cases it is essential that we have in place a
Humboldt University
of Berlin, Berlin, gender. Sex between men is the main cause of skilled nursing staff with humane attitudes
Germany. infection, accounting for 74% (10,695) of all towards people with AIDS and a high
Ulla Muinonen,
cases. Children aged 0±14 years (as at knowledge level regarding the disease and
MScN, RN,
Product Manager, March 1998) account for 327 AIDS cases and its treatment (e.g. Chitty 1989). Continuous
Janssen-Cilag, 779 HIV cases. Projected figures for 1999 research is also needed.
Espoo, Finland.
indicate that 2,010 new cases will appear As Webb and Askham (1987) have
(Requests for (CDC 1996). demonstrated, attitudes are closely linked to
offprints to TS) A sound and up-to-date knowledge base behaviour. However, Bennet (1995) has
regarding HIV/AIDS is required if the care stressed that a continued focus on attitudes
Manuscript
accepted: provided is to be effective and of a high may not be useful unless we validate their
15 January 2002 quality (e.g. Williams et al. 1992, Held 1993). influence on nursing action in clinical

492 Nurse EducationToday (2002) 22, 492±501 0260-6917/02/$ - see front matter & 2002 Published by Elsevier Science Ltd
1
doi:10.1054/nedt.2002.0747, available online at http: // www.idealibrary.com on

situations. On the other hand, Wells (1997)
and Phillips (1994) have stated that nurses with
homophobic views may bring their prejudices
to clinical practice and therefore potentially
jeopardise the care of their patients. Health
carers may also deny their own emotional
needs while continuing to provide the best
possible care to their clients. They may
attempt to compensate for the unfair
treatment and stigma their clients have
had to face (Bennett et al. 1995).
The purpose of this study is threefold.
Firstly, it is our intention to describe British
nursing students' knowledge base, attitudes
towards HIV/AIDS, level of homophobia,
their willingness to care for individuals with
HIV/AIDS and attitudes to sexual risk
behaviours. Secondly, we will be exploring
the associations between students' background
variables and their knowledge, attitudes,
homophobia level, willingness to care for
individuals with HIV/AIDS, and attitudes to
sexual risk behaviours. Third and finally, we
look at the associations between nursing
students' knowledge, attitudes, homophobia
level, willingness to care, and attitudes to
sexual risk behaviour.
Despite millions of pounds spent on
awareness campaigns the UK's rate of HIV
infection has risen (Pollard 2001). The British
Government has attempted to address this
issue by publishing its first National
Strategy on Sexual Health and HIV
(Department of Health 2001). If knowledge
of sexual health is inadequate this can lead
to serious consequences such as a rise in
unplanned pregnancies and an increase in
sexually transmitted infections.
It is important to assess nursing students'
understanding of sexual health issues such as
HIV/AIDS in order for educationalists to
address any deficiencies in knowledge and
understanding when planning curricula
content. This study is timely as it may
assist educationalists whilst planning new
curricula content when focusing on the
issues raised in the Peach Report (UKCC 1999).
From a student's personal sexual health
perspective nurse educationalists have the
opportunity to educate and to correct any
misgivings there may be surrounding
HIV/AIDS. They have the chance to
& 2002 Published by Elsevier Science Ltd
HIV/AIDS and its impact on student nurses
educate in order for students to care for
their own sexual health and also to enhance
the quality of their patient's care.
Literature review
Several studies have evaluated student
nurses' knowledge regarding HIV/AIDS.
It is important to have a sound knowledge
because feelings of fear are associated with
lack of knowledge and negative attitudes
(Figarrotto et al. 1991). Akinsanya and Rouse
(1992) found that health-care professionals
tend to have negative attitudes towards
people with AIDS, Steele and Melby (1995)
reported that nurses had inadequate
knowledge and misguided perceptions
regarding their risk of contracting HIV
through routine nursing care of clients.
Many nurses also readily admitted their
lack of knowledge.
Attitudes to HIV and AIDS and people
with HIV/AIDS in general are fearful
(Horsman & Sheeran 1995, Miller et al. 1997,
Fusilier et al. 1998) and negative (Robinson
1998). People working in a health-care
environment should nevertheless demonstrate
a caring and understanding attitude
towards HIV/AIDS. This requires a
significant knowledge base if quality
care is to be achieved (Robinson 1998).
However, it has been found that health-care
students have negative attitudes towards
AIDS patients (e.g. Kemppainen et al. 1992,
Halpern et al. 1993, Held 1993, Dubbert et al.
1994). Their attitudes are influenced by the
way in which the disease has been transmitted
(Leasure et al. 1995), by whether or not they
personally know an AIDS patient (e.g. Evans
et al. 1993, Anderson et al. 1997), and by how
long they have been studying (e.g. Mueller
et al. 1992). In general, attitudes towards
people with AIDS are informed by different
experiences of the AIDS epidemic (Capitanio
& Herek 1999).
The research evidence suggests that
attitudes towards homosexually oriented
people are related to attitudes towards
people with HIV and AIDS. Homophobia is
defined by Blumenfield (1992) as the belief
that heterosexuality is or should be the only
acceptable sexual orientation and as the
Nurse EducationToday (2002) 22, 492±501 493
HIV/AIDS and its impact on student nurses
fear or hatred of those who are sexually
attracted to those of the same sex. Furthermore,
homophobia has been described as a fear of
being present in the same room with a
homosexually oriented person (Cambell et al.
1991). In addition to fear, homophobia
involves negative thoughts about people
with a homosexual orientation (Froman et al.
1992). It has been found that higher
homophobic feelings among nurses are
associated with a lesser willingness to care
for persons with AIDS (Robinson 1998).
Donnelly et al. (1997) found that male
college students showed more negative
attitudes towards homosexuals and
homosexual situations than female students.
Synoground and Kellmer-Langan (1991)
describe in their study how 43% of student
nurses (n ˆ 87) would not excuse homosexual
practices, although 70% of the subjects
expressed a discomfort in working with
patients with AIDS.
Nursing professionals are expected to
take care of all kinds of patients without
discrimination (e.g. Dubbert et al. 1994).
However, negative attitudes to individuals
diagnosed with AIDS may affect their
willingness to take care of AIDS patients
(e.g. Tsai & Keller 1995). Sherman (1996)
used Roger's (1992) framework of the science
of unitary beings to explore relationships
between spirituality, perceived social support,
death anxiety and nurses' willingness to
care for AIDS patients. She concluded that
nurses' willingness to care for AIDS patients
was positively correlated with spirituality
and perceived social support, and negatively
with death anxiety. Furthermore, high death
anxiety also weakened the correlation
between spirituality and nurses' willingness
to care for AIDS patients. On the other
hand, it has been reported that avoidance
behaviours are associated with a lower
quality of care across all patients, regardless
of diagnosis (Siminoff et al. 1998).
A cross-sectional study of 481 sexually
active, heterosexual late adolescents (aged
18±20 years) found that attitudes to HIV and
AIDS are associated with attitudes to sexual
risk behaviour. The study showed that
heterosexuals may distance themselves from
HIV/AIDS because of its association
494 Nurse EducationToday (2002) 22, 492±501
with the gay community. At the same time,
they also engage in behaviours that put
them at greater risk of contracting the
disease (Burkhorder et al. 1999). Hesser and
Kim (1997) concluded in their telephone
study comprising 2,900 adults aged 18±64 years
that many of the respondents had changed
their sexual behaviour in order to reduce the
risk of infection. However, nearly two-thirds
of those who identified themselves as being
at elevated risk did not report behavioural
changes. In their longitudinal study Binson
et al. (1997) found that 90% of those women
surveyed who reported a risk behaviour did
not perceive themselves to be at risk. Lewis
et al. (1997) reported in their review of the
literature concerning heterosexual college
students and sexual risk behaviour that
condoms are never used; that HIV/AIDS
knowledge levels are at an adequate to
high level but this knowledge does not
reduce risk; that there are still misconceptions
concerning transmission routes; that there
is a neutral to negative attitude concerning
the incorporation of condoms and other safe
sexual practices into sexual life styles.
Method
Instrument
In this study, questionnaires were chosen
as the instrument as they are the most
appropriate tool to gather large amounts of
factual information concerning knowledge
and attitudes from large populations (McColl
1993). According to Parahoo (1993)
questionnaires will allow the researcher to
collect data on facts, beliefs, attitudes,
knowledge, opinions, experiences and
behaviour, therefore for the purpose of this
study this approach was most fitting. In
addition, questionnaires allow sensitive
questions to be asked, which may be too
sensitive to be asked via interviews.
Student nurses' knowledge level, general
attitudes to HIV/AIDS and homophobia
level were measured using a questionnaire
initially developed by Held (1993). The
knowledge test (33 items; 1 ˆ yes, 2 ˆ no,
3 ˆ don't know) sought to evoke data on
the immunopathology associated with AIDS,
& 2002 Published by Elsevier Science Ltd

the modes of transmission, disease
aetiology, risk groups and universal
precautions. General attitude items (26;
1 ˆ strongly agree, 2 ˆ agree, 3 ˆ undecided,
4 ˆ disagree, 5 ˆ strongly disagree) were
concerned with attitudes towards intravenous
drug users, prostitutes and individuals with
haemophilia. Fears about personal safety and
the safety of family and friends were also
included, as was the right to refuse to care for
individuals with HIV/AIDS. The level of
homophobia was evaluated with 13 items
(1 ˆ strongly agree, 2 ˆ agree, 3 ˆ undecided,
4 ˆ disagree, 5 ˆ strongly disagree). The scale
associated with homophobia measured
attitudes towards individuals who were
homosexually oriented.
A modified version of a scale developed
by Dubbert et al. (1994) was applied to
measure willingness to care for individuals
with HIV/AIDS. While the original instrument
was made up of a 370-word vignette, this
modified version was reduced to 13 words. The
vignette described a patient with AIDS whose
health was deteriorating. He had diarrhoea,
was pyrexial, doubly incontinent, vomiting and
was confused. The items attempted to
determine whether the student nurse would be
willing to undertake certain nursing tasks in
order to care for a patient.
Finally, student nurses' attitudes to sexual
risk behaviours was measured using Chng and
Moore's (1993) instrument, which was
originally developed to measure sexual risk
behaviour in the past. In this study, the
instrument was modified to reflect the
students' attitudes to certain sexual behaviours
in order to attempt to alleviate any
embarrassment or personal intrusion. The
items (1 ˆ strongly agree, 2 ˆ agree,
3 ˆ undecided, 4 ˆ disagree, 5 ˆ strongly
disagree) were related to behaviour with
a new partner and attitudes towards sexual
practices as opposed to safe sex activities.
As background variables, the student nurses
were asked to indicate their age, gender,
marital status, whether they had children,
length of time they had studied, whether
they knew a family member or any other
person with HIV/AIDS, whether they had
ever refused to care for an individual with
HIV/AIDS, whether they had ever cared
& 2002 Published by Elsevier Science Ltd
HIV/AIDS and its impact on student nurses
for an individual diagnosed with HIV/AIDS,
and whether they would be willing to care
for an individual with HIV/AIDS.
Procedure and ethical
considerations
The study was conducted in a UK university
that provides both pre- and post-registration
nurse education. A proposal was made to
the university's ethical committee and
permission was granted to recruit first-year
pre-registration student nurses. The students
were addressed in a classroom situation.
Instruction on how to complete the
questionnaire was given both verbally and in
writing. It was emphasised that the
questionnaires were to be confidential and
anonymity was to be maintained, and
participation was purely on a voluntary basis.
A consent form was attached to the
questionnaire. It was explained that after
completion, the questionnaire and consent
form would be separated to prevent
identification of the respondent. A contact
number and address was included in the
covering letter should any student have any
questions regarding the research. A total of
150 questionnaires were distributed;
138 were completed and returned, giving a
response rate of 87%.
Demographic data
The mean age of the nursing students was
26.3 years (Md 24), range 17 to 51 years (SD
7.89). The majority were female (83%, n ˆ 115),
and two-thirds (66%) were identified as
single; 28% were married; and 6% were either
widowed or divorced. About three-quarters
had no children (77%). Less than one-quarter
(23%) said they had known a family member
or a person with HIV/AIDS. Fifteen percent
had been asked to care for a person with
HIV/AIDS, 15% said they had never been
asked to care for a person with HIV/AIDS.
Only 17% of the respondents (n ˆ 137) had
cared for people with AIDS. The vast
majority (96%, n ˆ 135) indicated they
would be willing to care for a person with
HIV/AIDS, and 99% (n ˆ 135) said they had
never refused to do that.
Nurse EducationToday (2002) 22, 492±501 495
HIV/AIDS and its impact on student nurses
Student nurses who had known someone
with HIV/AIDS had more often cared for an
individual with HIV/AIDS than those
students who did not know anyone with
HIV/AIDS (2 ˆ 29.60; df ˆ 1; p < 0.0001).
Students who knew someone with HIV/AIDS
had also been asked to care for someone with
HIV/AIDS more often than those who did
not know anyone with HIV/AIDS (2 ˆ 18.12;
df ˆ 1; p < 0.0001).
Data analysis
Correct answers were coded as equalling 1
and all incorrect or unsure responses as equal
to 0. The data from the 33 AIDS knowledge
items were analysed by summing up each
respondent's answers (possible range 0±33
points). General attitudes to AIDS,
homophobia, willingness to care and sexual
risk behaviours were first analysed using
descriptive data analysis. For reporting
purposes the five-point scales used in the
measurement of attitudes, homophobia,
willingness to care and attitudes to risk
behaviour were combined into three-point
scales as follows: strongly agree (5) and
agree (4) ˆ agree; (3) ˆ undecided; and
disagree (2) and strongly disagree
(1) ˆ disagree.
Average scores were formed by summing
up the item values for each scale, then
dividing the value by the total number
of items. Differences between categorical
variables were established with the
Chi-square test. The Mann±Whitney U-test
or Kruskal±Wallis tests were used to test
associations between dichotomous background
variables and non-parametric average scale
scores. Pearson's product-moment correlation
coefficients were used to examine the
correlation between numerical variables. In
each test performed the p-values were less
than 0.05 and as such interpreted as statistically
significant.
The internal consistency of the scales
was measured by Cronbach alpha. The alpha
values for the scales were as follows: Attitude
0.89, Homophobia 0.89, Willingness to
care 0.95, and Attitudes to Sexual Risk
behaviour 0.78.
496 Nurse EducationToday (2002) 22, 492±501
Results
Knowledge
The results regarding AIDS immunopathology
demonstrated that all students (n ˆ 135)
were aware that the disease interferes with
the human immune system. Many students
knew that there is no cure for AIDS (91%),
that it is a lethal disease (79%) and infections
are a common complication of AIDS (78%).
However, there was much uncertainty (68%)
when it came to statements concerning the
function of granulocytes. The statement that
Kaposi's sarcoma is the most common
form of cancer among homosexual men
yielded the following responses: correct
(18%), false (4%) and don't know (78%).
Responses to the question regarding the
AIDS virus and other sexually transmitted
diseases demonstrated that 40% knew they
were different, but 84% were not sure
whether HTLV III/LAV was the retrovirus
that caused AIDS. Two-thirds (65%) of the
students were unsure about the function
of T-lymphocytes, 24% did not know whether
the symptoms of AIDS appeared within
6 months of exposure to HIV.
Almost everyone (98%) knew that AIDS
is transmitted via blood and blood products;
82% knew that it is not true that one can
get AIDS though casual contacts. Large
numbers (96%) also knew that sharing a
needle with a drug user was another route
of transmission and that transmission can
occur through both heterosexual and
homosexual contact (99%). Furthermore, it
was known that HIV is found in high
concentrations in saliva, tears and urine (78%).
Four-fifths (81%) responded correctly that
condoms do not give 100% protection
against HIV/AIDS and that individuals can
infect others with HIV without being ill
themselves (87%).
The majority of respondents knew that
the risk of acquiring the virus is highest
among IV drug users, individuals who practise
unsafe sex and prostitutes (96% responded
correctly). They also knew that the risk of
contracting the virus increases with the
numbers of sexual partners (87%), but that
AIDS is not a disease related to sexual
& 2002 Published by Elsevier Science Ltd

preference (86% correct answers). The
respondents also demonstrated awareness
of the precautions required to prevent the
transmission of AIDS. The vast majority (91%)
knew that regular condom use helps to
reduce the risk of transmission.
Over half (57%) said that hospitalised
individuals should be nursed with blood and
body fluid precautions, over three-quarters
(77%) that it is not necessary to use complete
protective clothing when caring for individuals
with HIV/AIDS. Most (83%) knew that it was
unnecessary to wear masks for routine care,
and just over half stated that pregnant
women are not at increased risk of contracting
HIV/AIDS (55%). A correct response rate
(62%) concerning isolation procedures and the
need to assess individual infections was
reported and that eye protection (80%) is
needed where blood and body fluids pose a
risk to the carer through splashing.
Out of the 33 questions concerning
knowledge, the mean number of correct
answers was 22.2 (Min 13, Max 29, SD 3.27).
No associations were detected between
background variables and the respondents'
knowledge level.
General attitudes
About one-third of the students (35%) said
they had no fears of being in contact with a
person with HIV/AIDS. Over half (55%) were
not worried about their family or friends being
in contact with a person with HIV/AIDS.
Eleven percent replied that they would not
want to be assigned to care for a person with
HIV/AIDS as they felt they were not
competent to meet the intense physical needs
involved, while 16% would not want to be
assigned to care for a person with HIV/AIDS
because of the psychological needs of people
with HIV/AIDS.
There were a number of students (40%)
who felt they should have the right to refuse
to care for people with HIV/AIDS, while only a
few (3%) indicated they would in fact refuse
to do so. Further, the vast majority (94%) felt
that institutions should not have the right to
refuse to care for people with HIV/AIDS. On
the other hand, less that one-fifth (17%) agreed
that people who care for individuals with
& 2002 Published by Elsevier Science Ltd
HIV/AIDS and its impact on student nurses
HIV/AIDS should do so on a voluntary
basis.
As regards caring for particular groups
of people, 78% indicated they would not feel
uncomfortable dealing with people who are
bisexual, if the individual was a child (80%), a
haemophiliac (73%), or a male or female
prostitute (82%). However, 18% said they had
little sympathy with drug users. Over half
(53%) felt more sympathetic towards those
who had acquired the disease through blood
transfusion as opposed to IV drug use.
The maximum being 5, the mean score in the
attitude scale was 3.74 (Md 3.72, SD 0.56).
Students who had taken care of people with
AIDS showed a more positive attitude to the
disease and AIDS sufferers than those who
had not done so (Mean 3.98, Md 4.12 vs.
Mean 3.70, Md 3.71, p ˆ 0.042). Students
who were willing to take care of a person
with AIDS also showed a more positive
attitude to these people (Mean 3.78, Md 3.76 vs.
3.07, Md 3.24, p ˆ 0.002).
Homophobia
The majority (84%) of the students said
they would not feel uncomfortable dealing
with an individual who had a homosexual
orientation, 87% said it would not bother
them. Three-quarters (75%) felt that
homosexuality should not be condemned as
an alternative life style, and 91% disagreed
that homosexuals who contract the disease
deserve what they get. Four in five or 82%
replied that they would not feel as comfortable
dealing with gay females as opposed to
females who had not identified themselves as
lesbian, and over three-quarters (78%) would
not feel comfortable instigating contact with
a person known to be homosexual as opposed
to a person who is heterosexual. The same
respect and information should be given to
the partner of a homosexual as to the partner
of a heterosexual (83%).
The mean score for the homophobia
questions was 4.26 (Md 4.44, SD 0.80), the
maximum again being 5. Older students
demonstrated a higher homophobia level
than younger students (r ˆ ÿ0.22, p < 0.009).
Students who were willing to care for
persons with AIDS showed less homophobic
Nurse EducationToday (2002) 22, 492±501 497
HIV/AIDS and its impact on student nurses
attitudes than students who were not willing
to do so (Mean 4.30, Md 4.44 vs. 3.51, Md 3.88,
p ˆ 0.02).
Willingness to care for a person
with HIV/AIDS
Our nurse students demonstrated a rather
positive attitude to caring for a person with
HIV/AIDS, especially general nursing tasks,
such as serving meals (97%), taking vital signs
(96%), feeding dinner (96%), changing bed
linen (94%), and emptying the urinary
drainage bag using gloves (91%). The majority
also indicated they would be willing to
complete catheter care using gloves (87%), to
clean up faeces (84%) or to shave (84%), to
change dressings (83%), and to give a bed bath
(81%). The figures were somewhat lower for
administering a blood transfusion (77%), for
cleaning supplies even using gloves after
the doctor has completed a diagnostic
procedure (75%), and especially for starting
IV fluids (42%).
In this scale lower scores indicated a
greater willingness to take care of people
with AIDS. The mean score on the scale
was 1.79 (Md 1.92, SD 0.66). Those who
had been asked to care for a person with
HIV/AIDS were more willing to provide
care than those who had not been asked
(Mean 1.52, Md 1.31 vs. Mean 1.83, Md 2.00,
p ˆ 0.045). Those who had cared for
a person with HIV/AIDS were more willing
to care for them than those who had not
cared for them (Mean 1.44, Md 1.31 vs. Mean
1.85, Md 2.00, p ˆ 0.005). When the students
were asked to indicate in a dichotomous
question whether or not they would be
willing to take care of a person with
HIV/AIDS, those who said they would be
willing to do so also had higher willingness
scores than students indicating they would
not be willing to take care of these persons
(Mean 1.75, Md 1.85 vs. Mean 2.29, Md 2.27,
p ˆ 0.045). Finally, single students showed the
greatest willingness to care for persons with
AIDS (mean 1.68, Md 1.61) followed by
divorced/widowed students (Mean 1.69, Md
1.73). Married students were the least willing
to care for people with AIDS (Mean 2.04,
Md 2.00). The differences between these
498 Nurse EducationToday (2002) 22, 492±501
three groups were statistically significant
(p ˆ 0.044).
Attitudes associated with sexual
risk behaviour
A clear majority (92%) agreed that refusal
to have sex with a partner who does not
practise safe sex reduces the risk of contracting
HIV/AIDS. Over four-fifths (87%) agreed
that regular condom use also reduces the risk.
The majority of students (76%) also agreed
that by avoiding sexual intercourse with a
person who had many sexual partners, even
if using a condom, will reduce the risk. Over
half (56%) thought that knowing the sexual
history of one's partner helped to reduce the
risk, while 62% responded that sexual
abstinence was a way of reducing the risk.
Over half of the students agreed that
performing oral (52%) or anal sex (64%) on
others with or without a condom increases
the risk of contracting HIV/AIDS. Over half
(52%) agreed that receiving oral sex from
others increases the risk of HIV/AIDS, and
64% indicated they were less likely to have
anal sex performed on them because of the
fear of catching AIDS.
The mean score on the risk behaviour
attitudes scale was 2.27 (Md 2.23, SD 0.64): the
lower the value, the more cautious the
students' attitudes to sexual risk behaviours.
Female students had a more cautious attitude
to sexual risk behaviours than male students
(Mean 2.2, Md 2.2 vs. Mean 2.63, Md 2.55,
p ˆ 0.006). Students who had children of their
own showed more cautious attitudes to
sexual risk behaviour than students without
children (Mean 2.06, Md 2.00 vs. Mean 2.34,
Md 2.33, p ˆ 0.010). In addition, a weak but
significant association was seen between age
and attitudes to sexual risk behaviours: older
students tend to be more cautious than
younger students (r ˆ ÿ0.18, p < 0.038).
Correlation between the scales
A strong and statistically significant
correlation was found between attitudes
to AIDS (and people with AIDS) and
homophobia: the more positive the attitude
to AIDS, the weaker the homophobic
& 2002 Published by Elsevier Science Ltd

attitudes (r ˆ 0.69, p < 0.0001). Those who
showed a more positive attitude to AIDS and
people with AIDS were more willing to take
care of these people (r ˆ ÿ0.43, p < 0.0001), but
they had less cautious attitudes to sexual risk
behaviours (r ˆ 0.33, p < 0.0001). Those with
strong homophobic attitudes also had less
cautious attitudes to sexual risk behaviours
(r ˆ 0.28, p ˆ 0.001), but they were more
willing to care for patients with AIDS than
those with strong homophobic attitudes.
Finally, the more knowledgeable the students
were, the less they showed homophobic
attitudes (r ˆ 0.21, p ˆ 0.017) and the more
willing they were to take care of these people
(r ˆ ÿ0.21, p ˆ 0.014).
Discussion
Student nurses in the UK seem to be quite
knowledgeable about AIDS. Having said that
there are certain areas where there remains
room for improvement; two good examples are
provided by ways of reducing the risk of
infection and isolation procedures. This is an
area that deserves priority attention in modern
nursing education: the prevention of infectious
diseases, high-quality infection control and the
protection of nursing staff against infectious
diseases. The importance of combating
infectious disease is underlined by the growing
problem in many Western countries of hospital
bacteria and the reappearance of many less-
common diseases such as tuberculosis.
Students who had taken care of people
with AIDS and those who were willing to take
care of people with AIDS showed a more
positive attitude to the disease. It is crucially
important to foster positive attitudes because
they may be associated with how nursing
interventions have been realised (see Webb &
Askham 1987). However, as Bennet (1995) has
highlighted, it is important to validate how
attitudes influence nursing actions in clinical
situations. Indeed clinical trials should be
conducted to produce evidence-based nursing
knowledge in this area.
In this data set 40% of the students felt
they should have the right to refuse to
provide care, even though only 3% indicated
they would in fact do so. However, 94% were
of the opinion that institutions should have
& 2002 Published by Elsevier Science Ltd
HIV/AIDS and its impact on student nurses
the right to refuse to care for HIV/AIDS
patients. It is important that nursing education
produces professionals who have high moral
standards, who are willing and prepared to
assume responsibility and who are capable
of dealing with problem situations in an
efficient and ethical manner. This should be
supported not only during training, but also
on the job by administrative means.
Overall the results of our study underline
the importance of HIV/AIDS education to
student nurses. There are already several AIDS
education programmes in different countries
(WHO 1993a,b,c,d). General awareness about
the dangers of AIDS has also increased.
Information technology and multimedia
programmes may offer new interesting
opportunities to offer this information to
nursing staff, nursing students, and general
in this regard.
There were some limitations in our study
that need to be mentioned. Firstly, the sample
size was comparatively small, although it
should be borne in mind that this was a pilot
study and as such highlighted interesting
issues related to student nurses and their
reactions towards HIV/AIDS. The instrument
used must also be seen as a potential
constraint. It could be suggested that the
students' responses were responses they felt
the researchers wanted to see. Future studies
must use a larger sample size and devise an
instrument that reduces the risk of the
Hawthorne effect.
Despite its limited scope our study
has important implications for nurse
education, practice and research. Firstly,
it is important that nurse educators continue
to ensure that education on all aspects of
HIV/AIDS is explicitly included in the
curriculum and that teaching reflects the
needs of learners. Developing computer
software offers exciting prospects for a
reorientation of education. Educators need
to adopt an approach that encourages
learners to inquire, reflect and devise
methods that can help resolve problems and
make the decision-making process more
transparent. Such recommendations can
only enhance practice and the quality of
care surrounding this complex and often
emotive area of care. In clinical practice the
Nurse EducationToday (2002) 22, 492±501 499
HIV/AIDS and its impact on student nurses
interventions may also need to be directed to
beliefs and not only to behaviours.
This study adds to the current knowledge
base concerning HIV/AIDS by raising the issue
at a time when there is an increase in the
numbers of people infected and affected by
HIV/AIDS. It provides insight into the
knowledge and attitudes of one cohort of
student nurses.
This small-scale study should be replicated
and a cross-cultural comparison is advocated
in order to consider issues from a more global
perspective. In addition, more systematic
clinical trials should be conducted to produce
information for evidence-based practice.
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