Nurse Education Today 49 (2017) 39–44

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Nurse Education Today

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Culturally construed beliefs and perceptions of nursing students and the

stigma impacting on people living with AIDS: A qualitative study
David Pickles a,⁎, Lindy King b, Sheryl de Lacey b
a
School of Nursing & Midwifery, Flinders University of South Australia, GPO Box 2100, Adelaide, SA 5001, Australia
b
School of Nursing & Midwifery, Flinders University, Adelaide, South Australia, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Background: Since HIV and AIDS were discovered, studies have demonstrated that negative perceptions and re-
Received 1 June 2016 luctance to provide care to affected people persist among nursing students throughout the world. This leads to
Received in revised form 28 October 2016 poor quality care.
Accepted 9 November 2016 Objectives: To report on a study that explored socio-cultural influences on the perceptions of international nurs-
ing students toward caring for people living with HIV/AIDS.
Keywords:
Methods: A qualitative descriptive research design, guided by stigma theory, was utilised. Participants were 21
Nursing
HIV/AIDS
international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing program at an
Stigma Australian university. Data were collected via semi-structured interviews in 2009 and 2011; manual thematic
Perceptions analysis was performed on interview data.
Nursing students Findings: Three major themes emerged: blame; othering; values. Perceptions were influenced by complex, inter-
Nursing education related factors and underscored by culturally construed blame and othering. People living with HIV/AIDS were
perceived as alien and assumed as homosexuals, drug users, or promiscuous. They were labelled ‘bad people’.
Many participants were compassionate but others struggled with differences between their personal values
and professional values expected of a Registered Nurse. There was considerable variation in the degree to
which participants were willing to embrace different perspectives and values.
Conclusion: Nursing curricula is vital to patient health and wellbeing and requires increased focus on the impact
of HIV/AIDS. It is important for educators to recognise that simply providing information to students does not
necessarily change their existing stigmatising perceptions. By addressing the effect of being stigmatised and
marginalised by society nursing care to all patients will be enhanced. Students must also reflect on their percep-
tions and values so as to embrace diversity.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction
When addressing the United Nations General Assembly Secretary-
General Ban Ki-moon emphasised that ‘The fight against AIDS also re-
quires us to attack diseases of the human spirit – prejudice, discrimina-
tion, stigma’ (Ki-moon, 2009). Similarly, Dr. Peter Poit, United Nations
AIDS (UNAIDS) Task Force Executive Director, argued that, ‘Misinforma-
tion about the disease and stigma against people living with HIV/AIDS
still hamper prevention, care and treatment efforts everywhere’
(UNAIDS, 2006, p. 3). The stigma that surrounds people living with
HIV/AIDS (PLWA) has shown little sign of abating and negative percep-
tions of PLWA still persist, accentuating and intensifying the experience
of PLWA.
Since HIV and AIDS were first identified, nurses have been at the
forefront of providing care to PLWA. However, literature has
⁎ Corresponding author.
E-mail addresses: david.pickles@flinders.edu.au (D. Pickles),
lindy.king@flinders.edu.au (L. King), sheryl.delacey@flinders.edu.au (S. de Lacey).
consistently shown that health care professionals and society at large
tend to have negative feelings and perceptions towards PLWA
(Akansel et al., 2012; Cornelius, 2006). As a result of their involvement,
the perceptions of nurses and nursing students towards PLWA have
been under scrutiny since the HIV/AIDS epidemic commenced. Early
studies demonstrated reluctance on the part of some nurses and nursing
students to provide care for PLWA due to their fear of being infected
with the virus (Robinson, 1998; Tierney, 1995). More recent studies
have consistently found that negative perceptions towards PLWA per-
sist among some nursing students throughout the world (Bektas &
Kulakac, 2007; Madumo & Peu, 2006).
According to a United Nations AIDS taskforce report (UNAIDS, 2006)
negative perceptions and reluctance to provide care resulted in poorer
quality of care provided to PLWA. This finding should be of great con-
cern to all in the nursing profession if it has continued to persist. Nega-
tive perceptions of PLWA have been found to exist in the nursing
profession as a whole, resulting in PLWA being treated unequally and
receiving a lesser quality of nursing support afforded to people living
with other chronic illnesses (Akansel et al., 2012; Rondahl, Innala &

http://dx.doi.org/10.1016/j.nedt.2016.11.008
0260-6917/© 2016 Elsevier Ltd. All rights reserved.
40 D. Pickles et al. / Nurse Education Today 49 (2017) 39–44
Carlsson, 2003). Inequality in care is a significant issue that needs to be
addressed by the nursing profession in relation to PLWA. It is therefore
important to identify where negative perceptions come from in nurses
caring for PLWA.
This paper is drawn from a wider study into culturally construed
perceptions of nursing students in relation to providing nursing care
to PLWA, the study was conducted as a PhD candidature project. How
students' culturally construed beliefs and perceptions of PLWA influ-
enced the stigma associated with PLWA was one of the major investiga-
tions of the study, and is presented in this paper. Other significant
aspects of this original and important study will be published in subse-
quent papers. Stigma has been strongly associated with HIV/AIDS and
PLWA have experienced stigma in many aspects of their lives, including
health care. Due to the ongoing association of stigma with HIV/AIDS,
stigma provided a logical theoretical framework for this study.
Deacon, Stephney & Prosalendis (2005, p. 19) consider stigma to be a so-
cial process of fear and blame with disease stigma pointing towards the
position ‘that people with a specific disease are different from ‘normal’
society, more than simply through their infection’. Stigma has stood as
a barrier to the delivery of quality, prejudice-free healthcare to PLWA,
hence the importance of investigating if this remains a current issue af-
fecting students involved in nursing education.
2. Methods
2.1. Aim
This qualitative research study explored socio-cultural influences on
the perceptions of nursing students from a number of countries towards
caring for PLWA. The specific objectives of the study were to:
1. Place nursing students studying in Australia in a cultural context
2. Provide insight into the experiences and perceptions gained by nurs-
ing students from living in their original culture/country on homo-
sexuality, IV drug use and HIV/AIDS, and how these views had been
influenced by family, community and government
3. Compare and contrast these perceptions between nursing students
from differing socio-cultural contexts
This enriched understanding and knowledge of socio-cultural con-
texts informing the perceptions of nursing students towards PLWA pro-
vided strong evidence upon which to make recommendations to inform
and enhance nursing education programs.
2.2. Theoretical Framework and Research Design
The interpretive paradigm and social constructionism provided the
philosophical foundations and stigma theory the theoretical basis to
the study. A qualitative descriptive approach was adopted as the re-
search design for the study, however, there have been no prescriptive
ways to go about this research approach published (Sandelowski,
2000). Rather, the method has been seen as an evolving entity with a
clear expectation; all qualitative descriptive approaches should be
well conceived, structured and conducted with the same rigor as any
other research approach (Sandelowski, 2010).
The decision to utilise stigma theory as the theoretical foundation for
this study stemmed from the overwhelming findings that stigma has
continued to surround PLWA. While the early understanding of stigma
evolved through the work of several stigma theorists and models, the
conceptualisation of stigma applied in this study was largely based on
the work of Deacon, Stephney & Prosalendis (2005) which specifically
focused on stigma related to HIV/AIDS (Deacon, Stephney &
Prosalendis, 2005). However, work of earlier theorists in the field of
stigma also influenced this study (Goffman, 1961, 1963; Link &
Phelan, 2001; Phelan, Link & Dovidio, 2008). When discussing stigma,
Goffman described how society tended to have the perception that
‘the person with a stigma is not quite human’ (Goffman, 1963, p. 5).
Although this was written 20 years before HIV/AIDS was recognised, it
was prophetic of how PLWA came to be perceived.
Numerous global campaigns over the past 30 years have attempted
to reduce the stigma of living with HIV/AIDS. Regardless of these efforts
‘stigmatisation has remained a core feature of the patient experience of
HIV/AIDS’ (Gilbert & Walker, 2010, p. 144). Similar findings have been
made in studies worldwide (Feyissa et al., 2012; Lekas, Siegel & Leider,
2011) causing this issue to remain of current concern.
2.3. Participants
Participants in this study consisted of undergraduate nursing stu-
dents enrolled at an Australian university. Two distinct groups of stu-
dents made up the participants, the first consisted of international
nursing students, the second were local Australian nursing students.
The intention was to have a sample that spanned the rich cultural mix
of nursing students, without allowing the majority local students to
dominate. Recruitment of participants consisted of: printed advertise-
ments placed on notice boards throughout the Campus of the School
of Nursing and Midwifery at the study university; email to all potential
student participants with a letter of introduction and detailed informa-
tion sheet attached; brief personal address to nursing students during a
scheduled lecture introducing the researcher and the study.
Selection criteria required participants to be: undergraduate nursing
students studying internally in the School of Nursing & Midwifery at the
university where the study was conducted; over 18 years of age; able to
give informed consent. There were no other inclusion criteria. The only
exclusion criteria applied to students personally known to the chief re-
searcher. Of the 25 students who volunteered to participate in the study,
four were excluded on the above grounds, and the remaining 21 were
interviewed by the researcher. The participants' countries of citizenship
have been summarised in Table 1.
Eighteen of the participants were female (86%) while three were
male (14%), a gender ratio similar to the nursing student population
and that of practicing nurses in Australia (92.8% female, 7.2% male)
and comparable Western nations such as: Canada (94.9% female, 5.1%
male); UK (90% female, 10% male); Norway (92.5% female, 7.5% male)
(Speedy, 2010). Participants fell into three age groups; six were be-
tween 18 and 24, eleven within the 25 to 34 range, four were aged
from 35 to 44. No participants were aged older than 45 years. Nineteen
of the students were enrolled in 2nd year, one participant was in 1st
year, and one in the 3rd year of the Bachelor of Nursing program. The
Bachelor of Nursing program, leading to the professional Registered
Nurse qualification, was a three year full time course of study (or part
time equivalent) typical of pre-registration programs at Australian
universities.
2.4. Ethical Considerations
The study was approved by the University's Social and Behavioural
Research Ethics Committee. All students invited to participate in the
study were free to decline to participate and to withdraw from partici-
pation at any time. All potential participants were given an information
sheet that outlined the study, explained their participation was entirely
Table 1
Participant nationalities.
Country of citizenship Number of participants
Australia 7
China 5
South Korea 2
Hong Kong 2
England 1
Tanzania 1
Iran 1
Japan 1
 D. Pickles et al. / Nurse Education Today 49 (2017) 39–44
voluntary, that their confidentiality and anonymity would be protected
and pseudonyms used in the study and subsequent publications. All
participants gave informed consent prior to commencement of their in-
volvement in the study.
2.5. Data Collection
Data were collected via semi-structured individual face-to-face in-
terviews in 2009 and 2011, the average length of interview was
38 min. The interviews were designed to elicit the students' thoughts,
feelings and beliefs towards PLWA. During the interviews, to assist in
exploring the participants' beliefs and perceptions about HIV/AIDS and
PLWA, the students were presented with four scenarios or vignettes.
The vignettes were based upon real life situations and included: a
woman dying from AIDS contracted via IV drug use; a man living HIV
who was indifferent to his potential involvement in spreading the dis-
ease; a transsexual diagnosed with HIV while in immigration detention
awaiting deportation for breaching visa conditions; a gay man with HIV
recovering from surgery, being assisted by his partner to shower. See
Fig. 1 for a sample of one vignette, each participant was presented
with all four vignettes.
The scenarios were a tool used to assist participants to indicate how
they characterised, comprehended and constructed their world view of
PLWA. By loosely structuring the interview topic guide (see Fig. 2)
around the scenarios, the interviews became conversations which ex-
plored what the students had to say about their own lived in world
(Kvale, 2007).
2.6. Data Analysis
A manual thematic analysis was performed on the de-identified
transcribed interview data. Participants were given pseudonyms to
maintain anonymity through the analysis process, and when presenting
data verbatim. An inductive five step data analysis strategy was devel-
oped, the approach involved analysis of the data using a process of con-
tent analysis, searching for categories, sub-themes and themes across all
the interview transcripts (Braun & Clarke, 2006; Glaser & Strauss, 1967;
Rose & Webb, 1998). Each transcript was read repeatedly, systematical-
ly analysed, coded and categorised. As the analysis progressed, the
emerging categories and themes underwent a process of verification
(Morse et al., 2002) through discussed with the researcher's academic
supervisors/co-authors. The categories were reduced to identify, classify
and extract sub-themes from the data, from these sub-themes, three
major themes were constructed. Table 2 provides an overview of the
three major themes and their constituent sub-themes.
3. Results
The culturally construed beliefs and perceptions of nursing students
and how they relate to the stigma associated with PLWA have been
Crystal
You are working night shift on a medical ward in a large public hospital, so far
it has been a quiet night. Crystal is one of your patients, she is 42 years old and
was diagnosed with HIV many years ago, now she is close to death from AIDS.
Crystal first injected heroin at the age of 15 and soon started prostituting herself
to pay for the drug habit. She had two daughters, both became drug addicts,
both are now dead, one from overdose, the other from suicide. Crystal has never
really been free from drugs during the past 27 years. Tonight is going to be her
last night, she knows it, she is scared, she doesn’t want to die alone. She asks
you to sit with her, hold her hand, be with her until the end.
Fig. 1. Sample vignette.
41
The following were cues used to commence each interview before presenting
the vignettes for discussion:
• Do you mind telling me a little about your family …
• How many brothers and sisters do you have?
• Tell me what it was like growing up in …
• Can you describe your high school experiences for me?
• As you are aware, the topic I want to discuss today is HIV/AIDS, would
you consider yourself knowledgeable about this disease?
• Was anything about HIV taught in class when you went to school? How
about among your friends, was it something talked about?
Fig. 2. Interview guide.
presented under the headings of the three major themes constructed
from the study data.
3.1. Blame
The student participants brought with them the dominant cultural
beliefs of their society to their nursing studies in Australia, including
their culturally construed perceptions of people who were homosexual,
drug users, or PLWA. There was an undercurrent of blame running
through these perceptions:
You know, the people who have very enjoyable sex life … not responsi-
ble for their sexual behaviour
[(Sang – South Korea)]
My culture has a very negative attitude towards those people with HIV
because we have some prejudice that HIV and AIDS are usually through
the sexual intercourse – we are very closed minded towards those stuff
[(Kim – South Korea)]
Drug use and sexual activity (both homosexual and heterosexual
outside of conventional marriage) along with fear of catching HIV
were the main issues behind the students' appropriation of blame. Intol-
erance of homosexuality and drug use reinforced the blame and associ-
ated stigma directed towards PLWA.
Well it's like you do wonder [how a person has contracted HIV] wheth-
er it's because of their use of drugs and that sort of stuff … like you'd
want to say a little bit like you're an idiot … like it's your fault
[(Janet – Australia)]
Although some participants showed empathy for PLWA, others had
little empathy and perceived PLWA to be responsible for their own in-
fection. The contrasts in the degree of empathy expressed appeared to
be strongly influenced by the socio-cultural context or background of
each individual nursing student:
The attitude of the local students it was shocking to me a little bit here
[in Australia] that they blame just a group of people – homosexuals, just
imagine, yeah it's terrible – because he's a homosexual and to think it
was deserved
[(Mari – Tanzania)]
Table 2
Themes and sub-themes.
Major themes Sub-themes
Blame ▪ Responsibility
▪ Fear of catching HIV
▪ Myths & misconceptions
Othering ▪ Homosexuality & drug use
▪ Influence of authority (power)
Values ▪ Disparity
▪ Professional values
42 D. Pickles et al. / Nurse Education Today 49 (2017) 39–44
Historically PLWA have been assumed to be either: homosexual, IV
drug user, or heterosexually promiscuous in many cultures around the
world. These perceptions resulted in some cultures stigmatising and
blaming PLWA for their disease; the impact can be seen in some of the
participants' responses in the study.
3.2. Othering
Being perceived as different, or ‘other’, and socially ostracised from
mainstream society was seen as a direct consequence of the stigmas con-
ferred to PLWA by some of the students' responses in the previous
theme. In addition, analysis of the interviews demonstrated how deep-
seated these cultural beliefs and perceptions were in the students' think-
ing. In the context of a multicultural nursing cohort, the diversity in
characterization and ‘othering’ of PLWA reflected understanding gained
from the students' previous social context and cultural background:
In China … my parents, my grandparents, they think HIV is so far from
our life – it's something really unfamiliar to them
[(Jiao – China)]
Very far from our culture in Korea
[(Kim – South Korea)]
In many instances culturally construed perceptions and beliefs
caused the students to see PLWA as being a threat, and to overlook
many of the social inequalities associated with HIV/AIDS. The existence
of such beliefs and perceptions was highlighted by similar comments
made by a number of the nursing students - that ‘bad people’ get HIV:
I want to tell you, yeah – in China … if I know you have AIDS, yes I never
make friends with you, I think you are bad people, you are a bad person
[(Ying – China)]
Well tons of people they get infected because they do drugs … these
people are called bad people. But some people like children get because
their parents get AIDS, so we need to support them, the children they're
good people, but the parents that's bad people
[(Yue – China)]
An undercurrent of prejudice was perceptible among a number of par-
ticipants in the study. While this did not present itself in any overt manner,
the stigma associated with HIV and stereotyping of PLWA became appar-
ent through the labels some participants assigned to PLWA. Perceiving
PLWA as being ‘bad people’ created a barrier to the provision of high qual-
ity nursing care to support them. Conceptualisations of homosexuality and
illicit drug use, along with the associated ‘othering’ and stigmatisation
were fundamental to some students' perceptions of PLWA.
3.3. Values
While cultural values served to construct the ‘othering’ of PLWA,
personal experience and positive contact with stigmatised minorities
fostered some students' acceptance. Student acceptance, understanding
and valuing of PLWAs lessened ‘othering’, stigmatising views and po-
tential behaviour:
I feel sorry for her [woman dying of AIDS contracted through intravenous
drug use] … I've been around people with drugs since at a young age
[(Melanie – Australia)]
I really sympathise with her about she had a problem with drugs then she
got AIDS and now she needs someone to be there … and I think in my
country if you got HIV through drug using you might be better off than
if you were a prostitute, yeah, to some degree, you know what I mean
[(Mari – Tanzania)]
Most of the students held clear images of who PLWA were and how
they perceived them to be as people. These perceptions were largely
based on the stereotypical images they were exposed to while growing
up; images that tended to stigmatise and label PLWA:
Yeah, the junky AIDS carrier, they're going to blame that person, he's a
homosexual HIV or a drug addict HIV, like it's all his fault
[(Anne – Australia)]
They are very sick and they are very lonely and they are quite isolated
from friends, even family … I'm sure that people with HIV or AIDS are
very psychologically ill as well as physically ill, and living a horrible life
[(Kim – South Korea)]
Compounding these perceptions were strong cultural taboos against
these students discussing sexual issues and behaviours:
My parents are really conservative parents and quite traditional parents
they don't really talk about sexual things. I think my mother wanted ask
me to protect myself – even though she was thinking that, she never
mentioned it
[(Mieko – Japan)]
Actually my parents would never discuss with me, because of different
culture in China, like different generation, different education, different
opinion – we don't learn much about this disease at home
[(Fan – China)]
These characterisations of PLWA and cultural taboos combined to
help create the social context of each participant, and contributed to ir-
rational fears of contracting HIV/AIDS. Some participants showed a will-
ingness to embrace new or different perspectives and values, to not be
bound by tradition or cultural taboos:
Japan is very conservative, but my perspective has changed since living
in Australia … the gay is not some weird thing anymore
[(Mieko – Japan)]
However there were other participants who had no such
willingness:
My idea is same in Australia, if I know somebody, even my friend, he or
she had HIV I think I would deliberately just keep away from them – it's
my culture from when I was born … the culture is already in my mind
… no I will not change, because … once the person has HIV or AIDS he or
she must have some behaviour badly – like intravenous drug use or like
prostitution – that's the cause of HIV
[(Ying – China)]
The perceptions of many participants towards the people portrayed
in the scenarios they were presented with showed compassion and un-
derstanding. Other participants, however, were struggling more to rec-
oncile differences between their culturally informed personal beliefs
and values, with the professional values expected of a Registered
Nurse. There was considerable variation in the degree to which partici-
pants were willing to embrace different perspectives and values.
4. Discussion
Complex and interrelated factors constructed the students' percep-
tions of PLWA. These perceptions were underscored with the prevailing
culturally construed blame associated with HIV/AIDS and directed to-
wards PLWA. This blame was closely associated with PLWA being held
personally responsible for their own behaviour which was perceived
to have resulted in them contracting HIV/AIDS. In turn, the behaviour,
homosexuality and drug use in particular, contributed to the ‘othering’
of PLWA. Responsibility and homosexuality & drug use, were important
 D. Pickles et al. / Nurse Education Today 49 (2017) 39–44
sub-themes contributing to the construction of the themes, blame and
‘othering’. The stigma found to be attached to PLWA, along with the
blame and ‘othering’ found to be major themes in this study concurred
with and supported the findings reported in previous research (Akansel
et al., 2012; Land & Linsk, 2013; Li, Scott & Li, 2008). However, most
other studies contrasting cultural differences compared people living
in different countries. This is distinct from the study reported here
where the study cohort had different cultural backgrounds but shared
a common context of living and studying in Australia to become Regis-
tered Nurses in Australia. The study demonstrated the diversity among
study participants of their culturally informed perceptions of PLWA.
These perceptions combined to construct the stigma associated with
HIV/AIDS and the stigma associated with homosexuality and illicit
drug use. Having an appreciation of these varied culturally construed
beliefs and perceptions, as well as having an understanding of influ-
ences on them, provides an important platform to the development of
strategies to reduce the stigmas that nursing students may associate
with PLWA.
The study also found that PLWA were generally stigmatised as ‘bad
people’, concurring with previous studies (Bektas & Kulakac, 2007;
Cornelius, 2006). Nursing students participating in this study tended
to perceive and label PLWA as being ‘other’, people likely to be
ostracised or marginalised by society. This and previous studies have in-
dicated PLWA have not only been stigmatised for having HIV/AIDS, but
also assigned one or more co-stigmas for being homosexual or an IV
drug user (Akansel et al., 2012; Land & Linsk, 2013; Li, Scott & Li, 2008).
Understanding the connections between beliefs, perceptions and
the stigmatisation of PLWA provides a basis for addressing this stigma.
Having an awareness and well developed understanding of how their
own beliefs and perceptions are culturally construed is necessary for
nursing students to be able to reflect on those beliefs and perceptions,
and to appreciate those of others. While these understandings provide
an essential prelude for addressing the stigma impacting on PLWA,
this alone may not result in greater empathy for PLWA. The study dem-
onstrated some participants had no willingness to change even with the
knowledge that their perceptions were likely to contribute to the
stigmatisation of PLWA.
4.1. Implications
Whilst HIV/AIDS may be included in nursing curricula in content
about infection control, the physiological response to virus infection
(and so forth), there may be limited attention paid to the aspects of
HIV/AIDS that directly impact the nurse-patient relationship. The fidu-
ciary nurse-patient relationship is vital to patient health and wellbeing.
However, it is important for educators to recognise that simply provid-
ing information to students does not necessarily change stigmatising
perceptions, if students already have negative perceptions about a
group in society, such as PLWA, then they may use new information
to reinforce rather than change their existing perceptions (Pasupathi
& Wainryb, 2010; Wojcieszak, 2011).
Nursing educators also need to be aware that there can be vast dif-
ferences in knowledge, values, perceptions and beliefs in relation to im-
portant social issues between nursing students from different cultural
backgrounds (Jeon & Chenoweth, 2007; Stankiewicz & O'Connor,
2014). Knowledge should not be assumed. Not only can this influence
the direct care provided to patients, it can also be a significant consider-
ation in the ability to competently carry out the educational role that
nurses perform as part of their duties. By including in the nursing curric-
ulum education in relation to comprehending the meaning of being
marginalised by society or being part of a stigmatised minority, students
can better understand difference and embrace diversity (Pasupathi &
Wainryb, 2010). This will enhance the ability of nursing students to pro-
vide holistic nursing care to all patients.
Students also need to be encouraged to examine their own percep-
tions of identity and self-awareness. Many nursing students have an
43
idealism (Day et al., 2005; Johnson, Haigh & Yates-Bolton, 2007) that
should be nurtured and channelled into their professional nursing iden-
tity. One study participant made the observation that ‘helping makes
you rich’, this was an example of the esoteric idealism that embodies
nursing and should be embraced by nursing educators. Nurturing and
building on this idealism will help to develop the personal qualities ex-
pected of the nursing profession.
4.2. Strengths and Limitations
In undertaking this research study, the researcher was aware that the
study had both strengths and limitations. The sample of nursing students
who became the participants was selected from one university setting
only. While these nursing students may be typical of nursing students
throughout Australia, this assumption was not examined in the study,
hence the validity of the assumption was not established. While
conducting the study at one university only can be seen as a limitation,
it can also be seen as strength. The study university nursing school had a
sizable international student cohort, enabling a culturally diverse study
sample being available for this study. The diversity of the study participant
group strengthened the study's findings and recommendations, and may
not have occurred if the study had been conducted in a university with a
small international student population. Nevertheless, these findings need
to be seen in the context of the study sample which is quite specific and
caution is advised in attempting to transfer the findings to other settings.
Several scenarios or vignettes were used during the participant in-
terviews. The researcher gave careful consideration before making the
decision to the use of such an approach. These scenarios or vignettes
evolved from the researcher's own experiences of nursing PLWA, were
based upon real people and situations and were independantly evaluat-
ed and appraised for their suitability by a highly experienced HIV/AIDS
nursing clinician. While they were used as an aid to stimulate thought
and discussion during the interviews, they were somewhat confronting
for participants, thus possibly influencing their perceptions and dis-
course during interview. By writing and presenting the sceanarios in
this manner, there was a risk of reinforcing sterotypical perceptions
the nursing students may have previously had of HIV/AIDS and of
PLWA. However, the vignettes were only a starting point, the interviews
flowed from there and participants were completely free to expound
their own thoughts, beliefs and perceptions.
5. Conclusion
The culturally construed beliefs and perceptions of nursing students
can be directly related to the stigma impacting on PLWA. Australia has
one of the most culturally diverse populations in the world, therefore
for Australian society to continue to develop and flourish, cultural plu-
rality must be embraced. With international nursing students, from a
rich diversity of cultures, accounting for some 16% of nursing students
in Australia, nursing education must be attuned to the wide variety of
socio-cultural contexts which shape the perceptions of an increasingly
international cohort of nursing students. Educators need to recognise
many nursing students have ingrained personal beliefs and values
which have the potential to impinge on their ability to provide unbiased
nursing care. The issues of stigma and culturally construed perceptions
must be addressed in nursing curricula. This is essential to ensure high
quality and compassionate nursing support is provided to all regardless
of their context or that of the nurse.
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