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Rutgers College of Nursing: Improving Care Through HIV/AIDS Research

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Having a life-threatening disease is traumatic. Add social stigma, with the potential loss of job and family, and there is much more at stake. Research being conducted at the Rutgers College of Nursing addresses those multifaceted issues with the goal of improving patient care for this global health issue.

Leading the research program is dean of the College of Nursing, Dr. William Holzemer. Dean Holzemer and a group of faculty members  are conducting these studies worldwide as part of  the International HIV Nursing  Research Network. The statistics underline the importance of HIV/AIDS research. Globally, more than 33 million people are infected with HIV, according to the World Health Organization. One million live in the U.S.; one in five is unaware of his or her infection, according to the Centers for Disease Control.

Prevention—U.S.

One novel approach to HIV prevention focuses on relationship issues of young urban women. “More than 90 percent of women with HIV become infected through unprotected sex with a male partner,” according to Dr. Rachel Jones, associate professor. The study, conducted by Dr. Jones and her team, employs a cell-phone soap opera series featuring women who, after engaging in high-risk behavior, transform and make healthier choices with sexual partners. Half of 250 participants receives one episode weekly by cell phone; half gets similar content on HIV prevention via text messages. “Knowledge has a limited role in whether condoms are used,”  Dr. Jones says. The way men and women communicate about sex has a much stronger influence on behavior. The video takes a phrase like “Why do you need a condom if you’re having sex with only me?” and turns it around to “It’s because I love you and care”  that condom use is important. Identifying with the heroines in the stories who grow and change encourages women to draw on their own strength and wisdom. Early feedback on Jones’s research indicates the soap operas are very popular. Results of this NIH-funded study will be released by early  summer. If the study’s approach works, distribution may be expanded, allowing women worldwide to  take their places on the front lines  of HIV prevention.

Prevention—Africa

Another study focuses on the impact faith-based organizations have on AIDS prevention in Malawi, Africa. “Malawi is a country heavily impacted by HIV with up to a 14 percent infection rate,” says Assistant Professor Dr. Teri Lindgren. In that small nation, religious organizations own and operate hospitals and clinics. Five religious groups were studied: Anglicans, Catholics, Baptists, Pentecostals and Muslims. Researchers interviewed leaders, local church or mosque clerics and congregation members. “We found that while the government sent out messages to abstain, be faithful and use condoms, the religious organizations only preached abstinence,” she says. “Condoms were associated with promoting promiscuity and failing  to be a good Christian or Muslim.”As a follow up to the study, Dr. Lindgren hopes to conduct an intervention with Muslims. “They were the group most interested in doing more,” she says. People in all religious groups were unaware that HIV could be transmitted from mother to child. That new information may initiate an effort to have pregnant women tested so transmission can be reduced.

Depression Management

Many years ago, when Dr. Lucille Eller, associate professor, cared for her first patient with AIDS, she observed that he suffered from severe depression. “What we’ve learned since then is that people with HIV who are depressed have poor medication adherence, are more likely to engage in risky behaviors and have more rapid disease progression,” she says. She is currently involved in research to identify factors that affect depression in this population. “Depression is common, with a prevalence of up to 60 percent in patients with HIV versus 2 to 9 percent in the general population,” she says. The current study examines how self-efficacy, self-esteem and self-compassion affect depression in 1,800 patients worldwide from Thailand, China, Africa, Canada, the U.S. and Puerto Rico. Results are planned for release this spring.

Self-Management

Dr. Dean Wantland, assistant professor, is exploring how a web-based video podcasting system called the ViP may help patients with HIV better manage their symptoms and stay on medication. Intervention patients will use the interactive ViP System compared to “usual-care” patients who access general Internet information.“With the ViP System, patients enter their symptoms and receive tailored strategies to deal with them,” Dr. Wantland says. Each time patients sign in, symptoms can be compared. “ViP may provide a way to improve patients’ relationships with their healthcare providers,” he says. The system can provide monthly progress reports on symptom management and how faithfully patients take medications. If the system proves effective in improving quality of life and medication adherence, it could be expanded nationally.

The Future

Dr. Holzemer says nurse scientists worldwide are conducting research in many areas that impact prevention and quality of life for people living with chronic illness, such as HIV/AIDS. Being on the front line of care, nurses are concerned with everything that could affect their patients. “As nurses, that’s what we do,” Dr. Holzemer says. “We help people live with their conditions and maximize their quality of life.