In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
Spanish Nu sing S uden s’ A i udes owa d People
Li ing wi h HIV/AIDS: A C oss-Sec ional Su ey
Ma ía Adelaida Ál a ez-Se ano 1, Enca nación Ma ínez-Ga cía2,3 ,
Adelina Ma ín-Sal ado 4,* , Ma ía Gázquez-López 1,*, Ma ía Dolo es Pozo-Cano 2,
Ra ael A. Capa ós-González 2,5 and Ma íaÁngeles Pé ez-Mo en e 6
1Depa men o Nu sing, Facul y o Heal h Sciences, Uni e si y o G anada, 51001 Ceu a, Spain;
adeal a ez@ug .es
2Depa men o Nu sing, Facul y o Heal h Sciences, Uni e si y o G anada, 18016 G anada, Spain;
ema inez@ug .es (E.M.-G.); pozocano@ug .es (M.D.P.-C.); cg477@ug .es (R.A.C.-G.)
3Guadix High Resolu ion Hospi al, 18500 Guadix, G anada, Spain
4Depa men o Nu sing, Facul y o Heal h Sciences, Uni e si y o G anada, 52005 Melilla, Spain
5Mind, B ain and Beha io Resea ch Cen e (CIMCYC), Facul y o Psychology, Uni e si y o G anada,
18016 G anada, Spain
6Depa men o Nu sing, Facul y o Heal h Sciences, Uni e si y o Jaén, 23071 Jaén, Spain;
[email p o ec ed]
*Co espondence: adema in@ug .es (A.M.-S.); mgazquez@ug .es (M.G.-L.)
Recei ed: 25 Augus 2020; Accep ed: 19 No embe 2020; Published: 22 No embe 2020
Abs ac :
Human immunode iciency i us (HIV) in ec ion is s ill a public heal h issue. Human
immunode iciency i us/acqui ed immune de iciency synd ome (HIV/AIDS) c ea es, in socie y,
s igma izing a i udes, ea , and disc imina ion agains in ec ed people; e en heal h p o essionals do
no eel ained enough o adequa ely ake ca e o hese pa ien s, which a ec s he quali y o ca e
p o ided o such pa ien s. The pu pose o his s udy was o explo e nu sing s uden s’ a i udes and
o he ela ed ac o s owa d people wi h HIV/AIDS, as well as hei e olu ion in subsequen academic
yea s. A c oss-sec ional s udy was pe o med wi h s uden s in ou academic yea s om ou Spanish
heal h sciences ins i u ions (n=384). Da a we e collec ed olun a ily and on an anonymous basis,
u ilizing he “Nu sing s uden s’ a i udes owa d AIDS” (EASE) alida ed scale. The s uden s’
a i udes owa d people wi h HIV/AIDS we e ela i ely posi i e, wi h a o al mean EASE alue
o 85.25
±
9.80. S a is ically signi ican di e ences we e obse ed acco ding o he academic yea
(p=0.041), in 4 ou o 21 i ems o he scale and among s uden s wi h no eligious belie s. By adjus ing
e e y a iable, only he weak associa ion wi h eligion was main ained (p=0.045).
Keywo ds: a i udes; HIV/AIDS; s uden s; nu sing
1. In oduc ion
Human immunode iciency i us (HIV) in ec ion is s ill an in e na ional public heal h p oblem [
1
,
2
].
In 2018, an es ima ed 37.9 million people wo ldwide we e in ec ed, o which 24.5 million people we e
ea ed wi h an i e o i al medica ions by mid-2019 [
3
]. In his sense, he Wo ld Heal h O ganiza ion,
wi hin he Sus ainable De elopmen Goals o he yea 2030, included as a global goal o educe HIV
in ec ion o ze o con agions, ze o disc imina ion, and ze o dea hs caused by he i us [2,4].
Today, pa icula ly in de eloped coun ies, people wi h HIV li e longe and expe ience he
disease as a ch onic condi ion, he mos common como bidi ies being ca dio ascula diseases, kidney
diseases, psychia ic diso de s, and neoplasias, mainly associa ed wi h aging [
3
,
5
,
6
]. Cu en ly,
ha ing HIV/AIDS s ill has a signi ican impac on he economic, poli ical, legal, and social le els [
1
,
2
].
In . J. En i on. Res. Public Heal h 2020,17, 8672; doi:10.3390/ije ph17228672 www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2020,17, 8672 2 o 9
Rega ding he la e , i has been documen ed ha HIV/AIDS gene a es, among people, s igma izing
a i udes, ea , and disc imina ion agains in ec ed pe sons [7].
Fu he mo e, wi h he passing o ime, as he disease se les in socie y, knowledge and educa ion
abou HIV/AIDS ha e been educed [
8
]. In he ield o heal h, se e al au ho s s a e ha e en heal hca e
wo ke s who a e mo e exposed o wo k acciden s wi h biological ma e ials [
9
], such as nu sing s uden s
and p o essionals, do no eel p epa ed enough o ea such pa ien s adequa ely [
6
,
8
,
10
,
11
]. Va iables
such as ideology, age, s ess, and nega i e opinions on homosexuali y a ec heal hca e p o essionals’
a i udes owa d people wi h HIV/AIDS [
1
]. In addi ion, he lack o knowledge and he exis ence o
e oneous concep s as ega ds ansmission o HIV no only os e s igma izing a i udes and ea
o con agion, bu hey also impac clinical p ac ices ela ed o HIV/AIDS and he quali y o he ca e
ecei ed by se oposi i e pa ien s [
6
,
10
,
12
–
14
]. In ela ion o hese a i udes, in a s udy ca ied ou
by Valencia e al., i was e lec ed ha women wi h HIV el ha hey we e mis ea ed by heal h
p o essionals and ha hei igh s o con iden iali y and p i acy we e iola ed [
15
], which undoub edly
unde mines legisla ion and e hics o ca e [12,13]
Wi h espec o he assessmen s o HIV/AIDS pa ien s pe o med by nu sing s uden s, he e is
esea ch ha a i ms ha hese nega i e e alua ions a e ela ed o s igmas ela ed o p omiscui y,
d ug addic ion, and homosexuali y [
8
,
16
,
17
]. In o de o change such pe cep ions, many esea ch
con ibu ions ha e shown ha an inc ease in knowledge in his a ea educes ea and anxie y [6,11].
Al hough i is easonable o hink ha nu sing s uden s’ nega i e a i udes owa d people wi h
HIV/AIDS will diminish as hei academic le el inc eases, he e is a disc epancy in scien i ic li e a u e
ega ding such a hypo hesis [
1
,
18
,
19
]. The e o e, he objec i e o his s udy is o explo e nu sing
s uden s’ a i udes and o he ela ed ac o s owa d HIV/AIDS and hei e olu ion in subsequen
academic yea s.
2. Ma e ials and Me hods
2.1. Da a Collec ion
An online, c oss-sec ional su ey was conduc ed anonymously by sel -adminis a ion.
The pa icipan s we e nu sing s uden s om ou Spanish heal h sciences, ins i u ions wi h a
ou -yea -long s udy p og am o 240 c edi s. Al hough hese ou ins i u ions a e loca ed in di e en
geog aphical a eas, s uden
´
s sociocul u al le els o simila . The collec ion o he ques ionnai es was
adminis e ed simul aneously in he ou ins i u ions du ing one mon h o he 2019–2020 academic
yea . I was sen h ough he eaching suppo pla o m, and pa icipa ion was olun a y ou side o
class hou s h ough he eaching suppo pla o m. The membe s o he esea ch g oup in i ed all
s uden s en olled ac oss he ou academic yea s o pa icipa e. A e he i s dissemina ion o he
ques ionnai e, a eminde was sen o hose s uden s who had no ye answe ed he su ey.
2.2. Measu emen Tool
Fo da a collec ion, he “Nu sing s uden s’ a i udes owa d AIDS” (EASE) one-dimensional scale
was employed, he Spanish e sion o which was ini ially c ea ed and alida ed by Tom
á
s-S
á
bado
(Appendix A) [
20
]. This ool showed good in e nal alidi y in he iden i ica ion o nu sing s uden s’
a i udes owa d HIV/AIDS in Spain (C onbach’s alpha coe icien =0.779). This scale comp ises
21 i ems wi h Like - ype esponses anging om 1 = o ally ag ee o 5 = o ally disag ee. The sco e
o each i em depends on i s di ec ionali y. I ems 3, 5, 7, 8, 11, 14, 15, and 21 a e sco ed om 5 o 1,
5 being o ally ag ee and 1 being o ally disag ee, and i ems 1, 2, 4, 6, 9, 10, 12, 13, and 16–20 a e
sco ed om 1 o 5, 1 being o ally ag ee and 5 being o ally disag ee. The scale’s maximum sco e is
105, which indica es he mos posi i e a i udes, and he minimum sco e is 21, which indica es he
mos nega i e and p econcei ed a i udes. Fo each pa icipan , he scale’s global alue was calcula ed
by adding each i em’s sco e (wi h a o al o 21 sco es). The o iginal scale was used in mos o he
s udies analyzed [
1
,
21
,
22
]. Addi ionally, he ollowing sociodemog aphic a iables we e conside ed:
In . J. En i on. Res. Public Heal h 2020,17, 8672 3 o 9
age, sex (male o emale), academic yea , ma i al s a us (in a ela ionship o no in a ela ionship),
sexual o ien a ion (he e osexual o non-he e osexual), and eligion (wi h eligious belie s o wi h no
eligious belie s).
2.3. Da a Analysis
P io o da a analysis, he in e nal consis ency o he scale was assessed by de e mining C onbach’s
alpha, wi h a sa is ac o y esul o 0.776. Nex , a desc ip i e analysis o he en i e sample was ca ied
ou by means o absolu e and ela i e equencies and he calcula ion o measu es o cen al endency
(i.e., median and s anda d de ia ion) acco ding o he quan i a i e o quali a i e na u e o he s udy’s
a iables. The scale’s no mali y o alues was explo ed, and as a esul o no being possible o e i y
hei pa ame ici y, o he in e en ial s a is ics, a nonpa ame ic analysis was adop ed. Di e ences
among he scale’s alues acco ding o he sociodemog aphic a iables and academic yea ca ego ies
we e analyzed h ough he Mann–Whi ney U es , and o a iables wi h mo e han wo ac o s,
he K uskal–Wallis H es was employed. In cases o signi ican di e ences among academic yea s,
pos -hoc mul iple compa isons we e ca ied ou h ough Bon e oni co ec ion. The e ec size was
calcula ed using Ke by
´
s o mula [
23
]. To es ablish a co ela ion be ween age and he inal sco e o
he EASE scale, Spea man’s Rho was used. Finally, he in luence o he sociodemog aphic a iables
and academic yea on he EASE scale’s inal sco e was explo ed by using a mul iple linea eg ession
model h ough he “in oduce” me hod, in which he academic yea , e-ca ego ized in o h ee dummy
a iables, was included, aking he i s yea as e e ence. Da a we e ea ed wi h he S a is ical Package
o he Social Sciences (SPSS) p og am, e sion 25, (IBM, New Yo k, NY, USA, o Windows).
2.4. E hical Conside a ions
This s udy complies wi h he good clinical p ac ice egula ions, as s a ed in he Eu opean Di ec i e
2001/20/CE and Law 14/2007, o 3 July, on biomedical esea ch. T ea men o pe sonal da a in heal h
esea ch is go e ned by O ganic Law 3/2018, o 5 Decembe , on Da a P o ec ion and Gua an ee o
Digi al Righ s. E e y pa icipan checked a box indica ing consen o pa icipa e in he s udy.
3. Resul s
The sample included 384 s uden s, wi h he esponse a e being 18%. Twen y-nine pe cen o he
sample (n=115) we e in hei i s yea o s udy. Wi h ega ds o sex, 84% we e women, and he o al
mean age was 23
±
6.7 yea s. In e ms o academic yea , he mean age was signi ican ly highe o
hose in hei ou h yea o s udy (p<0.001). Wi h espec o s uden s’ sexual o ien a ion, 337 (87.8%)
we e he e osexual, a highe p opo ion o which was obse ed in he hi d yea o s udy (p=0.012).
Rega ding ela ionship s a us, 207 (53.9%) s a ed hey we e no in a ela ionship, he ou h yea o
s udy being he yea wi h a highe numbe o s uden s in a ela ionship (p=0.008). O he o al numbe
o s uden s, 265 (69%) conside ed hemsel es as ha ing eligious belie s (Table 1).
The o al EASE sco e in he analyzed sample was 85.25
±
9.80. Table 2shows such alues acco ding
o sociodemog aphic a iables and academic yea . Among he second-yea s uden s and among
hose wi h no eligious belie s, he highes s a is ically signi ican sco es we e obse ed (p=0.041,
and p=0.006, wi h an e ec size o 0.17, espec i ely) (Table 2). Signi ican causes acco ding o
academic yea we e iden i ied in he second and i s yea o s udy (p=0.050 wi h an e ec size o
−0.22) ( esul s no shown).
The scale i ems ha eached a highe mean sco e we e P1 (“AIDS does no a ec he e osexual
couples”) wi h 4.62
±
1.01 and P11 (“being an AIDS ca ie should no be a ba ie o accessing
educa ion and employmen ”) wi h 4.68
±
0.87. Such i ems show he highes pe cen ages o “disag ee”
and “ag ee” answe s, wi h 83.1% and 83.9%, espec i ely ( esul s no shown).
In . J. En i on. Res. Public Heal h 2020,17, 8672 4 o 9
Table 1. Sociodemog aphic a iables o he sample acco ding o academic yea .
Va iables
1s Yea
(n=115)
2nd Yea
(n=104)
3 d Yea
(n=86)
4 h Yea
(n=79)
TOTAL
(n=384) p
M (SD) M (SD) M (SD) M (SD) M (SD)
Age (yea s) 21.37 (6.34)
22.79 (6.46) 23.71 (6.22) 25.46 (7.57) 23.12 (6.70)
<0.001 **
n(%) n(%) n(%) n(%) n(%)
Sex
Male 15 (13) 19 (18.3) 19 (22.1) 9 (11.4) 62 (16.1) ns
Female 100 (87) 85 (81.7) 67 (77.9) 70 (88.6) 322 (83.9)
Sexual o ien a ion
He e osexual 106 (92.2) 94 (90.4) 76 (88.4) 61 (77.2) 337 (87.8) 0.012 *
Non-he e osexual
9 (7.8) 10 (9.6) 10 (11.6) 18 (22.8) 47 (12.2)
Rela ionship s a us
No in a
ela ionship 67 (58.3) 60 (57.7) 51 (59.3) 29 (36.7) 207 (53.9) 0.008 **
In a ela ionship 48 (41.7) 44 (42.3) 35 (40.7) 50 (63.3) 177 (46.1)
Religion
Wi h eligious
belie s 74 (64.3) 71 (68.3) 64 (74.4) 56 (70.9) 265 (69) ns
Wi h no
eligious belie s 41 (35.7) 33 (31.7) 22 (25.6) 23 (29.1) 119 (31)
M=mean; SD =s anda d de ia ion; ns =p>0.05; * =p≤0.05; ** =p≤0.01.
Table 2.
Desc ip i e s a is ics o he EASE scale acco ding o he sociodemog aphic a iables and
academic yea .
Va iables M (SD) Mann–Whi ney
UTes pKe by´s
Sex 8836.5 ns
Male 84.52 (8.59)
Female 85.57 (9.68)
Sexual o ien a ion 9212 ns
He e osexual 85.08 (9.45)
Non-he e osexual 87.7 (9.75)
Rela ionship s a us 19,259.5 ns
No in a ela ionship 85.82 (9.58)
In a ela ionship 84.91 (9.45)
Religion 13,023.5 0.006 ** 0.17
Wi h eligious belie s 84.67 (9.14)
Wi h no eligious belie s 87.03 (10.14)
K uskal–Wallis HTes
Academic yea 8.27 0.041 *
Bon e oni Co ec ion
Fi s 85.15 (8.33) 7283 0.50 * −0.22
Second 86.39 (10.86)
Thi d 85.58 (8.48)
Fou h 85.72 (10.23)
To al 85.25 (9.80)
M=mean; SD =s anda d de ia ion; ns =p>0.05; * =p≤0.05; ** =p≤0.01.
Wi h espec o he ques ions asked in he scale, he e we e signi ican di e ences among academic
yea s in 4 ou o he 21 i ems included, namely in i em 2 (“ e uses in ec ed wi h AIDS should be
abo ed”), 3 (“ he e is no isk a ising om AIDS ca ie s’ use o es au an s and pubs”), 4 (“se oposi i e
women should no be allowed o ge p egnan ”), and 16 (“in hospi als, AIDS ca ie s should no sha e
a oom wi h non-in ec ed pe sons”) (Table 3). The causes o he signi icance among academic yea s in
In . J. En i on. Res. Public Heal h 2020,17, 8672 5 o 9
i em 2 we e obse ed be ween he i s and second yea s (p=0.041), be ween he i s and hi d yea s
(p=0.0001), and be ween he i s and ou h yea s (p=0.021); in i em 3, be ween he i s and second
yea s (p=0.022); in i em 4, be ween he i s and hi d yea s (p=0.018); and in i em 16, be ween he
i s and second yea s (p=0.014) ( esul s no shown). In all cases, he i s -yea sco e was lowe han
ha ob ained in he subsequen yea s.
Table 3. Desc ip i e s a is ics o he EASE scale i ems, acco ding o academic yea .
1s Yea
(n=115)
2nd Yea
(n=104)
3 d Yea
(n=86)
4 h Yea
(n=79) K uskal–Wallis
HTes p
M (SD) M (SD) M (SD) M (SD)
P1 4.61 (0.99) 4.61 (0.99) 4.62 (1.04) 4.68 (0.96) 0.76 ns
P2 4.11 (0.83) 4.34 (0.95) 4.58 (0.77) 4.46 (0.73) 21.48 <0.001 **
P3 3.87 (1.33) 4.34 (1.09) 4.05 (1.24) 4.03 (1.36) 8.69 0.034 *
P4 4.07 (0.95) 4.31 (0.87) 4.43 (0.83) 4.38 (0.85) 10.85 0.013 *
P5 4.37 (1.06) 4.14 (1.35) 4.06 (1.27) 4.28 (1.09) 3.04 ns
P6 4.57 (0.64) 4.62 (0.77) 4.47 (0.84) 4.52 (0.83) 2.68 ns
P7 4.43 (1.04) 4.19 (1.22) 4.01 (1.27) 4.25 (1.17) 6.9 ns
P8 3.57 (1.27) 3.67 (1.30) 3.6 (1.37) 3.75 (1.25) 1.03 ns
P9 4.29 (0.91) 4.42 (0.9) 4.45 (0.76) 4.25 (1.01) 3.09 ns
P10 2.97 (1.22) 3.19 (1.34) 3.2 (1.26) 3.35 (1.26) 5.21 ns
P11 4.71 (0.69) 4.67 (0.98) 4.7 (0.84) 4.7 (0.82) 1.61 ns
P12 3.8 (1.05) 4 (1.08) 3.91 (1.04) 4.01 (1.15) 3.95 ns
P13 3.62 (1.11) 3.78 (1.12) 4.03 (1.02) 3.78 (1.17) 6.99 ns
P14 2.03 (1.1) 2.12 (1.14) 2.21 (1) 2.15 (1.05) 2.33 ns
P15 4.5 (0.86) 4.43 (1.03) 4.44 (1.08) 4.43 (0.96) 0.73 ns
P16 4 (0.98) 4.36 (0.94) 4.19 (1.00) 4.1 (1.03) 9.57 0.023 *
P17 4.38 (0.94) 4.58 (0.87) 4.47 (0.93) 4.38 (0.97) 4.44 ns
P18 4.57 (0.65) 4.66 (0.71) 4.49 (1.02) 4.44 (0.98) 3.39 ns
P19 4.23 (0.95) 4.38 (0.89) 4.4 (0.77) 4.47 (0.88) 4.39 ns
P20 4 (1.30) 3.94 (1.34) 3.86 (1.31) 3.71 (1.40) 2.75 ns
P21 3.45 (1.28) 3.64 (1.32) 3.43 (1.39) 3.59 (1.32) 1.96 ns
M=mean; SD =s anda d de ia ion; ns =p>0.05; * =p
≤
0.05; ** =p
≤
0.01. De ini ions o P1–21 can be ound in
Appendix A.
In he mul iple linea eg ession model, i was obse ed ha by adjus ing all a iables, only eligion
was associa ed wi h he scale alues, wi h hose s a ing no eligious belie s showing mo e a o able
a i udes owa d HIV/AIDS ((95% CI: 0.05–4.26); p=0.045) (Table 4).
Table 4. Mul iple linea eg ession model o he EASE scale.
Va iables ß SD p95% CI
Age –0.029 0.08 0.704 −0.18 0.12
Sex
Male
Re e ence
Female 1.63 1.36 0.228 −1.03 4.30
Rela ionship s a us
In a ela ionship
Re e ence
No in a ela ionship 0.54 1.03 0.595 −1.48 2.58
Sexual o ien a ion
He e osexual
Re e ence
Non-he e osexual 2.12 1.56 0.171 −0.93 5.18
Religion
Wi h eligious belie s
Re e ence
Wi h no eligious belie s 2.15 1.07 0.045b * 0.05 4.26
Academic yea
Fi s
Re e ence
Second 2.42 1.29 0.060 −0.11 4.95
Thi d 1.78 1.37 0.194 −0.91 4.47
Fou h 1.60 1.45 0.269 −4.46 1.25
ß=Be a coe icien ; * =p≤0.05; CI: con idence in e al.

In . J. En i on. Res. Public Heal h 2020,17, 8672 6 o 9
4. Discussion
The a i udes owa d people wi h HIV/AIDS o he s uden s ha pa icipa ed in he s udy
we e ela i ely posi i e o a o able, since hey indica ed a mean EASE sco e abo e 85 poin s,
as ecommended by Tom
á
s-S
á
bado and A adilla-He e o [
1
]. This esul coincides wi h ha epo ed in
se e al simila ly designed s udies [
1
,
21
,
24
], ein o cing he idea ha nu sing, as a p o ession, h ough
i s humanis ic app oach, gene a es among u u e p o essionals posi i e a i udes owa d an in ec ion
such as HIV o a disease such as AIDS [25].
Acco ding o he academic le el, some di e ences we e ound in he EASE sco es, he i s
academic yea ’s sco e being lowe han hose ob ained in subsequen yea s. Such a esul coincides
wi h ha published by Ley a-Mo al e al., whe e he lowes pe cen age o posi i e a i udes was
obse ed among i s -yea s uden s [
25
]. Ne e heless, di e ences in sco es we e ound be ween he
second- and i s -yea s, bu no in subsequen yea s wi h espec o he i s one, which con adic s
p e ious s udies ega ding an inc ease in a o able a i udes as he academic le el inc eases [1,18].
Some au ho s ha e s a ed ha when acing p oblems ha a e especially sensi i e a a social le el
and ha a e ideologically cha ged, such as HIV and AIDS, an inc ease in knowledge alone is no
enough o change people’s belie s o a i udes [
22
,
24
–
27
]. Fu he mo e, con ac wi h ac ual pa ien s
occu ing in subsequen yea s du ing clinical p ac ice, on he con a y, could inc ease ea o con agion
among s uden s, hus obs uc ing an ad ance owa d highe le els o disease ole ance, which is an
issue ha equi es u he in es iga ion [22].
The median age o he analyzed sample was in acco dance wi h hose published in
simila
s udies [1,9,21,22,24,25,28]
, co esponding o young adul s, al hough his a iable was no
associa ed wi h a i udes owa d HIV/AIDS. Howe e , he obse ed endency, ha as age inc eased,
a i udes became mo e nega i e, coincides wi h he esul s o o he s udies ha con i med such an
associa ion [25,29–31].
Despi e he ac ha he analysis was econduc ed o assess he EASE scale’s in e nal consis ency
by ob aining a C onbach’s alpha sa is ac o y esul , some i ems showed a change opposi e o he one
expec ed. Tha is, i was expec ed ha in cases o posi i e asse ions he le el o ag eemen would
inc ease and in cases o nega i e asse ions, he le el o disag eemen would inc ease. Howe e , in
e ms o i em 14, “pe sons in ec ed wi h AIDS should be conside ed ic ims o he social sys em,” 66.4%
o s uden s disag eed o o ally disag eed, and o i em 10, “se oposi i e pe sons should be iden i ied
as such,” he opposi e occu ed, i.e., 30% o s uden s ag eed o o ally ag eed. Se ano-Galla do and
Gim
é
nez-Ma o o al eady iden i ied such con adic ions due o a ce ain deg ee o ambigui y in he
wo ding o hese i ems [
9
]. Al hough some o he i ems on he EASE scale could be conside ed ou da ed
a p esen due o clinical and cul u al changes, we belie e ha he scale allows gene al and non-speci ic
a i udes owa d HIV/AIDS among nu sing s uden s o be explo ed [25].
Ha ing no eligious belie s was he only analyzed a iable ha showed an associa ion wi h be e
a i udes owa d HIV/AIDS, ega dless o he in luence o he o he a iables. This esul coincides wi h
he indings o o he s udies, whe e nu sing p o essionals who p ac iced a eligion, o s uden s who
belie ed eligion had a signi ican ole in hei li es o i mly hough ha he disease e iology was due
o di ine e ibu ion, showed mo e s igma izing a i udes owa d hei HIV/AIDS pa ien s [
20
,
32
–
35
].
Limi a ions
This s udy has some limi a ions. Al hough he numbe o s uden s who ag eed o answe he
ques ionnai e was highe han he igu es published in o he s udies [
1
,
9
,
21
,
22
,
24
,
25
,
28
], we belie e
i could be imp o ed, since s uden s who a e mo e awa e o he subjec being analyzed could be
o e ep esen ed. I is also possible ha gi en he sensi i e na u e o he subjec add essed, when asking
o pe sonal opinions, he e could ha e been a social desi abili y bias ha was esol ed by gua an eeing
he anonymous na u e o all pa icipan s. Finally, and as we ha e commen ed p e iously, he clinical
and cul u al changes ha ha e occu ed in he las decade wi h espec o HIV/AIDS could mean ha
In . J. En i on. Res. Public Heal h 2020,17, 8672 7 o 9
some i ems on he scale a e ou o da e, al hough his possible limi a ion is minimized by es ablishing a
gene al analysis o a i udes owa d HIV/AIDS.
Despi e he limi a ions e e ed o abo e, his s udy con ibu es cu en in o ma ion on he
pe sis ence o alse opinions ega ding HIV/AIDS in a a ied sample o nu sing s uden s, since ou
heal h sciences ins i u ions we e analyzed, which we e loca ed in di e en geog aphic a eas bu sha ed
he same cu iculum. Resul s may be use ul o e hink he ype o aining ou s uden s ecei e and
abou he need, he e o e, o es ablish educa ional con en ha os e s close humaniza ion o ca e and
he educ ion o HIV/AIDS-associa ed s igma.
5. Conclusions
Nu sing s uden s’ a i udes owa d HIV/AIDS a e ela i ely posi i e and ge be e ollowing he
i s academic yea . When conside ing all a iables o he s udy, he in luence o he academic le el
waned and he associa ion wi h eligion was main ained. Thus, s uden s wi h no eligious belie s
showed mo e posi i e a i udes owa d his p oblem. An imp o emen in he le el o knowledge and
expe iences among nu sing s uden s does no seem o be enough o cause a change o a i ude, which
may e lec he s ong ideological cha ge ha s ill leads o his heal h issue oday.
I is he e o e necessa y o ca y ou a c i ical analysis o eaching s a egies in cu en nu sing
p og ams in o de o achie e no only be e and mo e in-dep h knowledge o he disease and i s
modes o ansmission, bu also a change o a i ude, ee o nega i e p econcep ions owa d HIV/AIDS.
This app oach would esul in a be e quali y and humaniza ion o he ca e p o ided o people wi h
HIV/AIDS. I would also be pe inen in u u e esea ch o e o mula e some o he i ems on he EASE
scale, adap ing hem o he cu en eali y o people wi h HIV/AIDS.
Au ho Con ibu ions:
Concep ualiza ion, M.G.-L.; me hodology, M.A.
Á
.-S., E.M.-G., and A.M.-S.; in es iga ion,
M.A.
Á
.-S., E.M.-G., A.M.-S., M.G.-L., M.D.P.-C., R.A.C.-G., and M.
Á
.P.-M.; da a cu a ion, M.A.
Á
.-S. and E.M.-G.;
isualiza ion, A.M.-S.; w i ing—o iginal d a p epa a ion, M.A.
Á
.-S., E.M.-G., A.M.-S., M.G.-L., M.D.P.-C.,
R.A.C.-G., and M.
Á
.P.-M.; w i ing— e iew and edi ing, M.A.
Á
.-S., E.M.-G., A.M.-S., M.G.-L., M.D.P.-C., R.A.C.-G.,
and M.
Á
.P.-M.; supe ision, E.M.-G. and M.
Á
.P.-M. All au ho s ead and ag eed o he published e sion o
he manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Acknowledgmen s: To all s uden s who pa icipa ed in his s udy.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
Appendix A
Scale o a i udes owa d AIDS o nu sing.
1. AIDS does no a ec he e osexual couples.
2. Fe uses in ec ed wi h AIDS should be abo ed.
3. The e is no isk a ising om AIDS ca ie s’ use o es au an s and pubs.
4. Se oposi i e women should no be allowed o ge p egnan .
5. AIDS is a p oblem ha a ec s us all.
6. Con inued ca e o an AIDS pa ien is synonymous wi h con agion.
7. AIDS ca ie s a e en i led o doc o –pa ien con iden iali y.
8. In daily ac i i ies, he e is no isk o ansmission o HIV.
9. Pe sons in ec ed wi h AIDS should be sepa a ed om o he sick pe sons.
10.
Se oposi i e pe sons should be iden i ied as such.
11.
Being an AIDS ca ie should no be a ba ie o accessing educa ion and employmen .
12.
Speci ic hospi als o AIDS pa ien s and ca ie s should be c ea ed.
13.
AIDS is he g ea es a lic ion o ou ime.
14.
Pe sons in ec ed wi h AIDS should be conside ed ic ims o he social sys em.
In . J. En i on. Res. Public Heal h 2020,17, 8672 8 o 9
15.
Being an AIDS ca ie should no be a ba ie o adop ing a child.
16.
In hospi als, AIDS ca ie s should no sha e a oom wi h non-in ec ed pe sons.
17.
I would no like o wo k wi h an AIDS ca ie .
18.
Child en who a e AIDS ca ie s should a end special classes.
19.
As a p ecau iona y measu e, we should a oid con ac wi h AIDS pa ien s and ca ie s.
20.
We should always use glo es when ouching someone in ec ed wi h AIDS.
21.
HIV es ing should be olun a y and anonymous.
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