Bermingham S, Kippax S
School of Behavioural Sciences, Macquarie University, Sydney, NSW.
Aust Fam Physician. 1998 Jul;27 Suppl 2:S60-5.
Reports into HIV-related discrimination reveal continuing concerns about the behaviour of health care workers, particularly with reference to practices such as excessive or selective infection control. This study examines whether the selective adoption of an infection control procedure (using gloves during venipuncture) is related to discriminatory attitudes, anxiety about HIV/AIDS and the degree of contact with HIV-infected patients.
In 1993 and 1994, 451 general practitioners (GPs) were surveyed in six of the 12 New South Wales Health Areas and Regions. The sample included 49 anti-retroviral prescribers. GPs were presented with six patient scenarios and asked with whom they would use gloves during venipuncture.
41.9% of GPs reported that they would selectively use gloves, and generally targeted the homosexual patient only, or combinations of patients that included the homosexual man. GPs revealed poor compliance with universal precautions, as only 37.5% reported that they would use gloves with all of the six patients. Intended glove use was significantly related to HIV-related discrimination (p < 0.0001) and anxiety about HIV/AIDS (p < 0.0001). GPs who selectively chose to use gloves had the highest discrimination and anxiety scores; GPs who chose not to use gloves with any of the patients had the lowest discrimination and anxiety scores, and were more likely to work in HIV medicine. Except for differences in Health Area, this study did not identify any factors that helped to explain which GPs consistently followed universal precautions.
This study demonstrates that selective infection control is related to discriminatory attitudes and anxiety about HIV/AIDS. GPs can avoid a discriminatory practice by consistently following universal precautions. More research is needed to identify the factors that promote good infection control practices.
有关艾滋病毒相关歧视的报告显示，人们持续关注医护人员的行为，尤其是过度或选择性感染控制等做法。本研究调查了选择性采用一种感染控制程序（静脉穿刺时戴手套）是否与歧视态度、对艾滋病毒/艾滋病的焦虑以及与艾滋病毒感染患者的接触程度有关。
1993年和1994年，在新南威尔士州12个卫生区和地区中的6个对451名全科医生进行了调查。样本包括49名抗逆转录病毒药物开处方者。向全科医生展示了六个患者场景，并询问他们在静脉穿刺时会与谁戴手套。
41.9%的全科医生报告说他们会选择性地使用手套，通常只针对同性恋患者，或包括同性恋男性在内的患者组合。全科医生对普遍预防措施的依从性较差，因为只有37.5%的人报告说他们会对所有六个患者都使用手套。预期的手套使用与艾滋病毒相关歧视（p<0.0001）和对艾滋病毒/艾滋病的焦虑（p<0.0001）显著相关。选择性选择使用手套的全科医生的歧视和焦虑得分最高；选择不对任何患者使用手套的全科医生的歧视和焦虑得分最低，并且更有可能从事艾滋病毒医学工作。除了卫生区的差异外，本研究没有发现任何有助于解释哪些全科医生始终遵循普遍预防措施的因素。
本研究表明，选择性感染控制与对艾滋病毒/艾滋病的歧视态度和焦虑有关。全科医生可以通过始终遵循普遍预防措施来避免歧视性做法。需要更多的研究来确定促进良好感染控制做法的因素。
