A qualitative description of service providers' experiences of ethical issues in HIV care.

BACKGROUND: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. PURPOSE: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. RESEARCH DESIGN: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. PARTICIPANTS AND CONTEXT: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. ETHICAL CONSIDERATIONS: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. FINDINGS: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. DISCUSSION: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. CONCLUSION: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

The promotion of mental health through cultural values, institutions, and practices: a reflection on some aspects of botswana culture.

Botswana has seen rapid socioeconomic development since the 1970s that has contributed to the erosion of the values, institutions, and practices that are believed to be supportive of mental health. In this paper, the author argues that the aspects of culture that are supportive of mental health have been diluted by the process of urbanization and the interactions of Batswana (the indigenous people of Botswana) with other cultural groups, particularly those from the western hemisphere. The paper further highlights some of the values, institutions, and practices native to Botswana and describes how they promote mental health. Lastly, recommendations for reviving the cultural values, institutions, and practices of Botswana are discussed.

The illness demands of diabetes on couples in Botswana.

This report is part of a larger study that investigated the relationships between illness demands, marital support, and psychological adjustment in the context of diabetes mellitus in rural and urban middle-aged marital couples in Botswana. Ninety-six persons experiencing diabetes and 87 of their spouses participated in the study. This report is based on data from 87 diabetic patients and their spouses. Data were collected through face-to-face interviews. Patients and their spouses were interviewed separately. Three open-ended questions elicited participants' personal experiences of illness demands. The couple participants reported many challenging illness experiences associated with the illness and contextual factors that influenced their perception about the burden of illness and reported that the illness experienced was often a growth-enhancing and maturing process.

Nursing, healthcare, and culture: a view of the year 2050 from Botswana and Israel.

This column presents a dialogue with nurse scholars Motshedisi B. Sabone from Botswana and Freda DeKeyser Ganz from Israel, who share their respective visions and understanding of each country's vision of nursing, healthcare, and quality of life in the year 2050.