Response to "Measuring Attitudes toward Persons with AIDS: The AAS-G as an Alternate Form of the AAS"
Stewart, Barbara M. PhD, Rn, Scholarly Inquiry for Nursing Practice
During seven years of researching family transitions over the AIDS trajectory across the United States (Giacquinta, nee Stewart, 1989; 1990; Stewart, 1994), I encountered the gamut of attitudes depicted in the carefully researched, thoughtprovoking article by Froman and Owen. At one end of the spectrum were family and community members who blamed and shamed persons with AIDS (PWA), judged their friends and families harshly, terminated interactions, or abused those experiencing AIDS. At the other end were those who threw themselves into the front line defense against the effects of the disease. They reacted against the stigma and discrimination, gathered available information about the disease, devoted themselves to care and/or intimacy with PWA, and even prepared or dedicated themselves for AIDS-related employment. I witnessed intensely polarized attitudes toward PWA during those years.
Sadly, the majority of the families that I studied mirrored the stigma and ostracism that were predominant in society at that time. These families kept HIV illness a secret; they felt plagued too. They isolated themselves within their own communities, felt alienated, and presumed that they caused the PWA to have problems that led to AIDS. These families became second-order patients, experiencing psychological problems across the longitudinal process of living with a PWA.
But a small number of families were able to struggle valiantly against the attitudes that prevailed in society and the deadly prognosis that was AIDS at that time. They fought rejection, fear, and isolation. Together with their PWA, they empowered themselves, took an active role in health-related decision making, and asserted control over their lives. They surmounted transitions effectively and strengthened the family in the process of living with AIDS.
At the time that I was engrossed with families infected/affected by HIV disease, I narrowed my field of study to specify and describe family transitions across the AIDS trajectory. None of the attitudes that ranged from obvious to subtle was measured. How valuable it would have been to accurately evaluate attitudes toward PWA as the disease hit major cities and small neighborhoods. Had I been able to use Froman and Owen's alternate tool, I would have been eager to learn how attitudes toward PWA varied in different regions of the United States. The tool could have been shared with other nurses around the world to measure and compare attitudes of American adults with adults in other English-speaking countries. How did attitudes shift as the disease became more common in various locations? Did attitudes improve when AIDS became more of a chronic illness than a terminal one? Were attitudes in families affected by the ups and downs of the illness? Was the trajectory itself influenced by the attitudes that Froman and Owen now measure? How did attitudes toward PWA differ among members of families of origin and families of choice? Did attitudes vary with increased exposure to PWA and/or with the increased life span of PWA? Did attitudes of family members shift in the stages of living with HIV/AIDS, the living-dying interval, or bereavement? Over time were attitudes toward PWA less polarized? These were some of the questions that were prompted by Froman and Owen's article.
As Froman and Owen indicate, it is important for nurses and/or others involved in the field to measure attitudes of adults to PWA as the face of AIDS and its treatment are changing. When I was active in AIDS research/care/education, negative attitudes against women, African Americans, Hispanics, poor, and intravenous drug users with HIV/AIDS, as well as homophobia, abounded. …