HIV clinic caregivers’ spiritual and religious attitudes and behaviors

doi:10.4236/health.2010.27120

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Vol.2, No.7, 796-803 (2010)

doi:10.4236/health.2010.27120

Health

HIV clinic caregivers’ spiritual and religious attitudes

and behaviors

Elizabeth A. Catlin1*, Jeanne H. Guillemin2, Julie M. Freedman3, Mary Martha Thiel4,

Sandra McLaughlin5, Cheryl D. Stults6, Marvin L. Wang7

1 Ethics, MassGeneral Hospital for Children, Department of Pediatrics, Harvard Medical School, Boston, USA; *Corresponding

Author: ecatlin@partners.org

2Sociology Department, Boston College, Boston, USA

3Infectious Disease Unit, Massachusetts General Hospital, Cambridge, USA

4Clinical Pastoral Education, Hebrew Senior Life/Hebrew Rehabilitation Center, Boston, USA

5Department of Social Services , M as s achusetts General Hospital, Cambridge, USA

6Sociology Department, Brandeis University, Waltham, USA

7MassGeneral Hospital for Children, Massachusetts General Hospital, Boston, USA

Received 10 March 2010; revised 15 March 2010; accepted 16 March 2010.

ABSTRACT

Based on prior research, we hypothesized that

staff in an outpatient clinic caring for an HIV

patient population might rely on religious and

spiritual frameworks to cope with the strains of

their work and that their responses to a spiritual

and religious survey might reflect work-related

spiritual distress. Surveys were completed by

78.7% of s taff (n = 59 ). All res pond ents scored in

the "moderate" range for religious and spiritual

well-being as well as existential satisfaction

with living. The large majority agreed that the

religious and spiritual concerns of p atients hav e

a place in patient care. Nurses, (88.2% of nurse

respondents) viewed assessing the spiritual

needs of patients as their responsibility, (p =

0.03). While 82% of HIV clinic respondents pri-

vately prayed for patients always, often or so-

metimes, this did not include physicians. Phy-

sicians in this clinic setting appeared to be less

spiritual and religious, based on their survey

responses, than coworkers and than US physi-

cians in general. The majority of clinic physi-

cians (78%) believed that God does not suffer

with the suffering patients, in contrast to the

majority of su pport staff (69%) and nearly h alf of

the nurses, who believed that God does suffer

with them, (p = 0.018). Contrary to our expecta-

tion, respondents did not report work-related

spiritual distress, which may be related to im-

proved therapies that can prolong and improve

patients’ lives. Survey data revealed, however, a

surprising level of engagement in and reliance

on spiritual and religious frameworks among

nurses and support staff. Whether the absence

of measured spiritual distress is linked, in a

causal rather than random manner, to spiritual

and religious reliance by certain of these health

care providers, is unknown.

Keywords: Spirituality; Religion; Caregivers;

Caregiver Bu rden

1. INTRODUCTION

The emergence of AIDS in the early 1980’s [1,2] pre-

sented formidable challenges to healthcare providers an d

hospitals. Mortality and morbidity caused by infectious

diseases had progressively declined in the twentieth

century; better sanitation, childhood vaccination, and the

introduction of antibiotics dramatically reduced the risk

of serious epidemics. Instead, hospital staffs grew famil-

iar with mortality from cancer, heart disease, stroke, and

other conditions associated with longer life spans and

industrial societies. The organizational response of hos-

pitals to the spread of HIV disease was the formation of

specialized infectious disease units. In the subsequent

nearly thirty years, advances in technology have sub-

stantially prolonged and improved the quality of life for

treated individuals with HIV disease, increasingly iden-

tified as a chronic condition. Consequently, the medical

management of patients with HIV disease resembles that

of other life-threatening conditions: the trajectory of a

patient’s life can be extended by reliance on technology

and clinical care, if available.

The epidemic, while fundamentally different, contin-

E. A. Catlin et al. / HEALTH 2 (2010) 796-803

797

ues [1]. Worldwide, 0.8% of adults are estimated to be

infected with HIV; resource-limited regions bearing the

greatest disease burden [3]. The estimated number of

persons in the U.S. living with HIV disease is 1.2 mil-

lion, 35,962 have progressed to AIDS [4]. Hospital staffs

remain responsible for chronic ambulatory care of these

individuals as well as for difficult, end-of-life care [5].

In addition, attention has turned to the suffering, physi-

cal and non-physical, of patients and to the potential role

of spirituality in the clinical setting. In 2006, for exam-

ple, the U.S. Department of State issued guidelines for

global AIDS relief that included spiritual care “that ad-

dresses the major life events that cause people to ques-

tion themselves, their purpose and their meaning in life”

[6].

In this article we pose the question of whether hospital

staffs that care for patients with HIV disease have a

sense of spiritual or religious dimensions in their work.

In a previous article [7] this and related questions were

asked of those who work in the newborn intensive care

unit (NICU) context, where caring for critically ill and

dying newborn babies raises existential and spiritual

concerns. These physicians, nurses, and other providers,

as they met their NICU responsibilities, were privately

concerned with the meaning of suffering and death and

were also aware of the need for pastoral support. In the

present study, we test the hypothesis th at HIV clinic pro-

viders might rely on spiritual and religious frameworks

in caring for their patients and that work-related spiritual

distress might be a common theme for them.

2. METHOD

This 65-item questionnaire study was approved by the

Human Studies Subcommittee of the Institutional Com-

mittee on Research, [Supplement]. The instrument used

was a version of the aforementioned NICU questionnaire.

It was revised for care providers of adult patients, with

added spiritual well-being questions [8]. From March

through July 2003, the survey was made available on

line to all staff members of an ambulatory HIV clinic in

a large metropolitan hospital, at a workstation away

from the immediate patient care area. Respondents were

also given the opportunity to write in comments, for

example, to questions concerning the particular difficul-

ties of their work. Participation was voluntary and

anonymous and a gift coupon was provided as reim-

bursement upon survey completion. A Microsoft Access

97 relational database was used to obtain and store re-

sponses from the questionnaire-assigned data table.

We surveyed 59 of the 75 staff members (78.7%). The

respondents included 23 physicians, 17 nurses, and 19

administrative and support staff. The complete data set

of survey responses was entered into a Microsoft Excel

spreadsheet and analyzed using the statistical software

program SPSS version 13.0. Frequency distributions

were produced, cross tabulations performed, and Pear-

son’s Chi-square statistics calculated on the independent

demographic variables of position, age, years worked in

the HIV clinic, years worked in the hospital, race/eth-

nicity, education, religion, marital status, parental status,

and gender against other relevant variables. Significance

was assigned for p values less than 0.05.

3. RESULTS

3.1. Staff Characteristics

Most participants (49.2%) were 30-39 years of age, fol-

lowed by 20.3% in the 40-4 9 years’ group, 16.9% in the

20-29 years’group, and 13.6% were 50 years of age or

older. There were more female respondents (34, 57.6%)

than male (25, 42.4%), (Ta ble 1). The support and ad-

ministrative staff were predominantly female (16/19),

and males comprised 70% of the physician staff. The

majority of respondents reported their race as white; less

than 10% identified themselves as African-American or

Asian (Table 2). One third (35.6%) of the HIV clinic

staff reported being parents; 49.2% of the staff were

married or pa rtnered.

3.2. Religious Identification and Spiritual

Assessment

The largest portion of staff, 28.8%, identified themselves

as Catholic, 18.6% as Jewish, 10.2% as Protestant, 6.8%

Christian Orthodox, 6.8% selected “other”, 5.1% Epis-

copalian, 1.7% reported being Buddhist, 1.7% Quaker,

and 13.6% of staff reported no religious affiliation.

However, of physician staff, one fifth (20%) answered

that they had no religious affiliation. All survey respon-

dents scored in the “moderate” range for spiritual well

being (41 to 99 score); similarly, 98.3% scored in the

“moderate” category for religious well-being. For satis-

faction with life, 98.3% indicated moderate levels. The

great majority of the staff acknowledged that sp iritual or

religious concerns were important in patient care. When

asked if the spiritual/religious concerns of a patient have

a place in patient care in your view, 49.1% answered

“always”, “often” or “yes” (2 responses), and another

44.1% (26) answered “sometimes”; 6.8% (4) answered

“seldom” (see Table 3). Overwhelmingly, the respon-

dents answered affirmatively, 93.2%, to the question of

the appropriateness of attending to spiritual/religious

concerns in the course of caring for patients while only 4

staff members answered “seldom” and no one replied

“never”.

E. A. Catlin et al. / HEALTH 2 (2010) 796-803

798

The HIV clinic staff was asked how frequently they as-

sessed the spiritual or religious needs of patients and

22% answered “always”, “often” or “yes” and 37.3%

answered “sometimes”. The remaining respondents were

more hesitant, 40.7% (24) answering “seldom” or “never”

(see Table 3). When aske d if they felt competent to do a

basic spiritual assessment, 25.8% answered “always” or

Table 1. Basic demograp hic s: complete c ases.

Frequency Percent

Position Physician 23 39%

Nurse 17 28.2%

Support and

Administrative

Staff 19 32.2%

Total 59 100.0%

Age in years 20-29 10 16.9%

30-39 29 49.2%

40-49 12 20.3%

50+ 8 13.6%

Total 59 100.0%

Years in

HIV < 1 6 10.2%

care 1-4 21 35.6%

5-9 15 25.4%

10+ 15 25.5%

missing cases 2 3.3%

Total 59 100.0%

Years at

study

institution < 1 11 18.6%

1-4 24 40.7%

5-9 14 24%

10+ 10 17%

Total 59 100%

Parent Yes 21 35.6%

No 38 64.4%

Total 59 100%

Gender Female 34 57.6%

Male 25 42.4%

Total 59 100%

Table 2. Basic demographics with missing cases.

frequency percentvalid %

Race African-American3 5.1% 5.4%

Asian 2 3.4% 3.6%

White 49 83.1% 87.5%

Other 2 3.4% 1.8%

missing cases 3 5.1% 1.8%

Marital

status Single 22 37.3% 40.0%

Married 21 35.6% 38.2%

Partnered 8 13.6% 14.5%

Divorced 4 6.8% 7.3%

missing cases 4 6.8%

Religion Jewish 11 18.6% 20.0%

Catholic 17 28.8% 30.9%

Episcopalian 3 5.1% 5.5%

Christian Orthodox4 6.8% 7.3%

Quaker 1 1.7% 1.8%

Protestant 6 10.2% 10.9%

Buddhist 1 1.7% 1.8%

None 8 13.6% 14.5%

Other 4 6.8% 7.3%

missing cases 4 6.8%

Education High School/GED3 5.1% 5.3%

Associates Degree4 6.8% 7.0%

Bachelors Degree 10 16.9% 17.5%

Masters Degree 16 27.1% 21.8%

MD 25 39% 40.4%

Other 1 1.7% 1.8%

missing cases 2 3.4%

“often” while 37.9% responded “sometimes” and re-

maining staff (36.1%) indicated “seldom”, “never” or

“no”. Nearly two thirds of staff across the various job

categories indicated that they were ill equipped to do a

basic spiritual assessment. Lack of training in spiritual

assessment was cited by more than half of the staff and

nother 38.5% replied that they were too busy or that

E. A. Catlin et al. / HEALTH 2 (2010) 796-803

799

Table 3. Staff self-assessment of spiritual care giving.

Spiritual concerns have role in

patient care I assess patients’ spiritual/

religious needs I am competent to perform

a spiritual assessment*

Always or Often 49.1% 22% 25.8%

Sometimes 44.1% 37.3% 37.9%

Seldom or Never 6.8% 40.7% 36.1%

*(1) case missing

spiritual assessment was not part of their job description.

When asked to identify which members of the staff

should be given the responsibility for assessing a pa-

tient’s spiritual needs, most respondents chose social

workers (88.1%), nurses (62.7%), attending physicians

(61%), followed by medical fellows (57.6%). Nurses, in

particular (88.2% of nurse respondents), viewed assess-

ing the spiritual needs of patients as their responsibility,

(p = 0.03), in keeping with the long-term historical inte-

gration of spiritual care into the discipline of nursing.

There was not a chaplain assigned at this time to the

HIV clinic team; staff responses to this and related ques-

tions may have been influenced by this fact.

When asked which members of the team should in-

clude consideration of the patient’s religious/spiritual

needs in planning their care, 93.2% selected the social

worker, 79.7% indicated the attending physician and

71.2% indicated the fellow. Physicians and nurses in

particular favored the fellow’s taking this responsibility,

(p = 0.016). Fewer respondents (42.4%) indicated the

intern or resident, while 76.3% indicated the nurse and

71.2% the nurse practitioner or physician’s assistant.

Note that in this question, respondents were asked to

select as many individuals as they thought should be

involved in th is process.

Hospital chaplains were favored by 40.7% of staff

when asked wh at resources they drew on to help resp ond

to a patient’s spiritual needs. A patient’s clergy person

was selected by 32.2%, colleagues by 42.4%, while

18.6% indicated that they would turn to reading or re-

search. 22.0% of staff replied that responding to a pa-

tient’s spiritual needs is not within the scope of their

practice: eight of these respondents were support and

administrative staff (p = 0.03).

3.3. Staff Experience

The staff experience in HIV work varied but overall was

modestly long-term. Ten of the 12 attending physicians

were experienced in HIV work for five or more years.

Twelve of the 17 nurses were experienced for five or

more years. The same was true for the three social

workers and for 4 of the 16 support and administrative

staff.

Concerning stress relief, many chose physical exercise

(61%), watching movies or reading (44.1%) and a few

indicated they relied on alcohol (3) or drugs (2). About

one third of the respondents (30.5%) indicated they re-

lied on “personal spiritual practice”. More indicated that

they participated in social activities (50.8%) or relied on

family and friends (54.2%). Some respondents sought

psychotherapy (15.9%) for relief of stress.

When asked, “Do you think spiritual caring is an ap-

propriate part of your caregiving role?” 72.9% of the

HIV clinic staff surveyed responded affirmatively. Phy-

sician staff differed somewhat in this response category,

as nearly 40% felt that spiritual caregiving was not an

appropriate part of their role in the clinic. Of the clinic

staff, 30% indicated that they always or often privately

prayed for their patients, but most respondents (66.7%),

when asked if they personally prayed with patients when

they were with them answered, “never”, (Figure 1, Ta-

ble 4).

When asked if they would like to offer to pray with

patients, (22) responded “never”. These included ten of

the 12 physicians (all six attending physicians, three of

the five fellows, and the one intern) who had responded

that spiritual care giving is an appropriate part of their

professional role. Others responded “sometimes” (35.9%),

and very few (3) indicated “always”, “often”, or just

“yes”, (Ta bl e 4 ). Despite this reluctance, most staff in-

dicated a willingness to respond to a patient’s request for

prayer. Asked to respond to, “If a patient asks for prayers

I get someone else to do it who is capable”, the staff

members who valued spiritual caregiving were divided

into approximately one-third who answered negatively

and two-th irds who respond ed affirmatively. Most of the

latter indicated that they would get someone else “some-

times”, while (8) indicated “always” or “often”. When

asked to respond to, “If a patient asks for prayers I don’t

follow through on their request”, 78.1% of those re-

sponding to the question answered “seldom” or “never”

(see Table 5).

3.4. Hardest Part of the Work

Respondents were asked to define the hardest part of

their work in the HIV clinic. The responses fell into three

general categories. One concerned technical and infor-

mational obstacles, that is, not having a cure or not being

E. A. Catlin et al. / HEALTH 2 (2010) 796-803

800

able to keep up with all the available and relevant infor-

mation. The second category of responses concerned

personnel and bureaucratic difficulties, such as difficult

colleagues or tedious paperwork. The third category in-

cluded respondents that cited suffering for and anxiety

about patients as the hardest part of their work. Of the 49

who responded to this survey question, physicians

tended to be more concerned about technical obstacles,

while nurses responded that personnel/bureaucratic is-

sues were the hardest part of their work (p = 0.002).

Compassion for the patients in answering this question

was widely evident but support staff displayed the most

concern.

Examples of the open text responses to, “What is the

hardest part of y ou r jo b?” included:

“Dealing with the inefficient and wasteful delivery of

care to our patients which leads to fewer resources avai-

lable for all.”

Figure 1. Prayer practices reported by clinic staff.

Table 4. Prayer practices reported by clinic staff.

I personally pray for patients

when I am with them

(n = 39)

I would like to offer to pray with

patients

(n = 39)

I privately pray for my

patients

(n = 40)

frequency frequency frequency

Always or Often 3 3 12

Sometimes 10 14 21

Seldom or Never 26

11 of 12 MDs replied “NEVER”* 22

10 of 12 MDs replied “NEVER”* 7

2 MDs replied “NEVER”*

*Each of these physician respondents had replied that spiritual care giving is an appropriate part of their professional role.

Table 5. Spiritual caring as an appropriate part of role: when a patient asks for prayers.

I do it myself I get someone else to do it I don’t follow through on

their request

frequency

(n = 39) frequency

(n = 43) frequency

(n = 32)

Affirmative

(Always, often, sometimes) 30 26 7

Negative

(Seldom or never ) 9 17 25

E. A. Catlin et al. / HEALTH 2 (2010) 796-803

801

“Telling someone they are HIV positive.”

“Watching the patients suffer with this terrible dis-

ease.”

“Being unable to alleviate or attenuate someo ne’s suf-

fering, or unable to help a person find hope or peace in

their life.”

3.5. Configuring the Spiritual Meaning of

Suffering

When asked what theological sense or ultimate meaning

they made of the suffering of patients, none of the staff

indicated a belief that the patients were being punished,

whether for original sin, or the sins of a partner. Some

saw causality based in ignorance regarding risk for con-

tracting HIV (10). Some also selected the r epl y, “We liv e

in an imperfect, fallen world” (12). The theological

sense made of patient suffering was thought by only one

respondent to be due to God wanting to teach a lesson; a

small number (7) indicated that patients suffered because

God had a plan. No clinic staff indicated that God

wanted to punish patients or that, “The devil has a hold

on this world”. However, many respondents believed,

“God suffers with them” (26) as a way of making sense

of the suffering. These included five physicians, nine

nurses, the three social workers and nine of the support

and administrative staff. This finding was statistically

significant, (p = 0.018), meaning that clinic position

category strongly predicted the response, “God suffers

with them”. Specifically, nurses and support/administra-

tive staff were more likely to respond that, “God suffers

with them”, while physicians were more likely to state

that, “God does not suffer with them”. Overall, 72.9% of

respondents did not feel that there were other explana-

tions for patient suffering; the remaining 27.1% felt the

explanation was not listed. Those that believed other

reasons explained patient suffering wrote open text re-

sponses such as:

“The answer to this is probably no t knowable.”

“The world is not fallen but is imperfect.”

“My role in care is to ameliorate suffering.”

“Suffering allows redemption.”

“We don't understand the mean ing of their suffering.”

Of the seven female physician staff, five felt that God

did not suffer with the sufferers, whereas the female

nurses were more evenly split between believing God

suffered with (5) and did not suffer with the patients (6).

Female support staff was more likely to feel that God

suffered with the patients (11). Most male physicians (13

of 16) felt God did not suffer, while of male nurses,

two-thirds felt that God did suffer with patients. Several

staff (12) indicated that, “There is no meaning to their

suffering”, that, “God is not able to prevent such suffer-

ing” (13), or that, “God chooses not to prevent su ch suf-

fering to give us free will” (15). A smaller number of

respondents (9) indicated that, “There are accidents in

nature” as an explanation for why patients suffer.

When asked about the suffering of the families and

friends of those with HIV disease, 35.6% indicated that

the families and friends suffered from the stigma associ-

ated with the disease but nearly all (96.6%) rejected the

idea of a punitive God, original sin, or the devil as hav-

ing any role in this problem. Some thought the suffering

might be part of God’s plan, that the world was imper-

fect, that there are accidents in nature or that God could

not prevent such suffering (15). Of these 15 respondents,

nurses were the least likely to believe that God could not

prevent such suffering. Some responden ts (14) indicated

that, “God chooses not to prevent such suffering to give

us free will”. As with the suffering of patients, more staff

(39.0%) thought that God suffers with the families and

friends of patients. Physicians, at 6.8%, were the least

likely to reply that God suffers with families and friends

of the patients.

Asked what theological sense they made of their own

suffering in caring for patients with HIV and their fami-

lies/friends, only three respondents (a physician, a nurse,

and a social worker) indicated that they did not suffer

when caring for patients with HIV and their families or

friends. All of the other respondents rejected the ex-

planatory options of: God is punishing me, the devil has

a hold on this world, or I suffer because of the social

stigma of working with HIV patients. A few (6) indi-

cated that they saw no meaning in their own suffering;

(11) indicated that God cannot prevent suffering and the

same percent indicated that God chooses not to prevent

suffering to give us free will. The largest number of re-

spondents (14) chose the option that, “God suffers with

me”.

When asked to choose a phrase that best expressed

their attitude toward “you r own suffering in your work”,

a few (7) opted for, “I personally do not experience suf-

fering in my work”. In contrast, 52 chose other options.

The largest response group (49) chose the option, “I

cannot change the fact of human suffering but I can alle-

viate it as much as possible”. No one chose the option, “I

cannot change the fact of human suffering and there is

nothing I can do about that”. The option, “I am willing

to suffer to alleviate the suffering of others” was selected

by (15); eleven of these were physicians, including six

attending and four fellows, two were nurses, one was a

social worker, and one was support and administrative

staff, (p = 0.007). Physicians reported being more will-

ing to suffer for their patients at 47.8% while the large

majority of clinic nurses and administrative staff replied

that they were not willing to suffer (88.2% and 89.5%,

respectively) to alleviate the suffering of others.

E. A. Catlin et al. / HEALTH 2 (2010) 796-803

802

4. DISCUSSION

Rapid advances in biotechnology have been associated

with longer survival and improved quality of living for

many patients with HIV disease. Nonetheless, it remains

a profoundly life-altering illness, challenging patients,

families, friends and caregivers and causing suffering

and anguish. Many Americans rely on religion as a cop-

ing mechanism when they are seriously ill, including

those with HIV disease [9,10] and those experiencing

severe stress [11]. We speculated that staff caring for this

patient population might also rely on spiritual and reli-

gious frameworks to cope with doing this work and we

wondered whether their self reports of well-being might

reflect distress. This new survey data provides surprising

and unexpected information about both areas of interest.

Many staff members in this HIV clinic appeared in-

vested in their spiritual lives and religious beliefs. The

fact that 82% of them always, often, or sometimes

prayed for their patients is telling, but this did not in-

clude physicians, whose replies tended to be more secu-

lar. Physicians in this clinic setting appeared to be less

spiritual and religious, based on their survey responses,

than their clinic coworkers and than American physi-

cians in general. One in three reported having no reli-

gious affiliation, whereas U.S. survey data indicate that

one in ten physicians reported having no religious af-

filiation [12]. Despite believing that spiritual caregiving

was an appropriate part of their professional duties, these

physicians often didn’t pray or want to pray for their

patients. How these providers conceptualized spiritual

care was not addressed in this study. The majority of

clinic physicians (78%) believed that God did not suffer

with the suffering patients, in marked contrast to the

majority of support staff (69%) and nearly half of the

nurses, who believed that God suffered with them, (p =

0.018). On the other hand, many of these physicians

were willing to suffer to relieve the suffering of their

patients, whereas the support and nursing staffs voiced

opposition to this altruistic appro ach. Another interpreta-

tion of physician responses might be that these responses

represented complex reactions to the clinical setting of

HIV disease, in “...a post-911 environment where spiri-

tual issues of life and death have taken on a new urgency,

but feelings about them are often ambivalent and diffi-

cult to articulate” [13].

That the clinic nursing staff demonstrated a strong

spiritual and religious orientation may be related to the

fact that a core spiritual dimension exists in all nursing

care, as taught by nursing scholars, who have studied

spiritual and religious components within their profes-

sion [14,15]. In addition to the spiritual orientation and

care provided by the nurses, support and administrative

staff in this HIV outpatient clinic emerged as an impor-

tant resource for spiritual support and caregiving to pa-

tients. They eagerly responded to patient requests for

prayer and were highly compassionate about the plight

of the patien t population. In fact, the support and ad min-

istrative staff appeared to be key care providers for pa-

tients, although not specifically recogn ized as such.

An unexpected result of this research was that these

healthcare providers and support staff consistently scored

in the “moderate” range for religious and spiritual well-

being, as well as existential satisfaction. In their work

with patients with HIV disease, these care providers

regularly face issues of mortality, the meaning of life,

and theodicy. HIV clinic patients themselves may ask

very difficult questions of staff; they have in common a

chronic, complex, and potentially lethal illness, each

with time to reflect on existential and spiritual issues [16,

17]. The relatively high spiritual well-being scores of the

care providers in this study suggest that they may have

successfully dealt with some of the aforementioned is-

sues. They may have also benefited from decades of

public education and technological innovation that have

changed the environment for HIV treatment. Earlier re-

ports documented job stress and fear of infection as fre-

quent problems characteristic among healthcare workers

caring for patients with HIV disease [18,19]. Distress

among healthcare providers of patients with HIV disease

and patients may have declined related to the success of

potent therapeutics, especially HAART regimens [20].

Patients with HIV disease are living for much longer

periods, with decidedly improved quality of life; these

factors allow for qualitatively different relationships to

be formed between staff and patients, about which much

more could be learned. Compassion for patients was

clearly evident in questionnaire answers and suppor ts the

conclusion that humane, personal attachments develop

between HIV clinic staff and patients, families and

friends over extended periods of treatment and follow up.

This continuity in positive relationships may explain

some of the apparent job satisfaction and lessened sense

of being oppressed by the actual patient work that was

measured.

The response rate of 78.8% to the survey was nu-

merically robust, but the study was small and its findings

may have been somewhat biased against secular results,

in that the staff members who chose not to participate

might be predicted to be unsympathetic to this subject

area. A division appeared to exist between physicians

who processed the difficulties of their work in a more

secular manner and the strong component of spirituality

and religiosity in the nursing and support staff of this

HIV clinic. Whether the spiritual and religious reliance

reported by these health care providers is linked, in a

E. A. Catlin et al. / HEALTH 2 (2010) 796-803

803

Marshall, G.N., Elliot, M.N., Zhou, A.J., Kanouse, D.E.,

Morrison, J.L. and Berry, S.H. (2001) A national survey

of stress reactions after the September 11, 2001, terrorist

attacks. New England Journal of Medicine, 345, 1507-

1512.

causal rather than random manner, to the absence of

measured spiritual distress, remains to be researched.

This survey data points the way to further social sci-

ence research, quantitative and qualitative, on the dif-

ferent clinical con texts for treating pa tients infected with

HIV. Of particular interest is the interplay of care pro-

viders’ spirituality and religious beliefs and those of pa-

tients with HIV disease, some from minority groups with

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