Vol.2, No.7, 796-803 (2010)
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/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.
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
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
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
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”
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.
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.
3.1. 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
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
E. A. Catlin et al. / HEALTH 2 (2010) 796-803
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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
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
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%
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
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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
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
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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
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
(n = 39)
I privately pray for my
(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 repliedNEVER”*
*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
(n = 39) frequency
(n = 43) frequency
(n = 32)
(Always, often, sometimes) 30 26 7
(Seldom or never ) 9 17 25
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“Telling someone they are HIV positive.”
“Watching the patients suffer with this terrible dis-
“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
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
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
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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
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
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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-
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-
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