From Fear to Empathy: What Student Nurses Learn When Caring for People Living with HIV/AIDS
Article information
Shi, C., & Cleofas, J. V. (2023). Student nurses’ perceptions and experiences in caring for people living with HIV/AIDS: A qualitative study. BMC Medical Education, 23, 99. https://doi.org/10.1186/s12909-023-04074-x
What this study is about
Caring for people living with HIV/AIDS requires more than technical knowledge. Nurses need clinical skill, infection control competence, ethical clarity, empathy, and the ability to provide care without stigma. This study asks: How do nursing students think and feel about caring for people living with HIV/AIDS, and how do those perceptions change after real clinical exposure?
The issue matters because student nurses are future registered nurses. If they enter practice with fear, misinformation, or stigma, this can affect the quality of care that people living with HIV/AIDS receive. But if nursing education can transform fear into informed, respectful, and empathic care, then clinical training becomes an important anti-stigma intervention.
What the researchers did
This was a qualitative descriptive study. The researchers interviewed 18 undergraduate nursing students who had already cared for people living with HIV/AIDS during clinical internship. These students came from 14 tertiary hospitals across seven provinces in China. Interviews were conducted by telephone and analyzed using Colaizzi’s seven-step thematic analysis.
The interview guide asked students what they thought of people living with HIV/AIDS when they first heard about AIDS, what their attitude was during care, what their attitude was now, what they felt during care, and what concerns they had while caring for PLWHAs. This guide is shown in Table 1 on page 3 of the article.
The participants were mostly female, aged 21–23, and had cared for between 1 and 8 PLWHAs. On average, they had received about 1–2 AIDS-related knowledge and skills trainings.
What the study found
1) Before care: fear, anxiety, stigma, and discrimination were common
Before receiving enough AIDS-related knowledge or clinical exposure, many students described fear and anxiety about HIV/AIDS. Some remembered early school lessons or social messages that made AIDS seem terrifying, incurable, and socially dangerous.
Half of the participants also associated HIV/AIDS with stigmatized identities or behaviors, including “free sex,” homosexuality, drug use, or being “bad people.” These early beliefs show how HIV stigma can enter nursing education before students even meet patients.
In plain language: before clinical exposure, many students were not only afraid of the disease. They were also carrying moral judgments about the people living with it.
2) During care: students struggled between fear and professional duty
When students actually cared for PLWHAs, their feelings became more complicated. Many feared occupational exposure, especially needlestick injury or contact with blood and body fluids. At the same time, they recognized that caring for PLWHAs was part of their duty as healthcare workers.
This created a psychological conflict: “I am afraid, but I am also a nurse-in-training, and this patient deserves care.”
Some students also felt anxiety mixed with curiosity. Because many had rarely encountered PLWHAs before, clinical care became both frightening and educational. This matters because curiosity can become an opening for learning when it is guided properly by clinical instructors.
3) After care: acceptance, empathy, and self-fulfillment increased
A major finding is that attitudes often improved after caring for PLWHAs. More than two-thirds of participants said they became less fearful and more accepting. Half described compassion and empathy toward PLWHAs and their families.
Some students also experienced self-fulfillment. They felt moved when patients expressed gratitude, and they felt they had grown through clinical practice. In other words, direct care did not simply reduce fear; it helped some students understand the human meaning of nursing work.
The study describes this as a movement across stages: from negative attitudes and misconceptions, to psychological struggle during care, to more positive perceptions after caregiving.
4) Students emphasized fair and respectful care
The students repeatedly said that PLWHAs should receive the same quality of care as other patients. In Table 3 on pages 6–7, the article summarizes the main themes and shows that 16 out of 18 participants emphasized fair services for PLWHAs.
This is a key ethical finding. Students recognized that discrimination can harm care outcomes. They believed PLWHAs should be treated as normal patients, without being made to feel different, inferior, or morally judged.
5) Students saw mental health care as part of HIV care
More than half of participants said PLWHAs need psychological or mental health support. They recognized that people living with HIV/AIDS may experience fear, anxiety, depression, social rejection, and discrimination.
This is important because HIV care is often discussed in biomedical terms: testing, medication, immune status, infection control. But the students’ narratives point to a more holistic view: people living with HIV/AIDS need emotional support, guidance, acceptance, and dignity.
6) Privacy and confidentiality were central concerns
Students also emphasized the need to protect patient privacy. They understood that disclosure can expose PLWHAs to stigma and discrimination. One-third of participants specifically discussed confidentiality as a professional and ethical responsibility.
This is a crucial lesson for nursing education. For PLWHAs, privacy is not only a legal issue. It is tied to safety, trust, continuity of care, and willingness to seek help.
7) Students wanted trust-based nurse–patient relationships
Some students described the importance of communication and trust. They recognized that patients need to trust nurses, and nurses also need to communicate clearly so care can proceed safely and respectfully.
This suggests that HIV nursing education should not only teach “facts about HIV.” It should also teach relational care: how to talk, listen, reassure, protect dignity, and build trust with patients who may already expect judgment.
8) Fear of contamination remained important—but could be managed
Students were very attentive to occupational exposure. All participants discussed universal precautions, such as gloves, masks, protective eyewear, and hand hygiene. They also emphasized assessing the patient, the environment, and their own readiness before procedures.
Students wanted guidance from clinical teachers and stronger professional skills, especially in procedures like venipuncture and needle handling. Their concern was not simply irrational fear; it was also a need for competence, supervision, and confidence.
Bottom line
This study shows that student nurses’ attitudes toward PLWHAs are not fixed. Fear and stigma can be present before clinical exposure, but well-supported caregiving experiences can produce acceptance, empathy, confidence, and professional growth. The findings suggest that nursing education should provide structured HIV-related training, supervised clinical exposure, stigma reduction, contamination-reduction training, and reflective learning.
Policy/practice recommendations
- Make HIV care training experiential, not only lecture-based
Students need accurate HIV knowledge, but they also need guided clinical exposure, case-based learning, simulation, and reflection to transform fear into competence and empathy. - Address stigma directly in nursing education
Faculty should explicitly discuss moral judgment, fear, discrimination, homophobia, and misconceptions about HIV transmission. - Train students in universal precautions and occupational exposure management
Fear often comes from uncertainty. Stronger training in PPE, hand hygiene, needlestick prevention, environmental assessment, and post-exposure protocols can improve confidence. - Protect privacy and confidentiality as core HIV care competencies
Students should learn how to handle sensitive information, avoid accidental disclosure, and understand why confidentiality is essential for trust and treatment continuity. - Integrate mental health care into HIV nursing education
HIV care should include attention to anxiety, depression, stigma, social rejection, and emotional distress among PLWHAs. - Support clinical instructors as role models
Students look to teachers and clinical supervisors when they feel afraid. Instructors should model calm, respectful, evidence-based, and non-discriminatory HIV care.
Glossary of key terms
- PLWHA / PLWHAs — People living with HIV/AIDS; the term used in the study for patients who have HIV and/or AIDS.
- HIV — Human immunodeficiency virus, a virus that affects the immune system.
- AIDS — Acquired immunodeficiency syndrome, the advanced stage of HIV infection when the immune system is severely weakened.
- HIV stigma — Negative beliefs, judgments, fear, or discrimination directed toward people living with HIV/AIDS.
- Qualitative descriptive study — A research design that aims to describe people’s experiences and perceptions in their own terms.
- Clinical internship — The period when nursing students practice in real healthcare settings under supervision before becoming registered nurses.
- Colaizzi’s thematic analysis — A structured qualitative analysis method used to extract significant statements, formulate meanings, develop themes, and validate findings with participants.
- Occupational exposure — Possible workplace exposure to infection risks, such as needlestick injury or contact with blood/body fluids.
- Universal precautions — Standard infection-control measures used with all patients, including hand hygiene, gloves, masks, protective eyewear, and safe handling of sharps.
- Needlestick injury — Accidental puncture by a needle, which can create risk of exposure to bloodborne infections.
- Person-centered care — Care that respects the patient as a whole person, including dignity, values, emotions, privacy, and social context.
- Confidentiality — The professional duty to protect patients’ private health information.
- Trusting nurse–patient relationship — A care relationship where the patient feels safe, respected, and able to communicate openly with the nurse.
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