Reflections on HIV, adherence, and objectivity.

As nurses take our place as scientists pursuing knowledge, we find ourselves confronting questions and situations that previous researchers have faced. Are we impartial observers or is our quest for knowledge driven by personal desires and motives? To be sure, the research that each nurse pursues must hold personal meaning for the investiture of the commitment necessary for the study of a research question. Certainly, this is also what directs individual nurses into different fields of clinical nursing, education, and policy development. Most would agree that although personal interests guide us to our chosen field, once there one acts with the greatest degree of accomplishment and objectiveness expected of a trained professional. I would like to suggest that objectiveness is a relative term and by no means implies an overall standard cognitive view of the world. Rather, the most one individual can expect of oneself is to bracket known biases before entering into the world of a client. This in and of itself necessitates the conscious awareness of one’s own partialities and requires the willingness to take an uncensored view of the self; a feat easier described than one delved into with rigorous honesty. In admitting the fact that predispositions exist for each and every nurse, we must admit the values that come with such a revelation. This is not to condemn or even criticize. As humans, we cannot not bring our personal experiences to our every day work with patients. Our admission and understanding of this is the first step toward learning from and letting go of these attributes. If I had read an article such as this a short time ago, I probably would have thought this an academic exercise and not really a difficult one at that. A recent experience has afforded me the opportunity to better view this stance. My program of research is in adolescent HIV/AIDS. Prior to my studies, I worked in pediatrics for 4 years while also maintaining a position working in adult HIV/AIDS hospice care. Both of these areas hold great value to me as a person and it has been natural for me to find myself drawn to both of these areas for graduate study. I have always felt connected to the clients with whom I work and respectful of their wishes while striving to assist them to retain optimal health throughout the continuum of HIV/AIDS care. We are all aware of the complexities of the HIV medication and treatment regimens. The prescribed regimens are complicated and disturbing to an individual’s daily life. Generally, rates of adherence have been shown to fluctuate widely from 20% to 80% (Holzemer et al., 1999). Many individuals report the loss of quality of life as of fundamental importance in the decision to stop taking medications. As health care providers, we assist individuals to make informed decisions about treatment options, but do we really do so from an impartial stance? I now believe this not to have been the case in my own practice. Nonadherence to HIV/AIDS treatment had always meant one of two things for me: lack of respect for personal health, or worse, disregard for the health of fellow humans by playing with the resistance of an infectious agent. Adherence was quite simply an all or none response. The two options were either 100% adherence to a medical regimen or illness as a result of noncompliance. I believe an implied value judgment is obvious. This realization did not come easily. In fact, for me the view of self as an unbiased, impartial clinician was shattered. Perhaps more troubling than an outright, stated prejudice was the subtle subconscious