***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses , who comprise the largest proportion of the health workforce in low- and middle-income countries ( LMICs ) . Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence -informed practice s for HIV care . Methods A prospect i ve quasi-experimental study in Jamaica , Kenya , Ug and a and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence -informed HIV care practice s. Hub members were engaged through a participatory action research ( PAR ) approach . Three intervention districts were purpose fully selected in each country , and three control districts were chosen in Jamaica , Kenya and Ug and a. WHO level 3 , 4 and 5 health care institutions and their employed nurses were r and omly sample d. Self-administered , vali date d instruments measured clinical practice s ( reports of self and peers ) , quality assurance , work place policies and stigma at baseline and follow-up . St and ardised average scores ranging from 0 to 1 were computed for clinical practice s , quality assurance and work place policies . Stigma scores were summarised as 0 ( no reports ) versus 1 ( one or more reports ) . Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores , and independent t tests for other measures . For South Africa , which had no control group , pre-post differences were compared using a Pearson chi-square and independent t test . Multivariate analysis was completed for Jamaica and Kenya . Hub members in all countries self-assessed changes in their capacity at follow-up ; these were examined using a paired t test . Results Response  rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up , respectively . Results were mixed . There were small but statistically significant pre-post , intervention versus control district improvements in workplace policies and quality assurance in Jamaica , but these were primarily due to a decline in scores in the control group . There were modest improvements in clinical practice s , workplace policies and quality assurance in South Africa ( pre-post ) ( clinical practice s of self — pre 0.67 ( 95 % CI , 0.62 , 0.72 ) versus post 0.78 ( 95 % CI , 0.73–0.82 ) , p = 0.002 ; workplace policies — pre 0.82 ( 95 % CI , 0.70 , 0.85 ) versus post 0.87 ( 95 % CI , 0.84 , 0.90 ) , p = 0.001 ; quality assurance — pre 0.72 ( 95 % CI , 0.67 , 0.77 ) versus post 0.84 ( 95 % CI , 0.80 , 0.88 ) ) . There were statistically significant improvements in scores for nurses stigmatising patients  ( Jamaica reports of not stigmatising — pre-post intervention 33.9 versus 62.4 % , pre-post control 54.7 versus 64.4 % , p = 0.002— and Kenya pre-post intervention 35 versus 51.6 % , pre-post control 34.2 versus 47.8 % , p = 0.006 ) and for nurses being stigmatised ( Kenya reports of no stigmatisation — pre-post intervention 23 versus 37.3 % , pre-post control 15.4 versus 27 % , p = 0.004 ) . Multivariate results for Kenya and Jamaica were non-significant . Twelve hubs were established ; 11 were active at follow-up . Hub members ( n = 34 ) reported significant improvements in their capacity to address care gaps . Conclusions Leadership hubs , comprising nurses and other stakeholders committed to change and provided with capacity building can collectively identify issues and act on strategies that may improve practice and policy . Overall , hubs did not provide the necessary force to improve the uptake of evidence -informed HIV care in their districts . If hubs are to succeed , they must be integrated within district health authorities and become part of formal , legal organisations that can regularise and sustain them This paper reports the findings of a study which examines changes in a group of Bachelor of Science ( BSc ) nursing students ' perceptions , knowledge of and attitudes towards human immunodeficiency virus/acquired immunodeficiency syndrome ( HIV/AIDS ) , accruing from attempts at a systematized education for the cohort . Based upon a 3-month study of 141 registered nurses enrolled in a BSc nursing programme at the University of Ibadan , Nigeria , it investigates alterations in knowledge and attitudes result ing from intense instruction on HIV/AIDS , AIDS patient care , and compliance with universal pre caution s. With regard to knowledge enhancement and attitudinal transformation , the research reveals that a number of positive changes occurred over the period of the study . Not only were the nurses better informed about AIDS than previously , but their attitudes towards the disease and patient care had become considerably more liberal , as well as their disposition to comply with universal pre caution s. The conclusion emphasizes that it is very important for education about HIV/AIDS to be incorporated within current undergraduate and in-service training programmes for Nigerian nurses Introduction Stigma associated with HIV has been documented as a barrier for accessing quality health-related services . When the stigma manifests in the healthcare setting , people living with HIV receive subst and ard services or even be denied care altogether . Although the consequences of HIV stigma have been documented extensively , efforts to reduce these negative attitudes have been scarce . Interventions to reduce HIV stigma  should be implemented as part of the formal training of future healthcare professionals . The interventions that have been tested with healthcare professionals and published have several limitations that must be surpassed ( i.e. , lack of comparison groups in research design s and longitudinal follow-up data ) . Furthermore , Latino healthcare professionals have been absent from these intervention efforts even though the epidemic has affected this population disproportionately . Methods In this article , we describe an intervention developed to reduce HIV stigma among medical students in Puerto Rico .  A total of 507 medical students were r and omly introduced into our intervention and control conditions . Results The results show statistically significant differences between the intervention and control groups ; intervention group participants had lower HIV stigma levels than control participants after the intervention . In addition , differences in HIV stigma levels between the groups were sustained for a 12-month period . Conclusions The results of our study demonstrate the efficacy of the modes of intervention developed by us and serve as a new training tool for future healthcare professionals with regard to stigma reduction BACKGROUND AND PURPOSE The purpose of this investigation was to determine the effect of an education unit on physical therapy students ' knowledge about acquired immunodeficiency syndrome ( AIDS ) , their attitudes toward patients with AIDS , and their willingness to treat patients who have AIDS . SUBJECTS A sample of convenience of 103 entry-level undergraduate junior physical therapy students , aged 20 to 35 years ( mean = 22.1 , SD = 2.8 ) , from one class at one institution participated in this study . METHODS A two-group pretest-posttest with control group delayed-intervention design was used . Subjects were r and omly assigned to either a group that received an AIDS education unit ( experimental group ) or a group that did not receive a special education unit ( control group ) . All subjects were pretested and posttested together with a modified version of the State University of New York at Buffalo School of Nursing AIDS Study Question naire . Willingness to treat patients who have AIDS was assessed based on self-report responses . After the pretest of both groups , the experimental group received an AIDS education unit followed by the posttest , whereas the control group received no AIDS education unit before the posttest . RESULTS The experimental group showed significant improvement of knowledge , attitudes , and willingness to treat patients who have AIDS as a result of the AIDS education unit . The control group showed no significant change or a lowered score and thus a change in a nondesired direction . The results of this study confirm the effectiveness of an AIDS education program for physical therapy students at this institution . CONCLUSION AND DISCUSSION Further study of entry-level graduate physical therapy students , licensed physical therapists , and other allied health professionals is needed to determine whether the education of these groups can affect their knowledge and attitudes toward patients with AIDS . Improved knowledge and attitudes of the health care provider with an increased willingness to treat patients who have AIDS ensures these patients will receive optimal and appropriate health care The study assessed the effectiveness of a programme aim ed at increasing medical students ' skills in counselling patients presenting for HIV testing/AIDS information . Senior medical students were r and omly assigned to receive a short course in pre- and post-test counselling , or to a control group which received the usual curriculum . The students ' performance in counselling simulated patients was videotaped at baseline and after 3 months . A sub sample was also assessed at 12 months . Students receiving the programme showed significantly greater improvement in pre- and post-test counselling skills over 3 months than did the controls . For the sub- sample continuing to 12 months , a significant effect over time was found ; however , there was no significant difference between the groups . This may have been influenced by the small sample sizes used for the 12-month assessment . General interactional skills improved for the over-all sample over 3 and 12 months , but again there were no significant differences between groups . Those exposed to the programme did not show significantly greater changes in either knowledge or attitude scores over either time frame , compared with controls . When taught in addition to the usual undergraduate curriculum at Newcastle University , this short interactional skills course significantly enhanced students ' ability to provide pre- or post-test counselling for HIV/AIDS Acquired immunodeficiency syndrome ( AIDS ) is a serious disease that has special concern for the health care provider . AIDS has continued to grow despite control efforts . As the disease infectivity period remains lengthy , and the heterosexual population is affected to a greater degree , the level of anxiety has also risen despite educational endeavours . Many fears and anxieties have been associated with AIDS patients by health care workers . The reduction of stress , perceived risk and discomfort following educational efforts have been supported in past research . Educational programmes will need to be given for current health care workers at all levels as well as nursing students . Future nurses must be prepared to meet this challenge . This study was conducted using a convenience sample of nursing students at a university in western United States . Its purpose was to assess any changes that occurred in state anxiety following an educational presentation .  Spielberger 's State-Trait Anxiety Inventory was used as the measurement instrument . Some anxiety levels were significantly reduced This study compared the effectiveness of an AIDS knowledge-only program ( knowledge ) with a combined program of AIDS knowledge and contact with people having HIV/AIDS ( PHA ) ( knowledge-contact ) in reducing nursing students ' stigma and discrimination towards PHA and in enhancing their emotional competence to serve PHA . Eighty-nine nursing students from two universities in Hong Kong were r and omly assigned to either the knowledge or the knowledge-contact condition  . All participants completed measures of AIDS knowledge , stigmatizing attitudes , fear of contagion , willingness to treat , positive affect , and negative affect at pre-test , post-test , and six-week follow-up . Findings showed that in both groups , significant improvement in AIDS knowledge , stigmatizing attitudes , fear of contagion , willingness to treat , and negative affect were found at post-test . The effects on AIDS knowledge , fear of contagion , willingness to treat , and negative affect were sustained at follow-up for both groups . Intergroup comparisons at post-test showed that the effectiveness of  knowledge-contact program was significantly greater than knowledge program  in improving stigmatizing attitudes . No significant difference between the two groups was found at follow-up . Findings showed the short-term effect of contact in improving nursing students ' attitudes and emotional competence in serving PHA . Implication s for research and training of nursing staff were discussed 
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This finding st and s in sharp contrast to the well-established Greater Involvement of People Living with HIV and /or AIDS ( GIPA ) and Meaningful Engagement of People Living with HIV and /or AIDS ( MEPA ) principles .
There was a significant lack of focus on historical , cultural , policy and legal context s of HIV and AIDS care ; theoretical justifications for the interventions were absent .