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Mvtesting for INSURANCE PURPOSES

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Mvtesting for INSURANCE PURPOSES mv TESTING FOR INSURANCE PURPOSES: A MULTI-FACETED EXPLORATION OF THE CLIENTS' EXPERIENCE AND ASPECTS OF CURRENT PRACTICE By: Michelle Shapiro Supervisor: Professor L. Richter Thesis presented for the Degree ofMaster ofArts (Clinical Psychology) University ofNatal, Pietermaritzburg July 2001 ACKNOWLEDGEMENTS: I would like to thank the people who encouraged and believed in this research, as well as the people who made the effort personally meaningful. I would like to thank my supervisors Professor. L. Richter and Professor. R. Griesel. I would like to thank Dr. 1. Van Wyk, ofthe pathology company, Dietrich Street and Partners, for his continued encouragement, and Dr. Penman for his agreement to participate. Similarly, I would like to thank the members of the Life Officers Association, for being receptive to research of this nature. I would also like to thank Desire Daniels ofOld Mutual, for her insightful contributions and support. On a more personal note, I would like to thank my sons Joshua and Gideon Shapiro, for their encouragement and for putting up with me whilst in the throes of research fever, and during the periods of research apathy. I would also like to thank Leonard Schneider for unfailing belief in me, and Eric Joffe for his invaluable practical computer assistance. Finally, I would like to thank the staffofthe Cape Town based pathology depots who took the time to distnbute the questionnaires, and the nursing sisters and insurance brokers who expressed their opinions regarding insurance HIV testing protocol. I would also like to thank all the insurance clients who were willing to complete the questionnaires, knowing that the benefit would hopefully accrue to others in time to come. ABSTRACT HIV testing is required for life assurance applications. A written infonnation document distributed at blood collection (venisection) serves as pre-test preparation. This study reviewed the adequacy ofthe document and explored possible alternative arrangements, by means ofthree research phases conducted at the point of venisection. Phase 1 used a specifically designed questionnaire which included a demographic section and questions assessing the applicant's appraisal of being adequately prepared, and their understanding and experience of testing. Constructed measures established their state ofanxiety at testing and their range ofinfonnation about HIV/AIDS. Phase 2 consisted ofa counselling intervention, followed by the questionnaire used in Phase 1. Phase 3 consisted of semi-structured interviews with nursing personnel and insurance brokers. The phase 1 results indicated that the majority ofapplicants knew they were having an mv test, did not feel coerced, had a moderate level ofinfonnation about mvand were not overly anxious at testing. The level ofinfonnation about mY/AIDS showed a significant correlation with their level ofeducation, and the infonnation document emerged as inadequate preparation. Answers given in Phase 2 differed qualitatively from those in Phase 1. Greater consideration of the impact of a positive result was shown, with increased concern about the implications for other people and anticipated acceptance ofa positive result emerged in Phase 2. The personnel interviewed for Phase 3 indicated that they felt ill equipped to offer pre-test preparation. i page CHAPTER 1:................................. 1 CONTEXT OF THE STUDY 1. INTRODIJCTION: 1 1.1. HUMAN IMMUNE-DEFICIENCY VIRUS (HIV) AND ACQUIRED-IMMUNE DEFICIENCY SYNDROME (AIDS): 3 1.1.1. Regional Patterns: ........................................................... ........... 3 1.1.2. The Third Epidemic: 4 1. 2. PSYCHO-SOCIAL ISSUES ASSOCIATED WITH mvI AIDS: 5 1.2.1. Social Support: 5 1.2.2. Social Sanctions: 6 1.2.3. Myths about HIV/AIDS: 6 1.2.4. Media: , 6 1.2.5. HIV / AIDS Highlighting Disempowennent and Bio-Psycho-Social Injustice:......... 7 1.2.6. Age as a variable for consideration:........................................ .. 7 1.2.7. A Cross-Cultural Psychological Perspective: 8 1.2.8. Individual versus Community Rights:............ 10 1.2.9. HIV and AIDS in South Africa:... 10 1.3. LIFE ASSURANCE IN THE ERA OF mv AND AIDS: 11 1.3.1. Life Assurance: 11 1.3.2. Modernization: 12 1.3.3. Life Assurance and mv/AIDS:. ............................................... 13 1.4. CONCLIJSTON: 15 CHAPTER TWO: 16 AN ETHICAL INQUIRY: 16 2.1. , THE RELEVANCE OFETHICS: 16 2.1.1. Principles and Practices in relation to HIV / AIDS: 17 2.2. ETHICS ofmvTEST PREPARATION: 18 2.2.1. Principles ofHIV Antibody Testing:................ 18 2.2.2. Informed Consent: ,.. .... 18 2.2.2.1. Consent or acquiescence:. .... ... .. ... ... ......... ...... .............. ... ... ..... 19 ii Page: 2.2.2.2. Consent for Tnsurance HTV Testing:....................................... 19 2.2.2.3. Levels ofCounselling and Information:.... 20 2.2.2.4. Special Status ofHIV testing: 20 2.2.3. Pre-Test Counselling: 21 2.2.3.1. Emotional Support Associated with Counselling:..... 21 2.2.3.2. Anxiety and Knowledge: Psychological attributes associated with mv testing: ..................................... 22 2.2.2.3. Counsellor Competence:.................. 23 2.2.4. The Role ofTesting in the Control ofthe Spread ofHTV/ ATDS:....... 24 2.3. LIFE ASSURANCE HIV-ANTIBODY TESTING PROTOCOL:.. 26 2.3.1. Life Assurance Protocol Associated with Informed Consent and Pre-test Counselling: 27 2.4. CONCLUSION: 29 CHAPTER 3: 31 METHODOI..()GY: 31 3.1. RATIONALE FOR THE STUDY: 31 3.2. AIMS AND ORJECTIVES OF THE STUDY: 31 3.3. METHOD:....... .............................. ............................................ 32 3.3.1. Research Questions: 32 3.3.2. Research Design: 32 3.3.2.1. Phase 1: 32 3.3.2.2. Phase 2: 32 3.3.2.3. Phase 3: 33 3.3.3. Procedure: 33 3.3.4. Population and Sampling: 34 3.3.5. Instruments: 35 A) The questionnaire: 35 B) Semi-structured interviews:..... 35 3.3.5.1. Construction ofthe Anxiety Measures:............. 36 3.3.5.1.1.Trait Anxiety: '" 36 3.3.5.1.2. State Anxiety: 36 3.3.5.2. Establishment ofthe Information Grid: 39 iii page 3.4. DATA COLLECflON:......... 40 3.4.1. Phase 1: 40 3.4.2. Phase 2:... 41 3.4.3. Phase 3: 41 3.5. MEmOD OF ANALySIS: ········ 42 CHAPTER 4: 43 RESULTS AND DISCUSSION: 43 PHASE 1: 4.1. DEMOGRAPmC INFORMATION: 43 4.1.1. Sex: 43 4.1.2. Language: 43 4.1.3. Age Groups:........................... 43 4.1.4. Socio-economic Status: , 43 4.1.5. Education: 44 4.1.6. Relationships:.................................................................... 44 4.1.7. Assessment ofthe availability ofpractical and emotional support from fiunily, partner and friends: 44 4.2. RESULTS OF mE TEST SPECIFIC QUESTIONS:................................. 45 4.2. 1.Understanding the Nature ofthe Test: 45 4.2.2.Previous Testing Experience: 45 4.2.3.Reasons for Testing: 45 4.2.4.Consent: 46 4.2.5.Subjective assessment ofbeing adequately infonned about testing: 46 4.2.6.Test choice: 47 4.2.7.Nervousness relating to testing: 47 4.2.8. Effect ofthe infonnation received from varied sources on their nervousness: 47 4.2.9. Having taken the time to think about the test result:... 47 4.2.10. Having taken the time to think about the possible consequences ofthe result: 47 4.2.11. Assessment ofthe sufficiency and helpfulness of the pre-test infonnation received from varied sources:.... .................... 48 iv page 4.3. GENERAL KNOWLEDGE ABOIIT H1V AND AIDS: 49 4.4. ANXIETY MEASURES: ····· 50 4.4.1. Trait Anxiety Measure Scores: 50 4.4.2. State Anxiety Measure Scores:............................................ 50 4.5. SUMMARY AND DISCUSSION OF TEST SPECIFIC RESPONSES: 51 PHASE TWO:...................................................... 51 4.6. GENERAL KNOWLEDGE ABOUT mv AND AIDS: 53 4.7.ANXIETY MEASURES: , 54 4.7.1. Trait Anxiety:... 54 4.7.2. State Anxiety Measurement:. ........................................................ 54 4.8. RELEVANT RESULTS OF THE TEST SPECIFIC QUESTIONS:................. 54 4.9. CONCLUSION I SUMMARY OF PHASE TWO:...... 55 4.10. STATISTICAL ANALYSIS: 55 4.10.1. Phase 1: Analysis associated with the measured information about HIV I AIDS: 56 4.10.2. Phase 1 -Analysis associated with the Level ofState Anxiety Experienced: ........................................................................... 59 4.10.3. Phase 1 - Analysis associated with Measured Trait Anxiety: ...................... 62 4.10.4. Comparison ofthe central variables ofinterest between phases 1 & 2: 63 4.10.5. Analyses associated with infonnation and anxiety for phase 2:.......... 64 4.10.5.1. Analysis associated with Information About mv I AIDS: 64 4.10.5.2. Analysis associated with the Measured State Anxiety at Venisection (phase 2):.......... 66 4.11. QUALITATIVE ANALySIS:........... 69 4.11.1. Qualitative Analysis ofQuestionnaire Responses: 69 4.11.1.1. Question 13. C: 'Imagined effect on life ifthe result was negative': 69 4.11.1.2. Question 13. d. 'Imagined effect on Life ifthe Result was positive':.................................................. ................... 71 4.11.1.3. Question 14: 'Who have you chosen to give you the result'?: 73 v 4.11.1.4. Question 9: 'Any Other Information Which You Think Relates to How You Experienced this Test?': 74 4.11.1.5. Question 15: 'What, ifanything, could have made this testlng...expenence easIer.?': . 75 4.12. PHASE THREE: THEMATIC CONTENT ANALYSIS OF PERSONNEL INTERVIEWS: 76 4.12.1. Composite Narrative ofthe Interviews with the Nursing Staff: 77 4.12.2. The Insurance Representative:........................................................ 81 4.12.3. Summary: 82 CHAPTER
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