Cadernos de Saúde Pública
Print ISSN 0102-311X
Cad. Saúde Pública vol.21 no.1 Rio de Janeiro Jan./Feb. 2005
Profissionais de saúde e AIDS: um estudo diferencial sobre crenças e
afetos associados à experiência de exposição acidental a material
biológico potencialmente contaminado
Maria Rosa Rodrigues RissiI; Alcyone Artioli MachadoII; Marco Antonio
de Castro FigueiredoI
IFaculdade de Filosofia, Ciências e Letras de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, Brasil
Ifaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,
Ribeirão Preto, Brasil
This study aimed to analyze affective and cognitive determinants of
the professional work of individuals caring for patients with HIV/AIDS,
in view of the risk and/or experience of accidental exposure to blood.
We drew on the theoretical-methodological references of Fishbein & Ajzen
and Maslow's theory. Fifty health care workers were evaluated using an
attitudes questionnaire and a needs and motivations instrument. The
research verified differences between answers by health care workers who
had never suffered accidents and those who had already experienced
accidental exposure to blood. Health care workers did their work
activities motivated by the need for self-fulfillment and valued their
own performance when they were able to meet the patients' emotional
needs. Among health professionals who had never experienced accidental
exposure to blood, the predominant beliefs was that patients feel
remorse over having expose themselves to HIV. Accidental exposure to
blood raises difficulties in personal life. Technical aspects are also
associated with the possibility of accidental exposure to blood.
Health Care; Occupational Accidents; Acquired Immunodeficiency
O objetivo deste estudo foi analisar determinantes afetivos e
cognitivos que influenciam o trabalho de profissionais que cuidam de
pessoas vivendo com o HIV/ AIDS, frente ao risco ou experiência de
exposição acidental a material biológico potencialmente contaminado (MBPC).
Utilizou-se o referencial teórico metodológico de Fishbein-Ajzen e a
teoria de Maslow, que propõe a hierarquia das necessidades humanas.
Cinqüenta profissionais de saúde foram avaliados por meio de escalas de
atitudes, e de um instrumento de avaliação de necessidades e motivações.
Verificou-se a diferença entre as respostas de profissionais que nunca
sofreram acidente e aqueles que já passaram pela experiência de acidente
ocupacional. Os resultados indicam que os profissionais exercem suas
atividades motivados pela necessidade de auto-realização e valorizam sua
performance quando podem atender as necessidades emocionais dos
pacientes. Para os profissionais que não se acidentaram predominam
crenças de que os pacientes se arrependem da exposição ao HIV. O
episódio de acidente acarreta dificuldades à vida pessoal e profissional
do trabalhador acidentado. Aspectos técnicos também aparecem associados
à possibilidade de ocorrência de acidentes.
Assistência à Saúde; Acidentes de Trabalho; Síndrome de
During their professional experience, health care workers who care
for individuals with HIV/AIDS need to be qualified to deal with the
specific requirements of the syndrome, which demands technical and
scientific knowledge and understanding of the ties established between
the clinical team and patients with HIV/ AIDS. An implicit concern
during daily practice by health care workers is the possibility of
infection with pathogens through accidental exposure to blood.
Several studies 1,2,3,4,5 have attempted to shed light on the extent
of the problem from a clinical and epidemiological point of view,
besides defining prophylactic post-exposure measures, but questions
related to the psychological implications of accidental exposure to
blood have rarely been discussed in the literature 6,7,8,9.
Some published studies and relevant informal observations have
indicated that accidental exposure is experienced with great anxiety by
the health care workers, and work by professionals caring for patients
with HIV/AIDS thus goes beyond intrinsic technical aspects, requiring
another dimension of care which includes awareness of patients'
psychosocial needs, indicating concern for the more human side of the
It thus seems evident that in addition to training for AIDS care as a
whole, it is crucial to understand the different psychosocial aspects
inherent to health professionals' practical work 13,14, indicating the
increasing need for support programs and psychological help in order to
establish a less threatening and more genuine relationship with the
In the present study, the Fishbein-Ajzen affective-cognitive model
was used, which conceives attitude as the result of the conjunction of
beliefs, values, and emotions 15 associated with any phenomenon 16, a
model representing an advance in the study of social attitudes.
To investigate the direction of motivations and needs inherent to
professional activity, Maslow's theory was also used 17,18. This model
proposes a hierarchy of human needs, supporting the theory that
individuals act in such a way as to satisfy or reduce their needs
according to factors inherent to their personality.
The theory's general principle is that individuals have primary or
physiological needs which, when satisfied, make way for secondary needs,
which in turn acquire the power of motivation. In this respect, these
models are believed to fulfill the objective of identifying affective
and cognitive determinants that lead health care workers to work with
The objectives of the present study were: (1) to analyze affective
and cognitive determinants of professional work by individuals caring
for patients with HIV/AIDS, using assessment instruments, and (2) to
determine which representations and motivations are part of the
experience of these professionals in view of accidental exposure to
blood risk and/or experience.
Population and methods
The study was carried out at the Special Unit for Treatment of
Infectious Diseases (SUTID), a regional reference center for this type
of care. The unit is a department of the University Hospital, School of
Medicine, Ribeirão Preto, University of São Paulo (HCFMRP-USP), a
600-bed facility with various medical specialties. The city of Ribeirão
Preto has a population of approximately 500,000 and is located in
northeastern São Paulo State, Brazil.
The research project was approved by the Institutional Review
Board/Research Ethics Committee of HCFMRP-USP (HCRP case no. 1170/99).
All health care workers participating in this study received detailed
written information on the study procedures and objectives, and only
those who provided their consent to participate were included, after
signing the document.
• Survey of prevalent modal beliefs
(a) Subjects: Fifteen subjects participated in the first phase of the
study after written informed consent was obtained, including five nurses
and ten nurse technicians who care for patients treated at the SUTID.
1. Interviews: Subjects answered individual semi-structured
interviews, following a procedure of evocation-enunciation-verification,
in order to obtain data regarding three categories of representation:
work itself, patients with HIV/AIDS, and accidental exposure to blood.
2. Content analysis and verification of the selected beliefs: During
this phase, a list of statements was presented to three reviewers who
grouped those that showed the closest content-related proximity. The
statements that were found to be at the judgment intersection for each
category were then verified graphically using the Venn diagram 19.
3. Construction of affective-cognitive scales: Content analysis of
the selected beliefs permitted their association with "b" scales, which
evaluate affective contents, and "e" scales, which evaluate cognitive
contents, using a 7-point Likert type scale ranging from +3 to -3 with a
median interval of zero 20.
• Application of a questionnaire for evaluation of needs and
(a) Subjects: Fifty health care workers participated in this phase of
the study, including 13 physicians, 9 nurses, 22 nurse technicians, 5
general service technicians, and 1 dentist, who provide services in the
SUTID. Inclusion criteria were the type of activity carried out, their
link with the service, and their availability and willingness to
participate in the study.
(b) Procedures: The questionnaire for evaluation of needs and
motivation was administered at the subjects' workplace. The responses
were then submitted to descriptive analysis according to the variable
"health care workers with a history of accidental exposure to blood" and
"health care workers without a history of accidental exposure to blood".
On the basis of this analysis, cutoff points were established and
subgroups defined for differential analysis.
After statistical analysis, distribution of responses within the
levels of need satisfaction was determined using Maslow's theory 21.
Data were analyzed for differences between satisfaction levels and for
each differential group.
• Determination of health professionals' attitudes towards certain
categories of AIDS-related contents
(a) Subjects: The same 50 subjects evaluated during the previous step
were assessed during this phase.
(b) Procedures: This phase consisted of three steps as proposed by
1. Application of the attitude instrument: Fifty observations were
made by applying two probability scales using a 7-point Likert
evaluation in order to determine affective "e" and cognitive "b"
attitude components. The responses were processed on the basis of the
Fishbein-Ajzen equation, calculating the relative attitudes for each
item and each category studied.
2. Differential studies: Differential studies were carried out using
the t-test and Mann-Whitney test for the determination of differences
within each subgroup ("health care workers with a history of accidental
exposure to blood" and "health care workers without a history of
accidental exposure to blood"), with the level of significance set at p
< 0.5 for rejection of the equality hypothesis. Descriptive statistics
were also applied to the data for each sub-sample when differences were
observed, or for the whole sample (n = 50) when differential analysis
did not reveal any difference, considering all categories evaluated.
3. Quadrant analysis: To determine the conjugation of cognitions and
emotions leading to the attitudes evaluated, quadrant analysis
consisting of the trisection between the "b" scores on the abscissas and
the "e" scores on the ordinates of the beliefs-versus-values
relationship was carried out. Conjugations were determined based on the
distribution of subjects among quadrants using the scores obtained by
the two scales. The modal quadrant was compared to the sum of the
remaining quadrants, with the level of significance set at p < 0.5 for
rejection of the equality hypothesis. The results were interpreted and
discussed on the basis of the meaning of the modal quadrant.
Survey of prevalent modal beliefs
Table 1 shows the final list of statements selected on the basis of
content analysis, which form the attitude instrument. A predominance of
contents related to the characteristics of the relationship established
between healthy care workers and patient can be noted, as well as
contents related to work contingencies and psychosocial aspects of the
patients that render work with AIDS specific as compared to other
Determination of satisfaction rates using a needs instrument
Table 2 shows the distribution of different needs satisfaction rates
for health care workers with and without a history of accidental
exposure to blood. For those accidentally exposed to blood, the results
indicate satisfaction in terms of the need for security (54%) and a
tendency towards satisfaction with the need for self-fulfillment (40%),
but lack of satisfaction of more basic needs such as survival, a need
which most professionals found to be unmet (72%).
According to the distribution of needs satisfaction rates for health
care workers who had never been accidentally exposed to blood, the needs
of security and self-fulfillment were satisfied, with both needs showing
a 64% satisfaction rate. A tendency towards satisfaction was also
observed in the need for socialization (36%). In contrast, a high rate
of lack of satisfaction was observed in relation to survival (54%) and
Summary of results obtainedby quadrant analysis
Table 3 shows an analysis of the conjugation of "b" and "e" values
assigned to the statements presented to the subjects as shown in Table
1. Quadrant analysis based on the conjugation of beliefs and values for
the work category demonstrated that contents related to emotional needs
(need for understanding and care) are part of the repertoire of beliefs
concerning the HIV/ AIDS patient and are positively valued, regardless
of history of accidental exposure to blood.
The results for the patient category indicate the importance of the
patient's role in the health care workers' work and the perception of
difficulties at the biological, psychological, and social levels
experienced by the HIV/AIDS patient. In this category, two items showed
statistically significant differences between the accidentally exposed
and non-exposed health care workers subgroups: the item related to the
importance of patients' perceiving their improvement and the item
related to patients' remorse over having been exposed to HIV. In the
first case, although significant differences were detected, conjugation
of the responses pointed in the same direction, i.e., patients perceive
their improvement and this is viewed positively (item 2.7, Table 3). As
for HIV/AIDS patients' remorse over having been exposed to the virus,
the results indicate that only professionals who were never accidentally
exposed to HIV believe in and positively value such an attitude. For
professionals who have been accidentally exposed, the results do not
indicate a prevalent quadrant.
Analysis of the accident category did not show any significant
difference between the two sub-samples for the items evaluated.
Analysis of the "b"/"e" conjugation for the whole sample showed the
presence of strong beliefs for two items, which were negatively valued
by the subjects: the fact that accidental exposure to blood results in
complications in the lives of health care workers and the possibility
that occupational exposure to HIV may have been caused by haste.
The results indicate that health care workers' professional practice
extrapolates intrinsic technical aspects, requiring consideration of the
psychosocial needs of HIV/AIDS patients during daily work. A tendency of
professional activity based on the search for self-fulfillment can be
observed. Since the clinical and psychosocial aspects of AIDS are quite
complex, health care workers involvement with the work and patients
becomes a privileged and essential instrument for a favorable treatment
With respect to the work itself, beliefs and values identified among
health care workers demonstrate awareness of patients' emotional needs.
Meanwhile, patient care represents a component of the professional role
which in turn shifts the recognition of technical and scientific
competence to another level of meaning that is necessary but not
sufficient to treat AIDS.
Strawn 22 reports that people react individually to life-threatening
diseases, especially AIDS. Therefore, reactions are related to the
meaning each person ascribes to both the disease and its extent and
physical and mental consequences. Stigmatized diseases entail the fear
not only of death, but also of discrimination and possible interference
with social and affective relationships.
The affective elements in the relationship between health care
workers and HIV/AIDS patients require reflection on the possibility of
maintaining a safe distance between technical knowledge and emotional
involvement. Health care workers appear to distance themselves from the
reality of daily difficulties and to act by idealizing their work,
viewing patients as deserving of care and understanding, even though
they need to distance themselves from judgments regarding HIV infection
routes and lifestyles.
Such idealization also influences health care workers' perceived
capacity to exercise their functions, even though they may not feel
completely secure or exempt from infection by accidental exposure to
blood. A distancing process from the concrete risk of accidental
exposure to blood and HIV infection is observed here, which enables
Health care workers to continue their search for self-fulfillment.
This idealization suggests a feeling of omnipotence which Figueiredo
& Turato 6 see as a determinant in the choice of the profession itself,
making health care workers feel consciously or unconsciously more
empowered within the context of human vulnerability to disease and
We observed a predominance of beliefs concerning the affiliation
process situating patients in first place in the lives of health care
workers. Since patients represent the main motivation for the
performance of health care workers' professional functions, treatment
evolution and response also depend on the success of those providing
patient care, thus ultimately leading to a "dilution" of the control
over their performance itself. Professional self-esteem also depends on
the patient's condition, mainly because health care workers assume the
obligation to maintain patients under treatment and to provide them with
care in order to guarantee their quality of life based on information
A significant difference in health care workers' self-esteem was
observed using accidental exposure to blood as a parameter. Health care
workers without a history of accidental exposure to blood were
unsatisfied with their desire to be properly recognized for their work.
We can assume that health care workers who have been accidentally
exposed to blood draw somewhat closer to the universe of the patient's
representation of health care workers' professional role. The importance
of this role for maintaining the connection with life thus becomes
clearer, especially during contact between the health care workers and
Due to changes in AIDS treatment, health care workers have begun to
act within a different reality. The introduction of highly active
antiretroviral therapy (HAART) has turned AIDS into a chronic disease,
leading to better quality of life and thus longer survival for patients.
This process poses an ongoing challenge for health care workers, who
must constantly strive to review their motivations and difficulties in
order to continue caring for patients 23.
Another level of representation refers to the impact of AIDS on
patients and their resulting feeling of revolt, besides the
diagnosis/prognosis of infection. Health care workers working with AIDS
may not significantly express a certain direction, indicating the real
or internally felt difficulties in judging the reactions of the patients
who show a heavily negative emotional content such as a feeling of
Health care workers see patients with HIV/ AIDS as "difficult", based
on their direct daily contact and the difficulties arising in this
coping process, leading to obstacles that impact these daily
relationships. Health care workers recognize that the "psychological
component" represents a special dimension of care, and the term
"difficult" thus appears to be associated with aggressiveness, demands,
needs, revolt, anxiety, and depression 24.
Another belief among health care workers relates to the fact that
some patients feel remorse over their HIV exposure; however, the present
study showed a difference between health care workers with and without a
history of accidental exposure to blood. Health care workers without a
history of accidental exposure to blood positively value such feelings
of remorse in patients, based on the belief that patients can redeem
themselves, allowing a process of acceptance and affiliation. Meanwhile,
responses from those with a history of accidental exposure to blood
suggest a difficulty in rationally evaluating the possibility of
patients' recognition of the options and choices they have made earlier
This difference indicates that the responsibility for possible HIV
infection through accidental exposure to blood appears to be related to
the so-called passive forms of infection (by blood transfusion or
mother-to-child transmission). According to Figueiredo & Turato 6, in
such cases health care workers show sorrow and identify with patients,
while almost never questioning the individual's shared responsibility.
Therefore, health care workers succeed in distancing themselves from
their own responsibility for avoiding accidental exposure to blood
through the proper use of universal precautions and personal protective
However, typical reactions at the time of accidental exposure to
blood, ranging from fear and emotional problems to despair, as reported
in different studies, appear to trigger the need to examine health care
workers' beliefs and myths about patients. Health care workers' capacity
to distance themselves from real suffering is jeopardized, and they
therefore identify with patients and consequently with the whole range
of prejudices and taboos surrounding patients' lives. Health care
workers become the target of AIDS-related stigmata, thus forcing them to
face their fears in caring for these patients 8,25,26.
Souza 27 has observed not only a concern on the part of health care
workers about accidental exposure to blood but also a return to their
own concepts about patients and their lifestyles, with a predominant
emergence of prejudices regarding risk behaviors. The mode of infection,
views concerning risk behaviors, and personal judgment frequently
permeate the relationships between health care workers and HIV/AIDS
patients in their daily contact 28. health care workers are also subject
to the same discrimination, even within their own social group.
Tribonnière et al. 26 observed feelings of anxiety, rage, anger,
insomnia, and depression among health care workers following accidental
exposure to blood. The ability to accept negative feelings towards work
and patients appears to be facilitated by the accidental exposure to
blood, accompanied by the subjective presence of prejudices and judgment
during Health care workers' contact with HIV/AIDS patients 24,27,28.
AIDS-related fear is also akin to other fears such as abandonment by
family and friends, rejection by society, and contact with life and
death. Post-exposure prophylactic measures are also uncomfortable and
expose health care workers to circumstances similar to those experienced
by AIDS patients, e.g., the large pill burden, sometimes highly
inconvenient side effects, the need to use condoms in all sexual
relations, and the necessary care to avoid pregnancy during the
observation period. Accidental exposure to blood renders health care
workers as vulnerable as their patients.
According to all evidence, the possibility of HIV infection through
accidental exposure to blood makes health care workers aware of more
immediate issues which had previously been located at another level of
representation. This is when health care workers realize that basic
needs associated with reality such as safety at work and one's own
health invariably lie on shaky ground. Fear of discrimination and social
rejection also begins to influence the lives and work of these health
Therefore, the two poles of representation and conduct by health care
workers caring for HIV/AIDS patients are defined between the loss of
contact with real immediate risks and over-valuing of the possibility of
reducing patients' suffering, on which is based a major portion of the
expectations for personal and professional fulfillment.
A third level of revelation regarding technical aspects that impact
work is the belief that haste may be a cause of accidental exposure to
blood. However, this contingency appears to be associated with other
difficulties in the work setting, such as insufficient staff, increasing
neglect of personal protective equipment over time, inadequate
procedures for disposing of sharps and other materials, haste during
procedures, and teamwork difficulties.
Some studies 8,26 have emphasized that many health care workers with
a history of accidental exposure to blood were able to modify habits,
especially those associated with the use of universal precautions and
personal protective equipment.
Professionals who succeed in consistently working out the situation
following accidental exposure to blood and reconsidering their lives by
viewing the past events in a normal light show important cognitive
responses, leading to transformation of their work in terms of
occupational safety. Souza 27 observed that responses are not always
determined exclusively by the stressful situation, but also depend on
prior experience and personal beliefs.
In conclusion, the complexity of HIV/AIDS patient care results in
significant emotional stress, indicating the importance of actions that
offer favorable working conditions including help and psychological
support for health care workers in order to establish a less threatening
and more genuine relationship with HIV/AIDS patients.
M. R. R. Rissi participated in the development of the research and
drafting of the article. A. A. Machado and M. A. C. Figueiredo
contributed with the choice and utilization of the research methodology
and collaborated in the analysis of the results and drafting of the
We thank the health care staff from the Special Unit for Treatment of
Infectious Diseases and all the individuals who participated directly or
indirectly in the present study.
1. Tokars JI, Marcus R, Culver DH, Schable CA, McKibben PS, Bandea
CI, et al. Surveillance of HIV infection and zidovudine use among health
care workers after occupational exposure to HIV-infected blood. Ann
Intern Med; 1993; 118:913-9.
2. Centers for Disease Control and Prevention. Update: provisional
public health service recommendations for chemoprophylaxis after
occupational exposure to HIV. MMWR Morb Mortal Wkly Rep 1996; 45:468-80.
3. Puro V, Ippolito G. Brief report: effect of antiretroviral agents
on T-lymphocyte subset counts in healthy HIV-negative individuals. The
Italian registry on anti-retroviral postexposure prophylaxis. J Acquir
Immune Defic Syndr 2000; 24:440-3.
4. Figueiredo RM, Garcia MT, Resende MR, Papaiordanou PMO. Adherence
of professionals to follow-up treatment after exposure to contaminated
material in a Brazilian university hospital. Infection Control Hosp.
Epidemiol 2000; 21:109-12.
5. Machado AA, Ujkawa LT, Castro G, Abduch R, Matos US. Occupational
exposure to potentially contaminated material among health care workers
at the university hospital. In: Anais do Congresso de Controle de
Infecções e Epidemiologia Hospitalar, III Congresso Pan-Americano, VII
Congresso Brasileiro, I Congresso de Odontologia de Minas Gerais; 2000
Nov 10-14; Belo Horizonte, Brasil. Belo Horizonte: Associação Brasileira
de Controle de Infecção Hospitalar; 2000. p. 109.
6. Figueiredo RM, Turato ER. A enfermagem diante do paciente com AIDS
e a morte. J Bras Psiquiatr 1995; 44:641-7.
7. Weiss SH. Risks and issues for the health care worker in the human
immunodeficiency virus era. Med Clin North Am 1997; 81:555-75.
8. Souza A. Risco biológico e biossegurança no cotidiano de
enfermeiros e auxiliares de enfermagem [Dissertação de Mestrado].
Ribeirão Preto: Escola de Enfermagem de Ribeirão Preto, Universidade de
São Paulo; 2000.
9. Canini SR, Gir E, Hayashida M, Machado AA. Acidentes
perfuro-cortantes entre trabalhadores de enfermagem de um hospital
universitário do interior paulista. Rev Lat Am Enfermagem 2002;
10. Carson V, Soeken KL, Shanty J, Terry L. Hope and spiritual
well-being: essentials for living with AIDS. Perspect Psychiatr Care
11. Cardo DM, Culver DH, Ciesielsky CA, Srivastava PU, Marcus R,
Abiteboul D, et al. A case-control study of HIV seroconversion in health
care workers after percutaneous exposure. N Engl J Med 1997;
12. Rissi MRR. Profissionais de Saúde e AIDS: um estudo diferencial
frente a ocorrência de acidente ocupacional com material biológico
potencialmente contaminado [Dissertação de Mestrado]. Ribeirão Preto
Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto,
Universidade de São Paulo; 2001.
13. Flaskerud JH. Psychosocial aspects of AIDS. J Psych Nurs 1987;
14. Miller D. HIV/AIDS health worker stress and burnout: introduction
and overview. AIDS Care 1996; 8:133-5.
15. Ajzen I, Fishbein M. Attitudinal and normative variables and
predictors of behavior. J Pers Soc Psychol 1973; 1:41-57.
16. Osgood CE, Suci GJ, Tannenbaum PH. The measurement of meaning.
Urbana: University of Illinois Press; 1957.
17. Maslow A. Toward a psychology of being. 2nd Ed. New York: Van
18. Maslow A. Motivation and personality. 2nd Ed. New York: Harper &
19. Rissi MRR, Machado AA, Figueiredo MAC. Fear of occupational
accidents and its effect on the performance of health workers caring for
patients with acquired immunodeficiency syndrome (AIDS). In: Proceedings
of the 13th World Aids Conference; 2000 Jul 9-14; Durban, South Africa.
Bologna: Monduzzi Editore; 2000. p. 147-51.
20. Figueiredo MAC. Escalas afetivo-cognitivas de atitude.
Construção, validação e interpretação dos resultados. In: Romanelli G,
Biasoli-Alves M, organizadores. Diálogos metodológicos sobre prática de
pesquisa. Ribeirão Preto: Legis Summa; 1998. p. 51-70.
21. Fioroni LN. Modos de enfrentamento da AIDS e condições de vida:
estudo baseado em fatores de personalidade e hierarquia de necessidades
[Dissertação de Mestrado]. Ribeirão Preto: Faculdade de Medicina de
Ribeirão Preto, Universidade de São Paulo; 2000.
22. Strawn JM. As conseqüências psicossociais da AIDS. In: Durhan JD,
Cohein FL, organizadores. A enfermagem e o aidético. São Paulo: Manole;
1989. p. 126-49.
23. Teixeira PR, Paiva V, Shimma E. Tá difícil engolir? Experiências
de adesão ao tratamento anti-retroviral em São Paulo. São Paulo: Núcleo
de Estudos em Prevenção de AIDS, Universidade de São Paulo; 2000.
24. Bennett L. AIDS health care: staff stress, loss and bereavement.
In: Sherr L, editor. Grief and AIDS. New York: John Wiley & Sons; 1995.
25. Niven CA, Knussen C. Measuring the stress associated with caring
clients with HIV/AIDS. AIDS Care 1999; 11:171-80.
26. De La Tribonnière X, Dufresne MD, Alfandari S, Fontier C, Sobazek
A, Valette M, et al. Tolerance, compliance and psychological
consequences of post-exposure prophylaxis in health-care workers. Int J
STD AIDS 1998; 9:591-4.
27. Souza M. Acidentes ocupacionais e situações de risco para equipe
de enfermagem: um estudo em cinco hospitais do Município de São Paulo
[Dissertação de Mestrado]. São Paulo: Escola Paulista de Medicina,
Universidade Federal de São Paulo; 1999.
28. Meneghin P. Entre o medo da contaminação pelo HIV e as
representações simbólicas da Aids: o espectro do desespero contemporâneo.
Rev Esc Enferm USP 1996; 30:399-415.
M. R. R. Rissi
Departamento de Psicologia e Educação, Faculdade de Filosofia,
Ciências e Letras de Ribeirão Preto, Universidade de São Paulo
Rua Terezina 380, apto. 24
Ribeirão Preto, SP 14055-380, Brasil