RESUMEN
The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = -0.154), education (r = -0.106), work status (r = -0.132), income adequacy (r = -0.204, self-esteem (r = -0.617), HIV symptom self-efficacy (r = - 0.408), and self-kindness (r = - 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.
Asunto(s)
Depresión/psicología , Infecciones por VIH/psicología , Autocuidado/métodos , Autoimagen , Autoeficacia , Adolescente , Adulto , Anciano , Canadá/epidemiología , China/epidemiología , Comorbilidad , Estudios Transversales , Depresión/epidemiología , Escolaridad , Emociones/fisiología , Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Humanos , Juicio/fisiología , Masculino , Persona de Mediana Edad , Namibia/epidemiología , Puerto Rico/epidemiología , Distribución por Sexo , Encuestas y Cuestionarios , Tailandia/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Depressive symptoms are highly prevalent yet undertreated in people living with HIV/AIDS (PLHAs). As part of a larger study of symptom self-management (N=1217), this study examined the prevalence, correlates, and characteristics (intensity, distress, and impact) of depressive symptoms, and the self-care strategies used to manage those symptoms in PLHAs in five countries. The proportion of respondents from each country in the total sample reporting depressive symptoms in the past week varied and included Colombia (44%), Norway (66%), Puerto Rico (57%), Taiwan (35%), and the USA (56%). Fifty-four percent (n=655) of the total sample reported experiencing depressive symptoms in the past week, with a mean of 4.1 (SD 2.1) days of depression. Mean depression intensity 5.4 (SD 2.7), distressfulness 5.5 (SD 2.86), and impact 5.5 (SD 3.0) were rated on a 1-10 scale. The mean Center for Epidemiologic Studies Depression Scale score for those reporting depressive symptoms was 27 (SD 11; range 3-58), and varied significantly by country. Respondents identified 19 self-care behaviors for depressive symptoms, which fell into six categories: complementary therapies, talking to others, distraction techniques, physical activity, medications, and denial/avoidant coping. The most frequently used strategies varied by country. In the US sample, 33% of the variance in depressive symptoms was predicted by the combination of education, HIV symptoms, psychological and social support, and perceived consequences of HIV disease.
Asunto(s)
Trastorno Depresivo/terapia , Infecciones por VIH/psicología , Autocuidado/métodos , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Antidepresivos/uso terapéutico , Colombia/epidemiología , Comunicación , Terapias Complementarias/métodos , Trastorno Depresivo/complicaciones , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Puerto Rico/epidemiología , Índice de Severidad de la Enfermedad , Apoyo Social , Taiwán/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.
Asunto(s)
Infecciones por VIH/psicología , Enfermedades del Sistema Nervioso Periférico/terapia , Asunción de Riesgos , Autocuidado/métodos , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/epidemiología , Antirretrovirales/efectos adversos , Actitud Frente a la Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/psicología , Prevalencia , Puerto Rico/epidemiología , Factores de Riesgo , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Taiwán/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Peripheral neuropathy is the most common neurological complication in HIV and is often associated with antiretroviral therapy. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of peripheral neuropathy in HIV disease, sociodemographic and disease-related correlates and self-care strategies. A convenience sample of 1,217 respondents was recruited from data collection sites in several US cities, Puerto Rico, Colombia and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified 20 self-care behaviors including complementary therapies, use of medications, exercise and rest and/or elevation of extremities. Ratings of frequency and effectiveness were also included. An activities checklist summarized into five categories of self-care behaviors including activities/thoughts, exercise, medications, complementary therapies and substance was used to determine self-care behaviors. Taking a hot bath was the most frequent strategy used by those with peripheral neuropathy (n=292) and received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.1 (scale 1-10). Other self-care strategies to manage this symptom included: staying off the feet (n=258), rubbing the feet with cream (n=177), elevating the feet (n=236), walking (n=262), prescribed anti-epileptic agent (n=80), prescribed analgesics (n=84), over-the-counter medications (n=123), vitamin B (n=122), calcium supplements (n=72), magnesium (n=48), massage (n=156), acupuncture (n=43), reflexology (n=23) and meditation (n=80). Several behaviors that are often deemed unhealthy were included among the strategies reported to alleviate peripheral neuropathy including use of marijuana (n=67), cigarette smoking (n=139), drinking alcohol (n=81) and street drugs (n=30).
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedades del Sistema Nervioso Periférico/terapia , Autocuidado/métodos , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/terapia , Actitud Frente a la Salud , Colombia/epidemiología , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/epidemiología , Prevalencia , Puerto Rico/epidemiología , Fumar/terapia , Taiwán/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Irrespective of powerful drug therapies, there has been a slight increase in newly diagnosed cases of AIDS in women. HIV/AIDS-related symptoms develop from the illness itself, treatments or medications. Symptoms and their reoccurrence remain problematic. This study is a secondary analysis of data exploring symptoms, symptom distress and functional status in 104 ethnically diverse HIV-positive women. Measures included the Brief Symptom Inventory, a General Symptom Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Inventory of Functional Status. Findings indicate that this sample of women was distressed, at risk for depression and had a moderate level of physical functioning. These findings support the need for symptom management interventions that enhance emotional wellbeing and self-care activities for HIV-infected women.
Asunto(s)
Seropositividad para VIH/psicología , Estrés Psicológico/etiología , Actividades Cotidianas , Adulto , Anciano , Estudios Transversales , Trastorno Depresivo/etiología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Heterogeneity is perhaps the most salient characteristic that defines Hispanic populations of the United States. Hispanic populations include native-born, migrant, and immigrant peoples with distinctive national origins and regional settlement patterns. This multigenerational migratory and social adjustment process has produced important cultural variations within and among the respective Hispanic ethnic groups. Moreover, the demographic structure of Hispanic populations is also varied and complex. These historical, demographic, and sociocultural features shape the health and disease experience of Hispanics. As expected, respective Hispanic ethnic groups vary in health status and have differing needs for health services. This article provides demographic background, a historical perspective, a synthesis of Hispanic issues identified in major and authoritative government documents, summary on the state-of-the-science for nursing research with Hispanics, and recommendations for future nursing research directions.
Asunto(s)
Causas de Muerte , Estado de Salud , Hispánicos o Latinos , Investigación en Enfermería , Femenino , Humanos , Masculino , Investigación en Enfermería/organización & administración , Investigación en Enfermería/tendencias , Estados UnidosRESUMEN
The cause of HIV-related fatigue is most likely multifactorial. When presented as a chief complaint, clinicians often include an assessment of stress level, depression, anemia, infection, and amount of sleep and activity. The empirical bases for these evaluations vary in their validity and implementation in clinical practice, but the basis for evaluating adequate amounts of sleep and activity currently lacks empirical research. The purpose of this study was to describe HIV seropositive women's sleep and activity patterns related to their fatigue experience. Sleep and activity were assessed with wrist actigraphy to obtain objective measures of total sleep time, number of awakenings, and sleep efficiency, as well as level of daytime activity, 24-hour activity rhythm, and naps. This sample of 100 women with HIV/AIDS averaged only 6.5 hours of sleep at night, and 45% of the sample napped. CD4 cell counts were unrelated to sleep and fatigue measures. Compared to the low-fatigue group, the women with high fatigue had significantly more difficulty falling asleep, more awakenings from nighttime sleep, poorer daytime functioning, and a higher frequency of depressive symptoms. Findings from this study provide clinicians with empirically based support for detailed clinical evaluations of sleep and activity patterns, as well as anxiety and depression, in clients who complain of fatigue. Findings also provide data for potential interventions to improve sleep and activity in persons living with HIV/AIDS and to reduce fatigue and depressive symptoms.
Asunto(s)
Fatiga , Infecciones por VIH/enfermería , Infecciones por VIH/psicología , Sueño , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Salud de la MujerRESUMEN
Although powerful pharmacological therapies are helping women with HIV infection live longer, women continue to experience the stressors of chronic illness. This study used a person-environment systems framework to describe social interactions, perceived social support, and psychological distress in HIV-positive women. A convenience sample of 104 HIV-positive women living in the San Francisco Bay Area completed a questionnaire on social interactions, perceived social support, and distress. Women reported limited social interactions with family and friends and a low level of perceived social support. Social support and level of distress did not differ by ethnicity. Limited perceived social support was a significant predictor of distress in this sample of women. Supportive interactions from health care providers can be useful in mediating the relationship between the stressor of HIV disease and distress in HIV-positive women. Community-based nurses can enhance HIV-positive women's support network by providing positive and supportive interactions as they intervene with women in symptom management, case management, and other health care services.
Asunto(s)
Infecciones por VIH/psicología , Relaciones Interpersonales , Apoyo Social , Estrés Psicológico/virología , Salud de la Mujer , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Análisis de Regresión , San Francisco , Estrés Psicológico/psicologíaRESUMEN
SETTING: Despite a continuing decline in tuberculosis (TB) in the US, jails remain a high-risk setting for the identification of active and latent TB infection (LTBI). OBJECTIVE: The purpose of this study was to document the change in TB prevalence in the San Francisco City and County Jail. DESIGN: Two period prevalence analyses were done, for 1994 and 1998. The sample included all persons booked into jail during the two years. The rates of inmates screened and the prevalence of active TB and LTBI by sex and ethnicity were compared using computerized records. RESULTS: Prevalence of active TB was 72.1 per 100000 jail population for 1998, and did not change significantly from 1994. In 1998 one third of active TB cases were found through jail screening. Latinos represented respectively 20.1% and 17.7% of those booked in 1994 and 1998, but 43.0% and 41.7% of inmates with LTBI. In 1998, being Latino (odds ratio 2.9) and male (odds ratio 1.6) were most strongly associated with LTBI. CONCLUSION: Screening for TB among jail inmates is an increasingly valuable clinical and epidemiological tool for case-finding and for identifying persons who would benefit from preventive therapy.
Asunto(s)
Prisioneros/estadística & datos numéricos , Tuberculosis/epidemiología , Adulto , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Prevalencia , San Francisco/epidemiología , Población UrbanaRESUMEN
The relationships among the biological and physiological indicators of cytopenias in AIDS and measures of quality of life are not well characterized. The purpose of this secondary analysis was to determine the relationships among anemia, neutropenia and thrombocytopenia and characteristics of the individual, physiological markers, symptoms, functional status, general health perceptions, and well-being in people with AIDS. The five dimensions of the Wilson and Cleary model of health-related quality of life provided the conceptual model for this study. In addition to descriptive statistics, logistic regression was used to analyze clusters of variables. The sample of 146 hospitalized patients with AIDS had an 85% prevalence of anemia, a 53% prevalence neutropenia and a 33% prevalence of thrombocytopenia. The mean age was 38 years old, 19% were female, 35% were white, 27% had a history of injection drug use and the mean T-helper cell count was 74 mm3. The five dimensions of the Wilson and Cleary model offered significant predictability for anemia only. Patients with higher symptom scores were more likely to have treatable anemia, defined as a hematocrit of < 30%. Treatable anemia was also associated with lower self-care scores and lower T-helper cells. Fifty-four percent of the cohort were candidates for colony stimulating factors, while only 17% of those eligible received them. These data suggest suboptimal treatment of anemia and neutropenia in this cohort of AIDS patients.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/psicología , Enfermedades Hematológicas/epidemiología , Enfermedades Hematológicas/psicología , Hospitalización , Calidad de Vida , Adulto , Anciano , Anemia/epidemiología , Anemia/psicología , Estudios de Cohortes , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Neutropenia/epidemiología , Neutropenia/psicología , San Francisco/epidemiología , Trombocitopenia/epidemiología , Trombocitopenia/psicologíaRESUMEN
This is a descriptive, correlational study of the predictors of perceived cognitive functioning. The convenience sample of 728 nonhospitalized persons receiving health care for HIV/AIDS was recruited from seven sites in the United States. All measures were self-reported. Self-perception of cognitive functioning, the dependent variable, was composed of three items from the Medical Outcomes Study HIV scale: thinking, attention, and forgetfulness. Data related to age, gender, ethnicity, education, injection drug use, CD4 count, and length of time known to be HIV-positive were collected on a demographic questionnaire. The scale from the Sign and Symptom Checklist for Persons with HIV Disease was used to measure self-reported symptoms. Data were analyzed using hierarchical multiple regression analysis. Predictors of perception of cognitive functioning explained a total of 36.3% of the variance. Four blocks--person variables (1.5%) (age, gender, education, history of injection drug use), disease status (2.3%), symptom status (26.5%), and functional status (5.4%)--significantly contributed statistically to the total variance. Among those individuals who completed the questions related to depression (n = 450), 28% of the variance in cognitive functioning was explained by this variable. The findings in this multi-site study indicate that symptom status explained the largest amount of variance in perceived cognitive functioning. Early identification of cognitive impairment can result in appropriate clinical interventions in remediable conditions and in the improvement of quality of life.
Asunto(s)
Cognición , Infecciones por VIH/psicología , Autoimagen , Adulto , Recuento de Linfocito CD4 , Escolaridad , Etnicidad , Femenino , Infecciones por VIH/etiología , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Análisis de Regresión , Factores de Riesgo , Encuestas y Cuestionarios , Estados UnidosRESUMEN
This article describes the Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention designed to enhance adherence to HIV/AIDS medications and reports the results of a pilot study aimed at assessing the feasibility of CAP-IT. Initially, CAP-IT was designed to be implemented by nurse case managers during regularly scheduled home visits; it is currently under revision for use in an outpatient, ambulatory care setting. CAP-IT is an innovative, structured nursing assessment and care-planning activity that allows a standardized assessment of client needs and tailored highly active antiretroviral therapy adherence intervention strategies. CAP-IT is significantly different from the current standard nursing case management practice. Pilot study results in a sample of 10 home care patients suggests that clients have knowledge and skill deficits related to adherence and in the management of the side effects of medications. In addition, the pilot study supported the acceptability of the protocol to clients and the feasibility of integrating CAP-IT into nurse case manager practice. The pilot study results also provided evidence for the efficacy of CAP-IT. The next steps include testing CAP-IT in a randomized clinical trial to determine its effectiveness.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Manejo de Caso/organización & administración , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Evaluación en Enfermería/métodos , Planificación de Atención al Paciente/organización & administración , Cooperación del Paciente/psicología , Adulto , Estudios de Factibilidad , Femenino , Infecciones por VIH/enfermería , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Evaluación de Necesidades , Investigación en Evaluación de Enfermería , Educación del Paciente como Asunto , Proyectos PilotoRESUMEN
This study examined the relationships between the five dimensions of the Wilson and Cleary model of health-related quality of life and three self-reported adherence measures in persons living with HIV using a descriptive survey design. Data collection occurred in seven cities across the United States, including university-based AIDS clinics, private practices, public and for-profit hospitals, residential and day-care facilities, community-based organizations, and home care. The three dependent adherence measures studied were "medication nonadherence," "follows provider advice," and "missed appointments." The sample included 420 persons living with HIV disease with a mean age of 39 years of which 20% were women and 51% were white; subjects had a mean CD4 count of 321 mm3. HIV-positive clients with higher symptom scores, particularly depression, were more likely to be nonadherent to medication, not to follow provider advice, and to miss appointments. Participants who reported having a meaningful life, feeling comfortable and well cared for, using their time wisely, and taking time for important things were both more adherent to their medications and more likely to follow provider's advice. No evidence was found demonstrating any relationship between adherence and age, gender, ethnicity, or history of injection drug use. These findings support the need to treat symptoms, particularly depression, and to understand clients' perceptions of their environment as strategies to enhance adherence. A limitation of this study was that adherence was measured only by self-report; however, the study did expand the concept of adherence in HIV care beyond medication adherence to include following instructions and keeping appointments.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/psicología , Cooperación del Paciente , Calidad de Vida , Encuestas y Cuestionarios/normas , Adulto , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Valor Predictivo de las Pruebas , Análisis de Regresión , Estados UnidosRESUMEN
PURPOSE: To examine fatigue as a symptom experienced by women with human immunodeficiency virus (HIV). SAMPLE: A convenience sample of 100 women with HIV. ANALYSIS: Independent sample t-tests were used to test for mean differences in fatigue related to variables in the women's sociocultural and home environment (ethnicity, employment, marital status, and parenting). Pearson product moment correlations were used to examine significant relationships between fatigue and physiologic variables (age, CD4 cell count, and sleep). FINDINGS: Lower CD4 cell counts were related to more daytime sleep, higher evening fatigue, and higher morning fatigue. Morning fatigue was related to duration of wake episodes during the night, napping, and perception of sleep disturbance during the past week. The number of awakenings during the first night predicted the severity of fatigue the next evening. CONCLUSION: To understand the fatigue experienced by women with HIV, researchers and clinicians must focus on the relative contributions of sociocultural, home, and physiologic environments within which these women live. Additional research is ongoing to identify the strategies these women use to manage daily activities such that gender-relevant and culturally relevant interventions for alleviating fatigue can be tested in women with a variety of chronic illnesses, including HIV and acquired immune deficiency syndrome.
Asunto(s)
Fatiga/etiología , Infecciones por VIH/fisiopatología , Adulto , Anciano , Estudios Transversales , Fatiga/psicología , Femenino , Infecciones por VIH/etnología , Infecciones por VIH/enfermería , Infecciones por VIH/psicología , Humanos , Persona de Mediana Edad , Análisis de Regresión , Sueño/fisiologíaRESUMEN
This article is a curriculum overview of a graduate program of the Advanced Practice Home Care Nursing (APHCN) Program, which began at the School of Nursing, University of California, San Francisco, in 1996. A historical perspective of home care and the need for advanced practice nurses in the home care industry is provided. Curricular components of the APHCN Program are outlined. The roles of the home care clinical nurse specialist, home care nurse practitioner, and home care administrator are presented. Finally, a discussion is presented in which home care nursing demonstrates the efficacy of the advanced practice role and the need for well designed outcomes-based research.
Asunto(s)
Enfermería en Salud Comunitaria/educación , Curriculum , Educación de Postgrado en Enfermería/organización & administración , Servicios de Atención de Salud a Domicilio , Enfermeras Clínicas/educación , Enfermeras Practicantes/educación , Humanos , Perfil Laboral , Enfermeras Clínicas/organización & administración , Enfermeras Practicantes/organización & administraciónRESUMEN
Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients' well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA's cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice.
Asunto(s)
Asiático/psicología , Actitud Frente a la Salud/etnología , Diversidad Cultural , Ética en Enfermería , Hispánicos o Latinos/psicología , Consentimiento Informado , Valores Sociales , Enfermería Transcultural , Población Blanca/psicología , Comprensión , Revelación , Femenino , Humanos , Masculino , Investigación Metodológica en Enfermería , Paternalismo , Autonomía Personal , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Since management strategies are guided by the assessment of the symptom experience, agreement between patients' and nurses' perceptions of symptoms is central to clinical management. In this study, acquired immune deficiency syndrome patients' perceptions of 41 human immunodeficiency virus-related signs and symptoms were compared in 207 pairs of ratings by patients (n = 207) and nurses (n = 103). Ten symptoms were reported by 50% or more of the patients. Mean patient intensity ratings for all signs and symptoms, with the exception of anxiety, were higher than nurse ratings. Using patients' ratings as the gold standard, chance-corrected estimates of sensitivity, specificity, positive predictive value, and negative predictive value of the nurses' ratings suggested that nurses' ratings poorly predicted patients' symptom experiences.