AIDS is the leading cause of death in sub-Saharan Africa. With a prevalence rate of 3.1% in 2006, Rwanda is one of the hardest hit countries. Nurses are often the leading health professionals in rural communities and at the forefront of the fight against the HIV pandemic. Little has been written on how nurses are prepared to intervene successfully along the continuum of HIV prevention and care. A mixed-methods sequential exploratory approach was used to explore this question.

In the first phase, cognitive, socio-psychological, and environmental factors of nursing education in Rwanda in regard to HIV prevention and care were qualitatively explored using grounded theory-guided data collection and analysis. Key informant interviews with nursing students, nursing practice instructors and nurses (N=25) completed by observations elicited three themes affecting nursing students' preparedness: perceived risk in the context of stretched resources, sexual risk prevention education and psycho-social counseling. These themes were linked with lack of emotional and cognitive preparedness to care as well as people living with HIV/AIDS (PLWHA) stigmatization among nursing students.

The results of the qualitative study were used to develop a questionnaire as a means of exploring and comparing HIV knowledge, attitudes, experience, expectations and their relationship to counseling self-efficacy among 2 ^nd and 3^rd year nursing students in Rwanda (N=203). In this cross-sectional design, respondents completed an anonymous, self-administered questionnaire. T-tests and chi-squares revealed that 3^rd year students had insufficient HIV transmission and prevention knowledge and had built a moderate level of counseling self-efficacy, but reported a lower degree of stigmatization and higher counseling expectations. They also reported more experience with PLWHA care, although 13% had not yet provided care to PLWHA. Multiple regression analysis revealed that being affiliated with the Catholic Church, correct knowledge and PLWHA care experience significantly predicted counseling Self-Efficacy.

Results point to a lack of readiness to participate in HIV prevention and care activities among nursing students in Rwanda. Results support the need to contextualize training, discuss culturally imbedded beliefs, emphasize self-efficacy building and strengthen psychosocial counseling and health education skills among students. Results of this study will inform the design and implementation of future nursing training programs.