Earlier this month, IntraHealth’s newest Board member, Nilda Peragallo, RN, DrPH, FAAN, was in our Chapel Hill office. I sat down to talk with her about her career in nursing, her research, and how her expertise aligns with IntraHealth’s mission of supporting health workers.
Dr. Peragallo is originally from Valparaíso on the coast of Chile. She studied nursing and worked as a nurse in Chile and in Germany before she came to the United States. Life took her to West Virginia and then Texas, where she worked and completed her master’s and doctoral degrees before she met a patient in Orlando, who would change the course of her career.
“It was around 1984, and I was teaching at the University of Central Florida. I had been watching the HIV statistics from CDC. The number of Latino women with HIV was small, but it kept climbing and climbing and climbing. One day, I was at the hospital with the students who were in their senior year, and we were doing clinical rounds.
“And there was this one man, a patient, and nobody on the floor wanted to go into his room. But I had assigned the patient to one of my students, so we went in. There were trays all over the place, and the curtains were down. This was a man with AIDS. Nobody wanted to enter that room because, at that time, people really didn’t know what AIDS was. It really affected me.
“So then I did a study that looked at nurses’ knowledge and attitudes towards HIV/AIDS-infected patients, although really a lot of these patients had full-blown AIDS. I found that indeed the connection between lack of knowledge and bias and discrimination was huge. Because of that study, the state of Florida changed its requirements to renew nursing licenses and required that nurses complete two hours of HIV/AIDS education. There is still stigma surrounding those patients, but I think it has really made a difference, and that’s how I got started in this field.”
Dr. Peragallo went on to do post-doctoral work as a Robert Wood Johnson nurse-scholar at the University of Pennsylvania and continued researching how the HIV epidemic was affecting the Latino community and how very little was being done to protect women.
She decided to do a study that examined the factors that put Latino women at risk for infection. One of the variables she chose to study was acculturation—or how much women had adapted to the culture they were living in. She found that Latino women, particularly young women, who were highly acculturated were at higher risk for HIV infection than those who were not as acculturated. She determined that although these women had adopted many of the behaviors of their American peers, they did not necessarily have the same support systems or access to information. For example, their American peers were more likely to talk openly with friends or partners about sex.
She took this work with her to Chicago where she started building interventions to help educate and protect women from HIV. Beyond its focus on Latino women, Dr. Peragallo’s work in Chicago was groundbreaking because it was also one of the first HIV prevention studies to integrate violence prevention.
“Lately you hear people talking about the intersection of violence and HIV, but back then no one was talking about it,” she said.
It was the women she was working with who brought it up. They needed help with violence—not just domestic violence but violence in their neighborhoods.
“It was really these women who informed me of what I needed to do rather than me guessing what they needed,” she explained. “The program was efficacious and worked because it was designed around what these women saw as their own needs.”
She found out quickly that it would take a lot of logistical and practical thinking to make the interventions work. The study participants were low-income Mexican and Puerto Rican women in Chicago, and they wouldn’t come to a program if it was publicized as being about HIV or drug recovery, especially because misconceptions and bias were rampant. The women were more likely to participate if it was situated in a hospital or community center where no one would wonder why they were there. She led a focus group one day and listened to the women share their own ideas about people living with HIV.
“These women were talking about all the prevalent misconceptions: that it only happens to sex workers, drug addicts, and gay men—but not to us,” she explained. “Then one of the women in the group got up and said, ‘But I am infected. My husband is a drug addict, and I am infected.’ And then another one got up and said, ‘I am infected too.’ It was a group of about ten women, and I really didn’t know how they all were going to react. They had just been discussing the idea that only certain kinds of people get HIV. They thought you could tell by looking at somebody if you had it. Then those women stood up and blew those misconceptions away. By the end, they were all embracing each other. It was really incredible.”
Dr. Peragallo went on to talk to me about the tremendous impact that HIV has had on our society and medical care, as well as her own career.
“Now, HIV is seen as a chronic disease,” she commented. “It is a good thing that we can manage and treat it and maintain people. But at the same time, it is dangerous to think treatment is a silver bullet because then people continue taking risks and don’t change the way they behave.”
You can hear from Dr. Peragallo on her thoughts about necessary changes in medical education and health worker recruitment systems in the United States by reading her blog, “How Can We Do Better by American Patients and Health Workers?”