Practice Tip of the Week: World AIDS Day
Tuesday, December 3, 2019
Posted by: Roy Muyinza
By: Kanaka Sathasivan, MPH
Over the past four decades, nurses have been on the frontlines in the fight against HIV and AIDS. In that time, research, technology and medicine have come a long way. An HIV diagnosis is no longer a death sentence. Medications can suppress the virus to the point that it is undetectable. Several studies show that pre-exposure prophylaxis (PrEP) can reliably prevent HIV transmission.
While the goal of zero AIDS cases — and even zero transmissions of HIV in America — has been discussed for many years now, an end may truly be in sight due to these advances. But reaching that goal depends on the health care workers, particularly nurses, who connect and keep people in care at every part of the HIV care continuum.
The HIV Care Continuum
Studies have shown that people living with HIV who engage regularly in their treatment and consistently adhere to medication routines can substantially reduce the risk of spreading HIV. However, there are many points where health care workers may lose touch with someone who is diagnosed.
The continuum of care for HIV, also called the HIV treatment cascade, starts with diagnosis, next linkage to care and finally viral suppression. By keeping patients on the treatment cascade, health care providers can help prevent spread of the disease. Nurses interact with people living with HIV at every step along the continuum and can effectively promote early diagnosis, care connections, and ongoing treatment.
Currently, the largest challenge to keeping people on the continuum of care is connecting people to care and providers. A 2015 CDC study showed that 91.5 percent of new HIV infections were spread by people who were not engaged in care, including people who did not know they were infected.
Ending AIDS and HIV
On Feb. 5, 2019, President Donald Trump announced his Administration’s goal to end the HIV epidemic in the United States within 10 years by reducing new HIV infections in the United States by 90 percent by 2030. The plan relies on antiretroviral therapy, rapid diagnostic tests, PrEP and effective engagement of people living with HIV along the entire continuum of care.
However, over four decades, the fight against HIV has not only been scientific, but also social. Stigma stops people from seeking care for symptoms, obtaining a diagnosis and receiving treatment. Many people who contract HIV are from marginalized or disenfranchised populations, including LGBTQ, Hispanic and black communities. Some people living with HIV are also struggling with nutritional, housing or mental health challenges. Additionally, treatment can be prohibitively expensive.
While Ryan White funding addresses some of these social challenges, funding can’t help unless people at risk and living with HIV are connected to resources, which every nurse can help facilitate.
Every Nurse’s Role
Nurses in every community, practice setting and clinical specialty should understand the risk of HIV in the population for which they care. In the United States, 48 counties accounted for over 50% of new HIV diagnoses. Second, remind patients of HIV risk factors, even if the patient believes they are in a monogamous relationship. Counsel all patients on how to prevent HIV, encourage them to get tested regularly and help people living with HIV stay engaged with care. Finally, know what resources your community has to connect people to care, including non-profits that offer free testing, case management and financial assistance.
Addressing stigma is a priority. Nurses have a critical role in changing conversations and attitudes around HIV and AIDS from correcting misinformation about how HIV is transmitted, to confronting personal biases about at-risk populations, to addressing prejudice and discrimination in clinical settings. All health care workers should help convey understanding and acceptance in all interactions with those living with HIV. Health care workers also need to strengthen interprofessional team collaboration, which has been shown to increase linkage to care.
Nurses can also advance the fight through policy and legislative initiatives that support education on transmission, prevention, and treatment; universal HIV screening; and access to and funding of prevention and treatment programs.