Increasing Impact Against HIV: The Crucial Role of Nursing

Robert Carroll
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Every year on December 1st, World AIDS Day affords us the opportunity to remember the lives of those lost to HIV and AIDS, to honor those dedicated to supporting and caring for those living with or affected by HIV, and to renew our global commitment to HIV prevention, care, and treatment. For World AIDS Day 2017, the theme guiding our reflections is Increasing Impact Through Transparency, Accountability, and Partnerships, which reminds us of the importance of working toward high-impact interventions that optimize resources and efforts in HIV prevention and treatment. 

Ambassador Deborah L. Birx, U.S. Global AIDS Coordinator, recently stated, “This theme reflects the United States government’s longstanding leadership in addressing HIV/AIDS both at home and abroad and how we are increasing our impact to move epidemics from crisis toward control. It also highlights the historic opportunity we have to accelerate progress toward ending the HIV/AIDS epidemic as a public health threat in the United States and around the world. We are at an unprecedented moment in the HIV/AIDS response. For the first time in modern history, today we have the tools to change the very course of a pandemic by controlling it without a vaccine or a cure. Controlling the epidemic would lay the groundwork for preventing, eliminating, or eradicating it, which we hope will be possible through continued and future scientific breakthroughs for an effective HIV vaccine and cure.” 


Guiding our efforts to realize these objectives is the continued focus on helping individuals living with HIV navigate the “Continuum of Care” from initial testing and diagnosis through engagement in care, adherence, and maintenance of viral suppression (the absence—or relative absence—of circulating HIV in an infected person’s bloodstream). The continuum (shown at right) is based on recent Centers for Disease Control and Prevention (CDC) data and provides a visual roadmap to understanding where improvements are needed to link more people to care, and keep them in the care system. Scrutiny of the numbers of people engaged with the HIV care system at each of the five continuum stages helps us to identify gaps in the system, in order to prevent drop-offs from care, and improve strategies that keep people moving forward toward long-term viral suppression. Combined with other behavioral prevention interventions such as condoms and pre-exposure prophylaxis (PrEP), viral suppression is a powerful tool in decreasing the number of new HIV infections, a fact recently reinforced by the CDC, which declared that when antiretroviral therapy (ART) results in viral suppression, it prevents sexual HIV transmission.

In 2014, UNAIDS created the “90–90–90” campaign to advance the goal of global HIV control.  Simply stated, this strategy intends that by 2020, 90 percent of all people living with HIV will know their HIV status; 90 percent of all people with diagnosed HIV will receive sustained ART; and 90 percent of all people on ART will achieve viral suppression. This is certainly a lofty aspiration, but one not easily achieved, since it requires expanded access to testing resources, medications, and laboratory monitoring. More importantly, these benchmarks will only be achieved through a significantly expanded skilled workforce to ensure continued engagement in care systems. But who will lead this charge? 

Nursing, of course. Since the earliest days of the HIV epidemic, nurses across this country and around the world have stepped up to provide the skilled care required by those living with—and dying from—HIV disease. As time has moved the epidemic forward, with the advent of life-sustaining medications and expanded prevention interventions, nurses have continued to be the front line in combatting HIV. And over the past three decades, the role of nursing has expanded beyond the bedside to encompass clinical and behavioral research, education and training leadership, policy development, program administration, and patient advocacy and activism. 

For 30 years, the Association of Nurses in AIDS Care (ANAC) has been the world’s largest HIV nursing professional organization. With more than 2,400 U.S. and international members, ANAC provides education, professional development, networking, and leadership support to nursing and allied health professionals working in HIV/AIDS, and promotes awareness of issues related to HIV/AIDS through public policy and advocacy. Most recently, ANAC has moved to the forefront of global efforts to achieve the 90-90-90 goals and highlighted the many ways nursing can lead the way. We know that nurses represent 80 percent of the global health care workforce, and often they are the sole care providers in many economically and geographically challenged locales. Moreover, intrinsic to the nursing role are many of the values and commitments central to the achievement of the ambitious HIV prevention, care, and treatment targets required to make 90–90–90 a reality, including:  
  • Ensuring patients’ rights to equitable and accessible health care
  • Providing care for underserved and vulnerable populations
  • Providing evidence-based and person-centered care
  • Providing care along the full HIV care continuum
  • Committing to interprofessional collaboration 
However, these values alone are not enough to ensure success, and nursing is often relegated to diminished practice roles and professional marginalization. Recognizing these challenges, this past year, ANAC declared a call to action to demand greater investment in HIV nursing worldwide, seeking to:
  • Advance nurse-led care through policies and legislation that support nurses’ true role in HIV prevention, care, and treatment.
  • Expand resources, budget allocation, and staffing structures that reflect the central role of nursing to HIV care and achievement of 90–90–90.
  • Develop health systems that ensure strong interprofessional collaboration.
  • Promote the equitable representation of nurses on health care and HIV decision-making bodies. 
By its very nature, nursing embraces transparency of practice, accountability to patients and society, and care partnerships that optimize impactful patient outcomes. I am proud to be an HIV nurse, and I recognize that nurses, as both frontline HIV care providers and the world’s largest health work force, are key to ensuring we achieve 90–90–90 by 2020. 

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