Treatment for the 1.1 million people in the U.S. living with HIV has improved vastly over the past few decades, thanks to antiretrovirals and pre-exposure prophylaxis (PrEP). As a result, nursing’s role in addressing the HIV/AIDS epidemic has shifted, as well, prompting the American Nurses Association (ANA) to update its policy statement on HIV prevention and care.
The new document, published on Sunday, Dec. 1, World AIDS Day, is the first from the organization since the ’90s, according to Lisa Stand, senior policy advisor for the ANA and one of the statement’s authors.
“Initially, our statements were very bold, calling for HIV treatment needs to be met for women, addressing healthcare workers, HIV risks and treatment for incarcerated people, just as examples,” Stand tells Florence Health. “We always saw the inequities in healthcare and had positions to address them, but we wanted to continue to do that in a 21st century lens.”
In particular, Stand says the updated guidelines are responding to several developments in care and access since the last statement: antiretrovirals, PrEP and the Affordable Care Act. The latest research — especially addressing demographic treatment disparities and the cooccurrence of HIV and hepatitis — features heavily, too.
For RNs and APRNs at home reading the new document, Stand highlights the “treatment-as-prevention approach” and the renewed emphasis on “nursing care throughout the continuum of HIV” as two important takeaways.
Here are a few ways to assure your patients and community are receiving the quality of care that the new ANA statement demands.
Follow testing protocols.
The National Institutes of Allergy and Infectious Diseases estimate that 15 percent of the 1.1 million people living with HIV aren’t aware of their condition. That’s why “the first step is identifying HIV cases and advocating for testing … [which will provide] prevention for partners and people in their communities,” Stand says.
The Centers for Disease Control and Prevention recommend everyone between 13 and 64 get tested for HIV at least once in their lives and those with risk factors get tested annually. Before the test, nurses should explain to patients what an HIV test is, why it’s necessary and what the results mean, ideally with an information sheet. Nurses should also indicate in EMRs when they’ve discussed and performed testing and whether the patient declined or consented.
The new statement also provides info on nursing plans of care and counseling.
Contact your local health department.
Because progress on HIV care requires institutional change, Stand recommends nurses interested in taking their advocacy to the next level contact their local health department. In particular, nurses should ask about HIV responses, needs and gaps.
For example, Stand says that many areas have conducted thorough responses to the opioid crisis, which include HIV testing, but they don’t have the resources to perform the necessary follow-up afterward.
“We have a lot of work to do to deliver the interventions appropriately in communities where they’re really needed,” Stand says. “That’s a great nurse advocacy leadership opportunity.”
Join the Association for Nurses in AIDS Care.
This organization, comprised of local chapters, has plenty of resources for nurses available on its website. If there’s no chapter near you, ANAC will help you start one, Stand says.
looking to keep up on HIV/AIDS research? ANAC’s peer-reviewed journal is an excellent place to start.
Fight for full practice authority for APRNs.
The first section of the guidelines addresses full practice authority for nurse practitioners, noting that “federal policymakers should take steps to expand APRN and RN practice in all federally funded health care programs that address HIV and viral hepatitis.”
It’s an important point that underscores how nursing can improve HIV treatment at every point of care. For example, expanding APRNs’ prescribing power will increase access to antiretrovirals and PrEP, and if given the right authority, nurses can influence widespread testing practices to be consistent with CDC guidelines.
Refresh your knowledge of caring for disenfranchised groups.
Much of the guidelines address the needs of overlooked groups at risk of developing HIV, including Black/African-American and Hispanic/Latino men who have sex with men (MSMs), transgender people, IV drug users, teens and older adults.
Some important points from these sections:
- Nurses should acknowledge that racism, homophobia, stigma, and sexual objectification all impact the healthcare of Black and Latino MSMs.
- Nurses should educate themselves in specific HIV risks and prevention approaches for minority and overlooked groups.
- Screen adolescents and youth for HIV as a part of routine health care, and refer them to appropriate, adolescent-centered follow-up care.
- Nursing and other medical education programs should teach their students about the health needs of injection drug users.
- Nurses should provide care individualized to meet each patient’s needs.
Learn about palliative care.
One of the last sections of the guidelines calls out the importance of palliative care, a relatively new specialty, even in the context of HIV treatment. The policy says that palliative care should begin as soon as a patient receives the diagnosis and should include, if necessary, bereavement care for patients’ families and friends.
In addition, palliative care should empower nurses to be active members of their patients’ multidisciplinary pain management teams, and education for nurses treating HIV/AIDS should include palliative care, as well.
Advocating for people living with HIV is a tough job, but Stand believes nurses are in the best position to do it.
“Nurses have always been on the frontlines providing compassionate care,” she says. “They work in environments where public health goals are part of the environment, and they’re so close to patients.”