Rutgers School of Nursing is taking the lead in a $6 million nationwide effort to greatly reduce new HIV infections - a battle complicated by both the aging of career HIV health care professionals and a failure to engage all people living with HIV into treatment.
"Testing and treating for HIV infection need to be part of routine primary health care," said John Nelson, director of the National Coordinating Resource Center at the school's François-Xavier Bagnoud Center (FXB Center), serving a network of 16 AIDS Education and Training Center programs. "All health care providers need to consider HIV infection the same as any other chronic illness, such as hypertension and diabetes."
Within the next few months, the FXB Center will launch a national campaign to teach primary care providers evidence-based practices to prevent an estimated 50,000 new HIV cases in the United States each year, many of which go undiagnosed, and to persuade HIV-infected individuals to seek treatment.
The four-year program is funded by a Health Resources and Services Administration grant.
Though the death rate from HIV/AIDS has fallen dramatically, the HIV/AIDS global pandemic continues to keep health care workers operating in crisis mode. Engaging and convincing high-risk individuals in rural and urban areas to be tested, continues to be a major obstacle to care, despite the success of the antiretroviral drug therapy.
"We have known for a while that treating a person with HIV as early as possible in the infection leads to significantly better outcomes," says Andrea Norberg, FXB Center's executive director, who will lead the grant effort. "A person who is diagnosed early and then started on the medications to lower the level of HIV in the body, can live a full life expectancy with a lower chance of getting sick from HIV and transmitting the virus to others."
But, she says, many people who might be infected with HIV - the virus that causes AIDS - fail to be tested because of the stigma they feel or anticipate when they show up for examinations, and also because many providers do not include HIV testing in routine physicals.
"We can now diagnose three weeks after you are infected and we know how to prevent HIV," says Nelson. "But the reality is that many health care providers are not comfortable talking about HIV and related behaviors."
Part of the grant funding will be used to help health care providers make clinical settings more patient-friendly. The FXB Center also will recommend stronger advertisements to promote testing to individuals who could be infected because they inject drugs or engage in unsafe sex practices.
Recruiting new providers to the struggle against HIV/AIDS is also a priority. The FXB Center has been at the forefront of local and national efforts to treat people living with HIV/AIDS and to educate health care providers since 1983, working with many whose careers have focused on caring for HIV-infected people. As professionals have begun retiring, their ranks are not being amply filled.
"We need to recruit and educate more people," Nelson says. "We are not meeting the demand caused by the rate of new infections."
Norberg and Nelson will help guide the recruitment of more providers and develop a national curriculum to teach providers about evidence-based HIV care services, ranging from testing to viral suppression in those living with HIV. The Centers for Disease Control and Prevention estimates that 13 percent of HIV-infected people are not aware of their condition and that only 30 percent of the infected population is taking medication to reduce the HIV level in their bodies.
"HIV and AIDS can be prevented and treated," says Nelson, "and we won't stop what we're doing until we have a cure for HIV."