From the very beginning of the AIDS epidemic in 1981, nurses have been at the forefront of patient care, advocacy, and research.
But even in the age of antiretroviral therapy and pre-exposure prophylaxis, many challenges remain in reducing the impact of HIV and AIDS, according to the special May/June issue of The Journal of the Association of Nurses in AIDS Care (JANAC). The official journal of the Association of Nurses in AIDS Care, JANAC is published in the Lippincott portfolio by Wolters Kluwer.
Assembling nine "state of the science" reviews invited from leading clinical scientists, the special issue of JANAC summarizes 40 years of nursing science throughout the HIV epidemic - highlighting "lessons learned and the way forward" in improving clinical care and quality of life for people living with HIV.
The HIV epidemic has been shaped, for the better, by dedicated nurses, nurse practitioners, and midwives who have provided direct care, questioned the status quo, advocated for patients' rights, taught the next generation of HIV clinicians, and advanced the science."
Michael V. Relf, PhD, RN, AACRN, ANEF, FAAN Editor-in-Chief, JANAC
Nurse researchers lead the way in improving HIV prevention and patient care
Several of the special-issue papers focus on groups that face disproportionately high burdens of HIV disease. Schenita D. Randolph, PhD, MPH, RN, CNE, of Duke University School of Nursing and colleagues review the evidence on HIV prevention and treatment among cisgender women in the United States.
In 2018, women accounted for 19 percent of new cases of HIV in the United States. The rate of new HIV cases is 14 times higher in Black women and three times higher in Latina women, compared to white women.
Dr. Randolph and colleagues discuss risk factors driving the HIV epidemic among US women, including interpersonal, community, and societal factors. They also provide an overview of evidence-based HIV risk reduction interventions, combining behavioral, biomedical, and structural strategies.
However, to end the epidemic of HIV among women, a primary focus on prevention must incorporate the unique needs of women at risk for HIV.
"Nurses have a unique role in developing and carrying out HIV interventions....particularly the recognition that the root causes of HIV include both social and biomedical factors," Dr. Randolph and colleagues write. They outline priorities and recommendations to make HIV interventions for women more sustainable, including efforts to engage women throughout the research process and incorporating technology approaches.
Carmen J. Portillo, PhD, RN, FAAN, of Yale University School of Nursing and colleagues present a review of HIV prevention approaches in Black and Hispanic/Latinx communities. In 2018, Black/African American people accounted for 37 percent of new HIV cases and Hispanic/Latinx people for 30 percent.
Structural racism and social inequities embedded in the economic, education, health care, and criminal justice systems are major contributors to the "overwhelmingly disparate" HIV-related health disparities in Black and Hispanic/Latinx populations. "[M]ulti-level interventions that address individual, structural, and social level components have demonstrated more sustainable outcomes," according to the authors.
Nurse scientists can play a major role in addressing racism as "the fundamental reason for health disparities," the researchers believe. Dr. Portillo and coauthors call for "updating antiquated curriculums in nursing, medicine, and public health that perpetuate racial, structural-level inequities and also increasing the pipeline for Black and Hispanic/Latinx persons to pursue research or clinical-focused doctorate degrees."
Other papers in the special issue address vulnerabilities to HIV among adolescents and young adults and people with differences in sexual orientation or gender identity/expression; important problems of aging patients with HIV, including cognitive changes and comorbid chronic diseases; and other key issues along the continuum of care including medication adherence, HIV-related stigma, and the future of HIV prevention.
Dr. Relf and colleagues conclude: "This body of work reflects an optimism that perhaps, in the next 40 years, we will be reviewing the key role that nursing played to help end the AIDS epidemic once and for all."