Human immunodeficiency virus (HIV) is an infectious disease-causing agent affecting millions of people around the globe, with some specific groups at a greater risk than others, largely depending on behaviors associated with sex or intravenous exposure secondary to syringe and needle use. The prevalence of HIV/acquired immune deficiency syndrome (AIDS) has decreased in the United States from 45 700 cases in 2008 to 37 600 new HIV infections in 2014.1 Approximately 1 million people were living in the United States with a positive HIV status at the end of 2015; in 2016, approximately 36.7 million people worldwide were living with HIV, with approximately half receiving antiretroviral therapy (ART) to manage the disease.1 Many people with HIV infection who have been treated early can live for almost as long as someone who is HIV-negative.2 AIDS is the gravest stage of HIV infection, with an untreated survival length of approximately 3 years. Individuals with AIDS may be highly infectious and have a high viral load, low immunity via CD4 cells, and opportunistic illnesses related to this low immunity.3 Most providers are likely familiar with these basic facts, but knowledge deficits and misunderstandings persist, perhaps, in some cases, resulting from stigmatization of the diagnosis and of the people associated with high-risk behaviors contributing to infection exposure.

Health care providers and those teaching these providers are ethically obliged to have a working understanding of HIV infection, including testing standards and prophylaxis. Informal conversations with nurses and nurse educators suggest that while some knowledge about HIV infection is widely known, other critical aspects of safe and responsible HIV infection practice are unfamiliar and perhaps not followed in practice. A nurse recently participated in 2 different workshops with nurse educators. Anonymous, casual surveying revealed that most were unfamiliar with preexposure prophylaxis (PrEP) and most had not been HIV tested. In addition, the audience of nurse educators did not actively and deliberately encourage nursing students to get tested as a routine matter of health promotion and disease prevention. These knowledge and practice deficiencies do not demonstrate readiness to correctly provide the requisite standard of care for HIV/AIDS prevention. This isolated example may illustrate a broader HIV/AIDS care deficiency among providers of all types in the United States related to many aspects of HIV/AIDS care and treatment, but most worrisome may be the lack of proactive and consistent encouragement of HIV testing.

The Centers for Disease Control and Prevention (CDC) recommends that everyone seek HIV testing at least one time between the ages of 13 and 64 years.4 Its Web site provides a rich repository of detailed information written in plain language about HIV/AIDS and PrEP. Interactive tools assist in decision making about sexual practices and also offer search tools to locate HIV testing sites based on zip codes. PrEP is a combination drug taken as a daily pill under the name of Truvada.5 It is comprised of 2 HIV/AIDS medications, tenofovir and emtricitabine. Truvada was approved by the Federal Drug Administration in 2012. Following a prescribed PrEP regimen reduces the risk of sex-based HIV transmission by 90% and intravenous transmission by 70%. Some people may initially experience nausea, but Truvada is not associated with severe adverse effects. Providers should be aware that there is also postexposure prophylaxis (PEP) available for people who may have been exposed to HIV within the previous 72 hours.

Published research findings suggest that care providers need to improve practice patterns related to discussing sexual activities, actively encouraging HIV testing, delivering HIV status findings, and prescribing and managing PrEP therapy.6-8 It is important for inexperienced providers to adopt PrEP into regular practice routines coupled with conversations about HIV and testing. The first step is to ensure that primary care providers of all licensure types are knowledgeable about PrEP's capacity to decrease the rate of contracting HIV/AIDS by 92% to 100% among those at risk who adhere to PrEP guidelines.6 Nurses practicing as registered nurses without prescriptive privileges and in settings that are not predominately focused on primary care, including those employed in high-acuity settings or long-term care, can contribute to PrEP uptake by initiating conversations about HIV testing guidelines put forth by the CDC and the opportunities available to prevent HIV transmission in those at risk-before or shortly after suspected HIV exposure. Most nurses are familiar with PEP specific to needlestick or blood exposure experiences during care delivery. Depending on their area of expertise and self-study, they may be unaware of PrEP.

Those who might benefit from PrEP therapy vary in sexual orientation, sexual activity, age, and other demographic characteristics. Current PrEP recommendations include those who are negative for HIV and sexually active with a partner who is HIV-positive.5 Clinical practice guidelines for PrEP also recommend therapy for anyone who is not in a mutually monogamous or exclusive relationship with a partner who has recently tested as HIV-negative and is (1) a gay or bisexual man who has had anal sex without condom usage or has been diagnosed with a sexually transmitted infection over the previous 6 months, or (2) a heterosexual man or woman who does not consistently use condoms during sex with partners of known HIV status who are at significant risk of HIV infection (eg, people who inject drugs or women who have bisexual male partners).5 Providers are also encouraged to consider PrEP for people who have used injectable drugs in the past 6 months and have shared needles or paraphernalia (aka "works") or have been in drug treatment in the last 6 months.5 PrEP guidelines are also available for people considering becoming pregnant with an HIV-positive partner.5

The first step that holistic providers need to address is to establish a consistent pattern of conversing with people about HIV testing recommendations. HIV testing must be normalized as a routine screening that occurs at least once in a lifetime. Providers need to avoid assumptions about people's sexual orientations and practices and eschew tendencies to conclude that those who use intravenous drugs or engage in behaviors that are risky for HIV transmission look or act in particular or unique ways. To effectively address patient or client needs, providers must have a working knowledge of evidence-based standards of care including obtaining sexual histories, encouraging HIV testing, and responding to opportunities for PrEP prescription or, in some events, PEP. There are many resources available for self-directed learning on this subject, including those accessible from the CDC and from other health agencies that have prioritized educating the public and providers about HIV testing and PrEP. Responsible and committed providers, including those who educate nurses and other frontline health professionals, are duty bound to develop this expertise and incorporate this learning into education and practice experiences. Perhaps, providers and educators might begin this learning trajectory by having their HIV status tested!

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