Even though the diagnosis of human immunodeficiency virus (HIV) infection is no longer a death sentence, failure to test, fear, misconception, and stigma still accompany HIV infection and illness (acquired immunodeficiency syndrome [AIDS]). How do we break down these barriers to confront this worldwide problem?
A Global Concern
I just returned from Botswana, a country where it is estimated that approximately 40% of the population is infected with HIV. Combating this disease is the nation's number one health priority. There is even an evening soap opera with HIV as the underlying thread in every episode. In the United States, an estimated 850,000 to 950,000 persons are living with HIV, including 180,000 to 280,000 who do not know they are infected (2004 Centers for Disease Control and Prevention source as cited in "A Step-By-Step Approach to HIV/AIDS" by Sande Gracia Jones in this issue of The Nurse Practitioner). The reality is that the numbers are more than likely much higher than these estimates.
What's Your Contribution?
For NPs in practice, do you recommend testing to all your clients? For NPs in education, do you teach students to assess HIV risks and status of all clients? For NPs in research, do you investigate questions that address factors influencing individual decisions to test and to disclose? All clients include children and the elderly (not just teenagers and young adults), the entire socioeconomic strata (not just the poor or disadvantaged), the spectrum of personal and societal values and beliefs (e.g., religion), and the diversity of relationships (beyond the conventional).
What about prevention? For NPs with community links, do you promote educational programs on HIV prevention for all residents? Almost twenty-five years into the AIDS epidemic and despite years of prevention efforts, messages are simply not getting through. Greater HIV prevention and testing efforts are needed to bring down transmission rates in order to stem the tide of new infections, particularly in communities that continue to be disproportionately affected by the epidemic.
What is your contribution to fight the battle against HIV and AIDS? Read Dr. Jones' article and consider.
The Emotions of HIV
Periodically, I will subject The Nurse Practitioner readers to my creative side. This poem reflects my emotions the first time I informed an adolescent that his HIV test was positive:
I did not know how to tell him
I was as afraid as he
He was so young with much ahead
I wanted to keep him free
I did not know how to tell him
That one time was all it took
To gain a lifetime membership
To a club so real as this
I did not know how to tell him
He brought along a close friend
For strength and hope and love
And support in his time of need
I did not know how to tell him
I looked into his eyes and spoke
"You are infected with HIV"
The tears began to flow
I did not know how to tell him
I was as afraid as he
This scenario repeats itself over and over in the lives of NPs who work with populations disproportionately affected by HIV and AIDS, particularly adolescents and minorities.
Look beyond identified groups, however, and do not chance missing even one person. Every individual at risk for contracting HIV deserves the opportunity to become informed and treated, if indicated. Ask and test.
Jamesetta Newland, PhD, APRN, BC, FNP, FAANP, FNAP
Editor-in-Chief
[email protected]