Archive for the ‘HIV/AIDS’ Category


As with Ebola Outbreak, Social Determinants of Health Crucial in Recent Rural U.S. HIV Outbreak

August 25, 2015

Rachel Parrill, PhD, RN, APHN-BC, is an associate professor of nursing at Cedarville University in Ohio

by banditob/flickr creative commons

by banditob/flickr creative commons

This past fall, with the world watching, a crisis unfolded in West Africa that challenged our understanding of sociocultural environments, epidemiology, and health. The spread of Ebola and the intercontinental transmission of the disease exposed weaknesses in our epidemiological defense system. It also drew attention to the powerful role that cultural beliefs and practices can have on disease transmission during outbreaks.

In that same time frame, and with similar cultural etiologies, another infectious crisis played out much closer to home. The setting: the rural Midwest, in and around the small town of Austin, Indiana. The disease: HIV. The crisis: an unprecedented outbreak—one with incidence rates (up to 22 new cases a day at the height of the outbreak) estimated to be higher than those in many sub-Saharan African nations and transmission rates through injection drug use higher than in New York City. Contributing to this “perfect storm” were socioeconomic factors characteristic of many rural settings, including poverty, low education levels, limited access to health care, and few recreational or employment opportunities.

In my work as a faculty member in a rural Midwest setting, I introduce undergraduate and graduate nursing students to concepts of public health nursing and try to provide opportunities for them to engage in local health initiatives. However, I often encounter an unconcerned or unengaged attitude towards the health risks associated with rural life—both on the part of my students and the community members that we serve.

Our local rural community seems mostly untouched by notable urban problems such as injection drug use, prostitution, sexually transmitted infections, and rampant violence, and issues seen in surrounding larger metropolitan communities like homelessness and human trafficking typically capture the interest of my nursing students far more than the run-of-the-mill comorbidities they often see in rural community members, such as heart disease, diabetes, cancer, and unintentional injury.

So I was captivated by the story that unfolded this past year in nearby Austin, Indiana, just a three-hour drive from our university. The devastation experienced by this community so similar to the one I call home provided a poignant learning opportunity for my nursing students, and for the broader nursing community.

In my role as a faculty member, I challenge nursing students to consider a broad range of social determinants of health when examining the health of a community. For example, I invite students to examine the income and educational levels of a community in light of important health indicators. We discuss the fact that health is too often connected with wealth, educational opportunities, neighborhood characteristics, race and gender inequalities, and social policy.

Similar to the West African Ebola outbreak, the HIV outbreak in Austin reveals the effects of sociocultural environments on health. The outbreak occurred among a network of injection drug users, mostly within multiple generations of a small group of families. In terms of context, Austin suffered from not only a high rate of prescription drug use, but also a lack of medical and drug rehabilitation services, inadequate public health infrastructure, a knowledge deficit regarding HIV risk, and a strong community-fed stigma surrounding HIV infection very similar to the one that played a role during efforts to combat the Ebola crisis. Read the rest of this entry ?


Tragic Plane Crash, Truvada Concerns, Changing Infection Rates: AIDS/HIV Issues in the News

July 21, 2014

Truvada / via Wikimedia Commons

By Jacob Molyneux, AJN senior editor

There have been a number of recent high-profile news stories as well as some notable new research related to HIV/AIDS and its treatment and prevention.

First, AJN would like to add its voice to those expressing heartfelt regret at the deaths of a number of prominent and widely respected HIV advocates and researchers in the Malaysia Airlines jet that appears to have been shot down over Ukraine last week.

The Truvada controversy. Those who who died on the plane had been heading to an international conference in Melbourne, Australia, where one of the hot topics under discussion would be the pros and cons of the continuing expansion of the use of the antiretroviral drug Truvada beyond the treatment of existing HIV infection to long-term prophylactic use by the uninfected.

The topic is particularly timely here in New York where Governor Cuomo last week announced that New York State would make Truvada a centerpiece of its HIV-prevention strategy. The drug, taken every day, is more than 90% effective in preventing infection, but, as an NPR story recently described, a number of experts have raised concerns about widespread long-term use of Truvada for HIV prevention, noting

  • serious potential side effects of Truvada.
  • the $1,300/a month cost of the drug.
  • the reduction in the use of condoms by some of those taking Truvada, which could lead to higher rates of other sexually transmitted diseases.

Read the rest of this entry ?


Addressing Health Care Disparities: Best Practices for LGBT Patients

June 9, 2014

By Sylvia Foley, AJN senior editor

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume, at a nursing care facility. Rheume suffered from Parkinson's dementia. The couple struggled to find a facility welcoming of them as a couple. Photo © Gen Silent documentary film /

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume. Rheume suffered from Parkinson’s dementia. Photo © Gen Silent documentary film /

It’s arguably easier these days to identify as “queer”—lesbian, gay, bisexual, or transgender (LGBT). Our society has come a long way since 1969, when the infamous Stonewall riots and other events heralded the gay rights movement. Many LGBT people can live more openly and fully as who they are. Yet this population—which constitutes an estimated 5% to 10% of the U.S. population—continues to receive often substandard health care. In this month’s CE feature, “Addressing Health Care Disparities in the Lesbian, Gay, Bisexual, and Transgender Population: A Review of Best Practices,” Fidelindo Lim and colleagues explore these disparities and explain why it’s important for nurses in all practice settings to know how to address them. Here’s a quick overview.

The health care needs of people who are lesbian, gay, bisexual, or transgender (LGBT) have received significant attention from policymakers in the last several years. Recent reports from the Institute of Medicine, Healthy People 2020, and the Agency for Healthcare Research and Quality have all highlighted the need for such long-overdue attention. The health care disparities that affect this population are closely tied to sexual and social stigma. Furthermore, LGBT people aren’t all alike; an understanding of the various subgroups and demographic factors is vital to providing patient-centered care. This article explores LGBT health issues and health care disparities, and offers recommendations for best practices based on current evidence and standards of care.

Lim and colleagues also consider issues specific to LGBT youth and older adults, and discuss the Joint Commission’s recommendations for health care leaders. And they provide

  • a practice guide to improving cultural competence.
  • a detailed list of Web-based resources, including videos.
  • evidence-based strategies for promoting inclusive patient- and family-centered care.

For more, read the article and listen to our podcast with the lead author; both are free. We invite you to share your experiences and insights with us below.

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Nursing, HIV/AIDS, Continuity of Care, Treatment Advances, and the ACA: The Essentials

March 6, 2014

As the Affordable Care Act takes effect, a timely overview in AJN of recent developments in screening, treatment, care, and demographics of the HIV epidemic


The ‘cascade of care’ (from the AJN article)

The newly released March issue of Health Affairs is devoted to looking at the ways the Affordable Care Act (ACA) will affect Americans with HIV/AIDS and those who have recently been in jail. One crucial feature of the ACA is that it prevents insurance companies from refusing coverage to those with a number of preexisting conditions. If you have a preexisting condition and don’t get insurance through work, you know how important this is.

Unfortunately, a large majority of those with HIV and AIDS do not have private health insurance. One article in the March issue of Health Affairs draws attention to the plight of the 60,000 or so uninsured or low-income people with HIV or AIDS who will not receive health insurance coverage because their states are among those that have chosen to opt out of the ACA provision that expands Medicaid eligibility. This means many patients in these states may lack consistent care and reliable access to life-saving drugs.

Antiretroviral therapy (ART) improves patient quality of life and severely reduces expensive and debilitating or fatal long-term health problems in those with HIV/AIDS. As noted in AJN‘s March CE article, “Nursing in the Fourth Decade of the HIV Epidemic,”

The sooner a patient enters care, the better the outcome—especially if the patient stays in care, is adherent to combination antiretroviral therapy (cART), and achieves an undetectable viral load.

The authors, pointing out that only 66% of those with HIV in the U.S. are currently “linked to care” and, of these, only about half remain in care, argue that

“[e]ngaging and retaining people with HIV infection in care is best achieved by an interdisciplinary team that focuses on basic life requirements, addresses economic limits, and treats comorbid conditions such as mental illness and hepatitis C infection.”

But there’s a lot more in this article about screening, advances in drug therapy, treatment, and epidemiology that all nurses will need to know as the ACA brings more HIV-infected patients into every type of health care setting. Here’s the overview, but we hope you’ll read the article itself, which is open access, like all AJN CE features: Read the rest of this entry ?


AJN’s December Issue: Working During a Pandemic, HIV Foot Care, Healing Pet Visits, a Focus on Narrative

November 27, 2013

AJN1213.Cover.OnlineAJN’s December issue is now available on our Web site, just in time for some holiday reading. Here’s a selection of what not to miss.

Working during a pandemic. Flu season is in swing, but how do nurses feel about working during a flu pandemic? Researchers investigating terrorism and catastrophic events found that up to 96% of health care workers reported being unable or unwilling to work during some emergencies, with some infectious diseases associated with the highest rates of unwillingness. “Predictors of Nurses’ Intentions to Work During the 2009 Influenza A (H1N1) Pandemic,” December’s original research CE, suggests that providing adequate resources during an emergency (such as personal protective equipment) will not only ensure the safety of patients, nurses, and nurses’ families, but may also increase nurses’ willingness to work in times of crisis. Earn 2.5 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article. The podcast is also available on our Web site.

HIV foot care. Peripheral neuropathy, which causes debilitating symptoms such as burning pain and sensation loss in the foot, continues to be prevalent in people with HIV, but is often overlooked. “HIV Peripheral Neuropathy and Foot Care Management” reviews what is known about distal sensory peripheral neuropathy in HIV patients, and provides nurses with information on its assessment and management. You can earn 2.5 CE credits by reading this article and taking the test that follows.

Hospital noise reduction strategies. The importance of maintaining a quiet, restful environment for patients has long been recognized by nurses. Our Cultivating Quality article, “Quiet at Night: Implementing a Nightingale Principle,” describes how nurses implemented a noise-reducing strategy in their hospital to provide patients with an optimal environment for care. Listen to a podcast interview with the author by clicking on the podcast icon on the first page of the article or downloading the podcast from our Web site.

Family pets in hospitals. Animal therapy for hospital patients can reduce stress and depression, and may aid in the healing process. “Family Pet Visitation” describes how nurses at one hospital instituted a pet visitation program to help patients feel more comforted and supported. Don’t miss the podcast interview with the author (click on the podcast icon on the first page of the article if you’re using your iPad, or visit our podcasts page).

Read the rest of this entry ?


A Face in a Village: Remembering a First Encounter with AIDS in Africa

February 8, 2012

We’d already guessed there was a problem at the health post—we hadn’t received the last several monthly statistical reports. As a Peace Corps volunteer in the Central African Republic in the early 1990s, I reviewed these reports as part of my job at the regional health office. Another part of my job was to join a supervisory team as it traveled over dirt roads to check on health facilities from hospitals down to the village health posts staffed by a single nurse. A few months into my assignment, on our way to the provincial hospital, the team decided to stop by this particular health post to find out why we weren’t receiving reports.

That’s from “A Face in a Village,” the February Reflections essay in AJN by Susi Wyss, the author of a well-received recent novel, The Civilized World (Henry Holt, 2011). Set in Africa, the novel, like this essay, was inspired by the author’s international health career. In this essay, Wyss recalls a vivid first encounter with the ravages of AIDS and the hopelessness it inspired. (Click through to the PDF version for a cleaner read.)—JM, senior editor


World AIDS Day, 30 Years On from That Fateful MMWR

December 1, 2011

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.”

So began the MMWR of June 5, 1981—the first herald of what became known as AIDS. Reading that report now, knowing the devastation that would follow, is chilling.

Today is World AIDS Day. It has been 30 years.

In some ways, we need this day more than ever, to remind us of the devastating potential of this condition—the Centers for Disease Control and Prevention (CDC) reports that only 28% of people in the U.S. infected with HIV get the treatment they need to suppress the virus. We need it to remind us of the millions who continue to suffer and die from it, mostly in Africa where two thirds of the AIDS cases occur.

We should also take time today to celebrate the victories. We’ve come far in the last 30 years. Effective treatments have been developed. Civil rights protections have been put in place. People with HIV can now live long, joyful, productive lives. Thirty years ago it was a death sentence, one that devastated those it affected—physically, socially, economically. Now it is a manageable illness that appears close to being controlled. Read the rest of this entry ?


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