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

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:

OVERVIEW: HIV has evolved over the past 30 years from a virtual death sentence to a chronic and manageable disease. Nurses in the United States have helped to change the epidemic through advocacy, education, care, and support for people living with HIV infection. They have contributed to the expansion of HIV prevention methods, provided support to this population and their families, and helped make HIV treatments more effective and efficient. People with HIV infection who access and remain in care can now enjoy both an improved quality of life and a greater life expectancy. Here, the authors discuss HIV epidemiology and policy in the United States, the concept of the HIV care cascade, advances in HIV testing and treatment, and how nurses can continue to have a positive impact on the HIV epidemic by encouraging testing, connecting newly diagnosed patients to specialty care, retaining these patients in long-term care, and providing access to combination antiretroviral therapy.

—Jacob Molyneux, AJN senior editor

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Ashley Stewart April 10, 2016 at 9:56 pm

    It is so sad that states would relinquish Medicaid benefits just to save money on their end. People with critical illnesses, such as HIV/AIDS need assistance, especially access to medications and for only 66% of people infected in the United States is very disappointing. Thank you for shedding light on these facts and hopefully there can be some type of movement in the way of change for how HIV/AIDS patients are treated.

  2. Stephanie April 15, 2014 at 6:14 pm

    Although, medically we’ve advanced to the point of controlling the effect HIV/AIDS has on an individual’s life, it brings up a very good point: what about those who can’t afford treatment on a consistent basis? This article is specifically about the plight of Americans but it reflects a small fraction of what is going on globally. The issue with HIV/AIDS is no longer that it can’t be controlled; it’s that treatment isn’t available to those affected whether because they can’t afford it or because they live in an impoverished area in the world. It’s unfortunate to see that although our government has attempted to make it possible for more Americans to have health insurance that many states still aren’t on board with the expansion of their Medicaid plans.

  3. Betsy Marville RN March 6, 2014 at 2:06 pm

    Thank you for reminding us of the terrible consequences of those state legislatures who are refusing Medicaid Expansion for our patients living with HIV and other chronic but manageable diseases. In my home state of Florida, despite unprecedented agreement to support a version of Medicaid Expansion by hospitals, employers, workers, unions, the Chamber of Commerce, insurers, a Republican Governor, all of the Florida Republican-majority Senate (save one), and many Republican State Representatives, and all of the Florida State Democrat Legislators, the Speaker of the House, Will Weatherford blocked the Republican legislation that would have brought $52 billion to the Florida economy, created over 100,000 needed healthcare jobs and covered over 1.2 million Floridians. He blocked it after admitting that during a family medical tragedy when he was a child, his family depended on Medicaid. He blocked it and continues to block it because he says that he does not trust the Federal Government to fund it, despite no history of this happening with Medicaid in the past.
    This is why nurses have to get political. Everything that we know and learn and strive to do for our patients, can be negated and blocked by a single politically powerful group or person for a political agenda, not an evidenced based healthcare reason. Just as we must be proactive for our patients in our practice, we must be also proactive politically. Our patients are counting on us.

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