By Pat Muccigrosso, contributor
December 13, 2010 - Thirty years after being declared epidemic in the United States, HIV (human immunodeficiency virus) is still infecting men, women and children and more than one million of them are living with the disease. And AIDs (acquired immune deficiency syndrome) is still killing people; 597,449 people, according to the Centers for Disease Control and Prevention (CDC), have died from the disease since 1981.
Adele Webb, PhD, RN, AACRN, FAAN, executive director/CEO of the Association of Nurses in AIDs Care, reports that people have become complacent and aren’t afraid of HIV/AIDS, causing an increase in cases for some populations.
There is good news for some groups; their numbers are going down. “In homosexual males, which people always used as a marker, the numbers are going down because they hear about it, they’re well educated; they have resources,” said Adele Webb, Ph.D., RN, AACRN, FAAN , executive director/CEO of the Association of Nurses in AIDs Care (ANAC).
For others, however, the news is not so good. The numbers are rising and so is the death toll.
“Our numbers just keep creeping up where the risk is highest,” said Webb. “We have a serious problem in the African American population and with the aging population, those over 55. We have a problem with women and now the numbers are starting to go up among adolescents.”
Webb dubbed this year as “...the year of complacency, the era of complacency. People don’t hear about it anymore. They aren’t afraid of it anymore.”
But the statistics say they should be afraid. The numbers for women, the poor and the black and Hispanic populations actually meet the UNAIDs definition for epidemic status according to a study by Paul Denning, M.D., MPH, and Elizabeth DiNenno, Ph.D., published by the CDC in August 2010. With an HIV prevalence rate of 2.1 percent in poverty-stricken, urban areas, America exceeded the 1 percent cut-off that defines a generalized HIV epidemic.
Arlene Bincsik, RN, MS, CCRC, AACRN, HIV program director for Christiana Care Health Systems, encourages her nursing staff to develop and apply special skills within their areas of interest in HIV/AIDS nursing.
For nurses like Arlene Bincsik, RN, MS, CCRC, AACRN, who is the HIV program director for Christiana Care Health Systems in Wilmington, Del., the statistics translate to growing caseloads at a time when resources are shrinking. “It’s a challenge. We are constantly tweaking our processes and trying to address the growing volume and complexity.”
Bincsik has been working as an HIV/AIDs nurse since 1986 when the disease was an unknown and cause and treatment were mostly palliative. “It’s been a real fast ride and a constantly changing one. The current climate of HIV management -- medication management -- is very complicated. You have to know what you’re doing.”
Treatment is challenging but it’s also effective according to Bincsik. “As a clinician, I have seen it go from a situation where 70 percent of our patients died in the first year to a disease that is more chronic in nature, more manageable, more treatable.”
Effective treatment is good news for patients but it also means more comorbidities, according to Webb. “People are living longer and are being seen for issues they never were seen for before –- cardiac issues, heart attack, high lipids, liver disease, menopause.”
“We end up managing hepatitis C, diabetes, cardiac disease,” added Bincsik. “It’s a lot more challenging, more complicated and more multifaceted.”
For Bincsik and her team, that means getting creative in how they handle the workload. “We have a tiered approach to our care. We utilize our nurses at a very high level -- doing a lot of triaging and a lot of care management for our patients. That allows us to streamline the other parts of our care.”
Nurses are pivotal in Bincsik’s program. To keep them, she offers them some unique opportunities to select and grow skills in their areas of interest. “I have a nurse who has an interest in managing our internal medicine clinic; she’s been allowed to develop that expertise and is the go-to person when it comes to diabetes. Another nurse who didn’t have HIV experience when we hired her had OB-GYN experience. She’s our go-to person for that. Another nurse didn’t know a lot about psychiatric manifestations but wanted to work in the mental health clinic.”
Opportunities to grow and learn are one of the reasons turnover in the Christiana Care team is nonexistent. “We actually have nurses who have been able to develop specialty expertise within the overall context of HIV management which keeps them challenged, professionally,” said Bincsik.
Nurses on Bincsik’s team get a chance to develop the medical, psycho-social skills needed to successfully treat HIV/AIDs patients. That’s not the case for a lot of nurses. “It would be safe to say that probably every nurse has had an encounter with someone who is HIV positive,” explained Webb. “Nurses are being forced into providing care that they don’t understand, haven’t been educated in.”
Education is key, according to Webb. “The most important thing you can do--not just for your patients but for yourself--is to be educated. Know the signs and symptoms; know who needs to be treated. Know how to protect yourself.”
Both Webb and Bincsik said there are plenty of ways to get educated including the Internet, professional agencies like ANAC, the AIDS Education Training Center (AETC), the HIV Case Manager Portal and conferences with AIDs tracks. As the numbers rise and HIV/AIDs remains an epidemic among poor and minority populations in the United States, resources like these make it easier for nurses to be prepared to care for the HIV/AIDs patients they will see.
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