Nurses Continue to Help Define HIV Care, and Are Pivotal to Ending the Epidemic

  

The moving documentary film 5B testifies to the compassionate, committed responses of a nurse-led community in the early days of the HIV and AIDS epidemic. 5B was a ward of San Francisco General Hospital where nurses, along with patients and their caregivers, redefined palliative care in the face of a cruel disease and a health care system in the 1980s that was tragically unprepared. The film is a tribute to nurses who were on those frontlines. On camera, veterans of 5B reflect on their experience and how they transformed care, long before the term “person-centered” entered the lexicon of health care delivery and public policy.

5B viewers are also clearly able to understand, nearly 40 years later, how nurses remain on the frontlines, and continue to play a key role in HIV and AIDS care. Today, more than one million people in the U.S. are living with HIV, and around 15 percent of these people are unaware that they have HIV. As nurse leaders in the field Carole Treston and Carol Dawson-Rose write in the December 2019 issue of American Nurse Today, we now have treatment and prevention technologies that are “proven to work and allow us to imagine an end to the HIV epidemic.”

Treatment as prevention is the approach that holds the promise of reaching that goal of ending HIV. Specifically, effective use of antiretroviral treatment can lower HIV levels to the point where HIV cannot be transmitted. Recognizing the power of this approach, the American Nurses Association (ANA) recently signed onto the U=U prevention campaign (Undetectable = Untransmittable, or, U=U). In addition, use of preexposure prophylaxis (PrEP) is a proven intervention to prevent HIV from being acquired through sexual contact.

As Treston and Dawson-Rose point out, however, not everyone is benefitting from these approaches. The barriers are many, including stigma, systemic racism, sexism, homophobia, transphobia, lack of affordable health care coverage, and other social determinants of health such as lack of transportation or housing. The implications of these challenges for nurses’ role in ending the epidemic are explored in ANA’s updated position statements Prevention and Care for HIV and Related Conditions.

Nurses are pivotal to efforts to end HIV, by supporting patient access to testing, as well as ensuring access to treatment and prevention. A new ANA publication Ending the HIV Epidemic: Frontline Interventions Every Nurse Should Know links to useful guidelines and practice resources. Many advanced practice registered nurses can prescribe HIV treatment and PrEP, and nurses can coordinate care for people living with HIV when they need support to stay in treatment.

In addition to supporting a treatment-as-prevention approach, ANA prioritizes community-based solutions that meet the needs of diverse groups of people living with HIV and AIDS. The policy statements also highlight the APRN’s role with prescriptive authority to treat and prevent HIV, and call for full practice authority at the federal and state levels. The updated policy statements are aligned with national strategies and goals, and mirror the policy priorities of ANA’s partner Association of Nurses in AIDS Care (ANAC).

Legislation to End Workplace Violence Passes in the House of Representatives

  

Just prior to the Thanksgiving holiday, the House of Representatives dedicated hours of work, debated, and ultimately passed, another priority of ANA – H.R. 1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act.

Studies show one in four nurses has been assaulted at work – making nurses more likely to be exposed to violence than either prison guards or police officers. H.R. 1309 requires the Department of Labor to address needed protections from workplace violence in the health care and social services sectors. It directs the Occupational Safety and Health Administration (OSHA) to issue a standard requiring health care and social service employers to develop and implement a comprehensive violence prevention plan tailored to the facility and services with the intention to protect employees from violent incidents in the workplace.

We are pleased to report the final vote in the House of Representatives was 251-158 – including 32 Republicans. Unlike other pieces of legislation that ANA supports, including the recently passed H.R. 728, Title VIII Nursing Workforce Reauthorization Act, H.R. 1309 is not as bipartisan. A chief concern amongst Republicans is the worry about smaller hospitals and facilities complying within the given time. With that said, we are very encouraged to hear Republicans and Democrats all acknowledge this is a major issue and something needs to be done. The issue is finding the sweet spot where the legislation can receive bipartisan support.

So, now we look to the Senate knowing we have an uphill battle ahead. We must continue to educate members of Congress about this issue and its severe implications if something is not done soon. To join us in this effort, please go here.

However, ANA is not just focused on Congress. Before the vote in the House of Representatives, the White House issued a statement of administration policy which stated that it opposes H.R. 1309 in its current form. An example given is the Administration believes the bill’s timelines for issuing the interim final, proposed final, and final standards are inappropriate. It notes that OSHA has announced plans for a Small Business Regulatory Enforcement Fairness Act (SBREFA) panel to address these issues. We are calling on the SBREFA panel to come together and make a final decision as soon as possible.

Additionally, ANA staff is meeting with key agencies, including OSHA, to educate agency staff on the importance of this issue and see how we can all work together to move the needle in the right direction.

Safe work environments and quality care are not mutually exclusive; both must be considered in order to promote positive health outcomes for patients and communities. Let’s work together to continue to send that message to Capitol Hill to ensure that nurses are safe in the workplace.