Nurses are playing a bigger role than ever in the fight against HIV – they deserve more support

The first cases of HIV were reported in 1981 . Since then, nurses all over the world have been at the forefront of the fight against the epidemic. They have stepped up to provide skilled care for those infected and affected by the virus.

The World Health Organisation marked 2020 as the year of the nurse and the midwife . As this challenging year comes to a close, it is imperative to reflect on the resilience and impact of nurses in the fight against the HIV epidemic.

An inspirational documentary film 5B testifies to the compassionate, committed responses of a nurse-led community in the early days of the HIV epidemic. In the film, nurses and other healthcare providers reflect on their experience and how they transformed care.

The film shows nurses taking extraordinary actions to comfort, protect and care for people living with HIV in the United States. But the resilience of nurses in the fight against HIV is the same across the world. Nurses in high and low-income countries continue to dedicate their lives to caring for those living with the virus.

Nurses represent 50% of the global healthcare workforce. And they are often the sole healthcare providers in many low and middle-income countries. They are pivotal to efforts to end HIV, by helping people with testing, treatment and prevention. That is why nurses all over the world have moved to the forefront of the global efforts to achieve the 90-90-90: Treatment for All goals. These are the Joint United Nations Programme on HIV and AIDS' (UNAIDS) goals to help end the AIDS epidemic by 2030.

Expanding role

As life-saving medications and prevention interventions have been discovered, nurses have continued to be champions in the fight against HIV and AIDS. The role of the nurse has expanded over the years beyond skilled care at the bedside to include clinical and behavioural research, education and training leadership, programme management, policy making, and patient advocacy and activism.

Nurses are initiating and managing antiretroviral therapy (ART) in places where there are no or limited physicians. Key tasks include preparing patients for ART; determining medical eligibility; recommending first and second-line ART regimens; clinical monitoring; and managing side effects.

Nurses have also formed organisations such as the Association of Nurses in AIDS Care (based in the US, with a chapter in Nigeria) and the National HIV Nurses Association in the UK.

These organisations help provide education, professional development, networking, research and leadership support to nursing and allied health professionals working with people living with HIV. They also promote awareness of issues related to HIV through public policy and advocacy.

Since the announcement of the 90-90-90 targets by UNAIDS, the Association of Nurses in AIDS Care has underscored many ways in which nurses can lead. The association has developed several policies, including:

• Ensuring patients' rights to equitable and accessible health care

• Providing care for underserved and vulnerable populations

• Providing care along the full spectrum of HIV services

• Providing evidence-based and person-centred care

• Committing to inter-professional collaboration

Despite the COVID-19 pandemic's serious impact on the most vulnerable communities worldwide and threat to the progress of HIV care, nurses remain at the frontline of service. They have demonstrated incredible courage, selflessness and stoicism in this unprecedented year. They are applying the lessons learned during the early days of the HIV and AIDS epidemic in response to the COVID-19 pandemic.

It's important to recognise all the nurses and midwives who have been lost to the fight against HIV and AIDS and now COVID-19.

What next

Nurses' values and commitment alone are not enough to ensure success in ending HIV and AIDS by 2030. Nurses are often relegated to reduced practice roles and are sidelined. This is why the Association of Nurses in AIDS Care has declared a call to action to demand support for HIV nursing globally, seeking to:

• Advance nurse-led care through policies and legislation that support nurses' true role in HIV prevention, care, and treatment

• Expand resources, budget allocation, and staffing structures that reflect the central role of nursing to HIV care and achievement of global targets

• Promote the equitable representation of nurses on healthcare and HIV decision-making bodies

• Develop health systems that ensure strong inter-professional collaboration

Jerry John Nutor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

By Jerry John Nutor, Assistant Professor, Family Health Care Nursing, University of California, San Francisco