NPs & HIV/AIDS Awareness Month Advocacy Guide
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HIV/AIDS is a critical public health issue that demands attention. In 2019, the most recent statistics available, the CDC reported that there were 36,801 new HIV infections in the US. While this number is a 9 percent decrease since 2015, it is still alarmingly high, considering the number of available preventative medications and testing services.
Nurse practitioners are on the frontline of HIV/AIDS care, and they have a unique opportunity to raise awareness of this epidemic during HIV/AIDS Awareness Month in December. Raising awareness of HIV/AIDS is important in fighting this epidemic. By educating others about HIV/AIDS and advocating for increased funding for research and prevention services, NPs can significantly impact the fight against HIV/AIDS.
The first step in awareness is helping people better understand the disease. “HIV is the same as any other chronic health condition,” says Dr. Ann Bagchi, nurse practitioner and assistant professor at Rutgers University School of Nursing. “It doesn’t have to have exceptionalism about it anymore.”
What is frustrating for many healthcare providers is that HIV/AIDS is currently a solvable problem. “We have the capacity to eliminate HIV and AIDS if we could just get everybody on board. We know how it’s transmitted, how to prevent it, and how to treat it,” says Dr. Bagshi. “We don’t yet have a cure yet, but if we could get everybody who’s currently infected to reduce viral load, we could eliminate it as a health problem.”
Unfortunately, the stigma and lack of awareness around this disease continue to be among the most significant barriers to testing and care: “I was talking to a care provider about routine HIV testing, and he said, ‘Oh, is HIV still a problem?’” says Dr. Baghsi. “You have this dichotomy of some people who still just find it very stigmatizing and others who just are completely oblivious to the fact that it’s still out there. There needs to be greater awareness that it is still an issue and people are suffering unnecessarily.”
Get ready for HIV Awareness Month in December with this expert interview with Dr. Bagchi. Learn about the state of HIV in the US, how the stigma of this disease is being tackled, and how it is being addressed in the primary care setting.
Meet the NP: Ann Bagchi, PhD, DNP, FNP-C, APN
Dr. Ann Bagchi is a nurse practitioner and associate professor at Rutgers University School of Nursing. Her research is centered on exploring the stigma of living with HIV. She has successfully implemented a statewide People Living With Stigma Index and will create multidisciplinary teams to complete needs assessments relating to telehealth technologies among underserved populations across New Jersey.
Dr. Bagchi holds a master’s of science and PhD in sociology from the University of Wisconsin–Madison and a doctor of nursing practice in family practice nursing from Rutgers University.
The State of HIV in the US
According to the CDC, in 2019, more than 1.2 million people in the US were living with HIV. Of those, approximately 13 percent don’t even know they are infected. While the number of new infections does continue to drop, the rate has certainly slowed. “One thing that’s very disturbing is that for many years, there were around 40,000 new infections every year. It’s gone down a bit, but it’s still really high given that we have biomedical approaches that can get someone who has HIV to an undetectable viral load, and they literally cannot transmit the virus,” shares Dr. Baghi.
She continues, “Also, we have PrEP (pre-exposure prophylaxis), so if someone is potentially at risk, they’re not going to get infected. The fact that the number of new infections is not budging suggests that we haven’t addressed the issue as we need to. Currently, the funding is focused on the highest risk and highest transmission areas. But I think that it needs to be a much broader approach, and if we can get primary care providers involved in this process with routine HIV screening, then we don’t have to have quite so targeted.”
Thankfully, due to medical advances, new treatments have made living with HIV much more tolerable: “When they came out with the first antiretrovirals, people used to have to take dozens of pills a day. These days, there are single-pill regimens along with some that only require two or most of them have three medications. Recently, they’ve come up with injectables that people can take once a month or every two months. This prevents the virus from being able to replicate. So it’s still present somewhere in your body and cells, but it’s not replicating. And so if it’s not replicating, you can’t pass it on to others.
These new treatments have drastically improved the outlook of patients. “Prognosis for those living with HIV is excellent these days. Someone living with HIV can live as long as someone who isn’t infected, and the vast majority of people with HIV die from the same causes as the general population,” says Dr. Bagchi. “The medications have far fewer side effects than the early ones and are a lot more effective.”
Nurse Practioners’ Role In HIV Care
Nurse practitioners can be instrumental in the prevention and treatment of HIV. “Nurse practitioner training is focused on therapeutic patient communication, so they have an excellent opportunity to provide compassionate and targeted care,” says Dr. Bagchi. “Nurse practitioners are quickly becoming the primary points of medical care in the United States. We have the potential to make a tremendous difference in patients’ lives.”
“Nurses have always taken a leadership role in the HIV epidemic,” Dr. Bagchi adds. “The Association of Nurses in AIDS Care (ANAC) has been around since the start of the pandemic. We have the potential to make an impact in how these issues are addressed and communicated in a more therapeutic and supportive manner.”
Reducing the Stigma of HIV
According to Dr. Bagchi, one of the biggest hurdles to HIV prevention, as well as one of the hardest parts of living with HIV, is the stigma associated with this virus. “We did a comprehensive study of stigma among people living with HIV in New Jersey. We initially thought that people were experiencing a lot of HIV-related stigma during clinical visits, which they often do. However, we found that the gossip stigma people faced the most was from their community. This gossiping fuels social isolation from family members and neighbors, and that was the thing that people reported finding most troubling,” she shares.
To help address this, Dr. Bagchi developed a comprehensive community-centric program: “The intervention I have developed is for any kind of community-based setting. We do trainings in churches and community centers and aim to educate people about where we are with HIV right now,” she says. “We talk about how stigma harms people living with HIV and harms our efforts to eliminate this epidemic. We also empower people to step up and say something when they see stigma happening. We need people to understand this is just like any other viral infection or chronic disease.”
In addition to working in communities, there is a concerted effort to reduce the stigma of HIV testing as part of a routine physical. “If you get primary care providers talking about HIV to their patients like any other health condition, you can go a long way to affecting the stigma. People don’t necessarily want to go to an HIV clinic because people will see them. If they can just be tested and treated in a primary care practice, that can go a long way,” says Dr. Bagchi.
Barriers to HIV Testing in Primary Care
Dr. Bagchi firmly believes that HIV prevention should be a primary healthcare issue. Despite the advances in HIV care, many primary care providers simply don’t have the most current understanding or training to make this happen. “A colleague of mine and I did a thorough systematic review of the international literature, looking at barriers to routine HIV screening in primary care practices. And while there are many, most were related to a lack of awareness. We want HIV screening to be like getting your pap smear or your cholesterol tested.”
Primary care providers should complete additional training and continuing education to better understand how to address this epidemic. “Many primary care providers don’t understand that HIV is eminently treatable these days. When I was doing my research, some were still saying things like, ‘Oh, but they have to take all those pills.’ They don’t even understand that the regimen can be very simple these days, and many of them were not aware of PrEP,” says Dr. Bagchi.
“Then there are a lot of emotional barriers, such as worrying about how it might affect a patient to suggest HIV screening and assuming that patients will be offended or concerned if you even bring it up. Also, some doctors are worried about how they would manage if someone does test positive.”
Kimmy Gustafson is a freelance writer with extensive experience writing about healthcare careers and education. She has worked in public health, at health-focused nonprofits, and as a Spanish interpreter for doctor’s offices and hospitals. She has a passion for learning and that drives her to stay up to date on the latest trends in healthcare. When not writing or researching, she can be found pursuing her passions of nutrition and an active outdoors lifestyle.