AIDS Doesn’t Discriminate

Link to MinorityNurse.com

Additional Information
For more information, contact the Association of Nurses in AIDS Care at:

ANAC
11250 Roger Bacon Drive, Suite 8
Reston, VA 20190-5202
Phone: (800) 260-6780, (703) 925-0081
Fax: (703) 435-4390
E-mail: AIDSNURSES@aol.com
Web site: www.anacnet.org

The A.C.R.N. (AIDS Certified Registered Nurse) certification program is sponsored by the HIV/AIDS Nursing Certification Board. The certification examination in HIV/AIDS nursing is administered by the Professional Testing Corporation (PTC), 1350 Broadway, 17th Floor, New York, N.Y., 10018, (212) 356-0660, www.ptcny.com. Questions concerning the examination should be referred to PTC.

By Susan Wessling

Delbra Peters, R.N., B.S.N., has seen the changing face of AIDS care during the eight years she has worked for the Visiting Nurses Association of Dallas. As a member of the VNA’s AIDS team, Peters has worked with many dying patients—but that isn’t the sole focus of her job.

Delbra Peters, RN, BSN

“People think of AIDS as a death sentence,” Peters says. “The first years I worked in this field, I did lose a lot of patients. Now, I’ve had to redirect my goals with my patients to help them live with this disease, instead of just helping them [as they] die.”

Over the past four to five years, Peters says, new therapies and treatments have lengthened the lives of those diagnosed with AIDS, a disease that attacks the immune system and leaves the body vulnerable to a variety of life-threatening illnesses. These new treatments have also slowed down the progression of HIV to AIDS in many people.

As a visiting nurse, Peters often cares for patients who have recently returned to their homes after being released from a hospital. “They have been in the hospital and were very, very sick, and now they need follow-up,” she says. “Most of them have had some type of HIV-related opportunistic infection. A common problem is that they will have just gotten sick for the first time, so they are recently diagnosed with HIV. They waited until they got sick, and once they went to the hospital” they were tested for HIV.

Peters has seen a change in the type of patients she is working with through her job with the VNA. “Within the last couple of years, I have treated a lot more African-American men and women than in the past, and I have also been working with a lot more Hispanic patients,” says Peters, who is herself African American. “Initially it was mostly gay men who were getting HIV and AIDS, and a lot of other people felt they were safe.”

A Growing Problem

Hermeyone Hunter, R.N.-C., M.S., F.N.P., a research clinician with the AIDS Research Consortium of Atlanta, says African Americans and Hispanics make up most of her caseload. Hunter is responsible for enrolling patients in clinical studies, then monitors those patients throughout the study and consults with their health care providers.

“We are seeing more minorities who are newly infected,” says Hunter, who is African American. “You have to look at the progression of the disease. When they first discovered HIV, it was drug users or gay men who were becoming infected. Other people didn’t think they were at risk. Now the group [of AIDS patients] that has grown the fastest is women, especially African-American women.”

In fact, AIDS is the leading cause of death for African-American women and men between the ages of 25 and 44, according to the National Institutes of Health. Statistics from the NIH show that African Americans and Hispanics represented 78% of the AIDS cases reported among women in 1996 and 56% among men.

Marjorie Dehlinger, R.N., D.N.Sc., a nurse consultant for the HIV research branch in the Division of AIDS at the NIH, says several factors, including socioeconomic status, come into play when looking at these numbers. “I think unfortunately, minorities tend to fall into the lower socioeconomic status a good deal of the time. Consequently they might not have health insurance, so they don’t get to health care facilities until they are really sick. And because they may not have the opportunity for education, they don’t get the information they need [before that],” she says.

The patient-provider relationship is another factor, she says. “Sometimes the provider’s attitude toward people with lower incomes can hinder what type of care they get,” says Dehlinger.

These reasons make it all the more important, Dehlinger says, for minority nurses to take a leading role in this field. “I think minority nurses have a much better handle on issues confronting minorities than non-minorities do,” she says. “I think that minority nurses can provide a tremendous amount of input. Their knowledge, expertise and visibility are certainly all very important. I think it would help tremendously to get people in for care if [minority nurses] can make themselves as visible as possible.”

Sylvia Moreno, RN, BSN

Sylvia Moreno, R.N., B.S.N., the director of nursing for Parkland Health & Hospital System in Dallas, says it’s difficult to reach out to the minority community, including its professional people, about this disease. “We still have to struggle every day with the fact that people think this is just a gay disease; it is not,” says Moreno, who is in charge of Parkland’s HIV/AIDS Program.

In that role, Moreno oversees funding for the program, writes grants and works as a liaison between the hospital system and the community as well as between Parkland and the federal government. “Back in 1986, we had 100% gay white males as patients,” she says. “Today, at least 50% of all of our patients—and we have 3,200 patients—are minorities.”

Community Service

The devastating impact AIDS has had on the minority community is what led Cassandra Miller-Hardwick, R.N., B.S.N., A.C.R.N., to enter the field of AIDS care. Miller-Hardwick is the HIV/AIDS coordinator for the Birmingham Veterans Affairs Medical Center in Alabama and became involved in HIV education when she was a nursing student.

Cassandra Miller-Hardwick, RN, BSN, ACRN

“I took the Red Cross class to be an AIDS educator and started giving some classes in my community,” Miller-Hardwick says. “I saw how HIV was impacting the African-American community and saw this as an opportunity to enhance what was going on as far as education in my immediate area.”

The AIDS research she undertook for several assignments in nursing school also helped shape her future goals. “That really opened my eyes to the opportunities that lay ahead for me as a black nurse who had an interest in making an impact in HIV care, not only in my community but in the lives of patients at risk who I would be taking care of,” she says.

Miller-Hardwick, who serves as the case manager for HIV-infected veterans at the Birmingham center, is still involved in educating people about AIDS and HIV. “The impact of AIDS on our community has been enormous,” she says. “I don’t want to say that our prevention efforts have not had any impact, but looking at the numbers, we haven’t had as big an impact as we would like to have and that is very unfortunate.”

What catches people’s attention, she says, are reports that numbers of AIDS deaths are down in the United States. “But what they fail to publicize is that the number of new infections is up at a phenomenal rate; our prevention efforts are being stifled by that,” she says.

Like Dehlinger, Miller-Hardwick says it would be helpful if more nurses of color entered the field of AIDS care. “In my area, I know about 30 nurses [who are in this field] and only seven or eight of them are African Americans,” says Miller-Hardwick, the president of the North Central Alabama chapter of the Association of Nurses in AIDS Care (ANAC). “There aren’t a lot of African-American physicians providing HIV care in my area either, but most of our clients are minorities. I think in time we will have more minority nurses, but right now the numbers are not as high as I thought they would be.”

Hunter, the immediate past president of the Metro Atlanta chapter of ANAC, says that trend also holds true in her area. Moreno, meanwhile, also expresses frustration at what she sees as a similar situation in the Dallas area. “That has been an area of great disappointment for me,” says Moreno, who is Mexican American. “I hardly see any minority nurses in HIV/AIDS care, and it has been very hard for us to recruit nurses to work with this population.”

ANAC reports that 16% of its 1,950 membership is minority. Seven percent of ANAC’s members are African American, 4% Hispanic, 3% Asian and 2% Native American. However, there are 30% more African-American ANAC members this year compared to last, while the number of Asians has doubled since last year.

Some providers do make an effort to make sure minority nurses are well represented in their facilities. On the HIV floor where Camille Matienzo, R.N., works at Cedars-Sinai Medical Center in Los Angeles, there is a diverse mix of caregivers. Matienzo, who is of Filipino descent, says she believes this is a result of her nursing manager’s efforts. “On our floor there is a good mix. I can’t say one race dominates like on other floors. ... HIV affects so many different classes now. Even though you see a lot of gay men, it impacts a lot of different races now. And I think [my manager] takes that into consideration when hiring people. There is a little bit of every [race] there, and that is good because I think we learn a lot from each other.”

Experience Counts

There are many different aspects of HIV and AIDS nursing, according to Hunter. She also says there are a lot of positions being generated fairly quickly because of the changes in the field. Preventative care and education are an option for those looking into HIV and AIDS care, she explains, and positions are also available in hospitals, hospices, clinics and research.

Once people get into this type of nursing they tend to stay, Hunter says. “The knowledge and the skills you need to really manage the HIV-positive patient [are extensive]. It is a rapidly changing field as far as drug therapies and treatment, and you have to be able to understand the social issues surrounding HIV and AIDS,” she says. “A lot of times when you have all those things going on, there is not a lot of turnover because the field needs people who are experienced.”

Matienzo, who is relatively new to nursing, says the short period of time she has worked in the field, coupled with the fact that ongoing education is necessary in AIDS care, are the biggest challenges she faces. “There are just so many things to it,” she says. “It is going to be a continuous thing where I am constantly learning. I don’t think there is ever going to be an end to it.”

Matienzo first gained experience in the field immediately after graduating from nursing school when she took a position as a nursing assistant on the HIV floor where she now works. She suggests nursing students look into this type of job to help them prepare for their nursing careers, something she says she wishes she did when she was in school.

“When you are in nursing school, you are very restricted,” she explains. “You only spend so many hours with a patient and the whole time you have an instructor hovering over you, so I don’t think you really get the experience as to what is going to happen when you get out of school. My experience working as an assistant nurse and my experience working as a student nurse were completely different. You can’t really compare the two.”

Matienzo worked as a nursing assistant for several months until she took her state boards, and then she was offered her current position, which she has held for the past 21/2 years. She describes her current duties as typical bedside nursing. She is involved in assessment, medication administration and making care plans for patients. “On our floor we see a lot of patients at the end [stage of the disease], so we provide a lot of supportive care for the patients and their families,” she says.

Taking a position in emergency care is another way to gain some experience in this field, says Hunter, who adds that this is how she became involved in AIDS care. She also suggests that nursing students or nurses considering a career change into this area get involved in ANAC.

Lucille Johnson, R.N.-C., A.C.R.N., an administrative coordinator at a hospital in Newark, N.J., who has over 20 years of nursing experience, decided to become certified in AIDS care after working on a hospital unit that served AIDS patients. Johnson, who is originally from the West Indies, says preparing for the A.C.R.N. certification test helped her expand her base of knowledge about the disease. “It makes you think about what you know and what you don’t know,” she says.

Johnson adds that she keeps abreast of the current trends and information about the disease by attending conferences regularly. She estimates that she has been to some eight AIDS conferences—given by such groups as ANAC, the Infectious Disease Association, and the AIDS Education Center in Newark—in the past year. ANAC is an excellent resource for finding such educational offerings, she says.

Incidental Compensation

Johnson says it is rewarding to work with patients who sometimes feel they have no hope. “When you are taking care of someone who has received an actual diagnosis of AIDS (as opposed to being HIV-positive), some of them have no family and no friends,” she says. “They are alone and the nurse is the only person they have to rely on. If I can be there when they need someone—not always as someone to talk to, but someone just to be there, to be a presence when no one else is there for them—that is my reward.”

Having such a significant impact is also what Miller-Hardwick finds rewarding. “If I helped someone make it through the day or helped improve the quality of someone’s life, that is my reward,” she says. “Five or six years ago, we were losing a lot more patients [than we are now]. With the new developments, we are seeing people who are doing better. You get to see people who were so sick when they came to us who got better and might be able to go out and get a part-time job. That kind of thing gives me the best feeling.

“I want to be able to make an impact in someone’s life and help them maintain a good quality of life,” Miller-Hardwick adds. “Personally as a nurse, my goal is to make a positive impact in someone’s life. Every day, that is my goal.”

Susan Wessling is a free-lance writer based in Worcester, Mass.