Leopold Linton faulted the omelet he ate during a flight five years ago to Jamaica, his country of origin. He was sick to his stomach by the time he arrived at the airport in Black River on a Tuesday. By Friday, he was admitted to the hospital, where a doctor informed him he had full-blown AIDS.
While shocking, the news actually solved the mystery of why his health had deteriorated so rapidly during the previous year. He’d felt weak, lost weight, and soaked his bed sheets at night with sweat. He rarely saw his doctor, so he surmised his diabetes was out of control. His trip back home, in fact, was prompted by a gut feeling he was dying, although he didn’t know why. “I might as well spend my last days where it’s warm,” he remembers thinking.
Linton started antiretroviral therapy in Jamaica, allowing him to return in 2010 to the Washington DC region, his home for the past 40 years. He is now happily receiving care at Whitman-Walker Health, DC’s preeminent health care provider for low-income people with HIV/AIDS.
At 68, Linton received his AIDS diagnosis as a senior citizen. He joins the growing ranks of people over 50 grappling with HIV/AIDS—a population that includes long-term survivors, the newly diagnosed, and the newly infected. Thanks to groundbreaking antiretroviral drugs developed in the mid-1990’s, HIV has gone from being a death sentence to a lifelong, chronic illness like diabetes, where treatment adherence can prolong life expectancy. The CDC estimates that by 2015, 50% of people with HIV in the United States will be in this age group, presenting unique challenges and opportunities for nurses.
Nurses: Front and Center
As HIV shifts from being a fatal illness to a manageable one, experts say HIV care will become a routine element of primary health care. Nurses will be on the front lines in the expanded effort to test seniors, educate them about risk factors, and motivate them to stay in treatment if they test positive.
“When it comes to retention and keeping people in care, nurses are so important,” says Wayne E. Dicks, MPH, a training coordinator with the Pennsylvania/MidAtlantic AIDS Education Training Center based at Howard University. “They need to be understanding and compassionate.”
Nurses, in fact, were at the heart of Whitman-Walker’s restructuring of its health care delivery system five years ago. The goal was to be more medically—rather than social service—oriented, says Justin Goforth, RN, BSN, Director of the Medical Adherence Unit at Whitman-Walker Health.
During the epidemic’s early days, HIV/AIDS care was palliative, focusing on getting patients basic necessities like food, shelter, and end-of-life pain medication since they weren’t expected to survive. A case management system was established at Whitman-Walker, but staffed with social workers and activists who had passion for the cause but little medical training, according to Goforth, who has been HIV positive since 1992.
With the antiretroviral revolution came the need for medical expertise—especially from those who could speak in plain language to patients about comorbidities and non-infectious, age-related illnesses exacerbated by HIV and, in some cases, HIV medications. Comorbidities include heart and kidney disease, high blood pressure, cognitive impairments, depression, and non-AIDS related cancers affecting the anus, prostate, and colon.
“Every time a new comorbidity is added on and a new treatment is added on, the complexity of [a patient’s] whole regimen is affected,” Goforth says. “We have to sit down with them, and say, ‘OK, where are we going to fit this in? Does this have any contraindications with taking it at the same time as this other med?’ I’m not sure who would do this except a nurse.”
In 2008, Whitman-Walker replaced their social work staff with nurse case managers, each of whom oversees a 250 to 300 patient caseload. Support staff handles referrals to benefits, food, and housing assistance. And while each Whitman-Walker client is assigned a physician, doctors only have 15-minute timeslots to see patients—enough time to prescribe medications or order labs, but not enough to talk in detail about their HIV care regimen.
“We needed nurses as case managers because we’re going to need to be teaching people throughout their lifetime about what’s going in their bodies and why is this treatment something they need to commit to,” says Goforth. “And why they need to integrate it into their lives.”
Accelerated Aging with HIV
Diagnosed in 1989, Kermit Turner is an immaculately groomed retired IT professional who hasn’t let HIV slow him down. It’s hard to imagine the 59-year-old has had four near-death experiences from HIV-related infections between stretches of good health.
“I’m not the rocking chair type,” he says. “Yes, HIV is going on [in] your life, but HIV is not your entire life.”
Another Whitman-Walker client, Turner has battled pneumocystis pneumonia—the strain associated with early AIDS sufferers—in addition to a locked bowel and non-Hodgkin’s lymphoma. In 2011, his left lung was removed because of aspergillosis, a pulmonary disease caused by a fungus affecting people with weakened immune systems.
Turner experiences problems with vision and short-term memory. A sense of humor, he says, is an essential weapon against forgetfulness—and HIV.
“I’m the one with the Post-its about the Post-its,” Turner says.
Researchers are beginning to understand how HIV accelerates aging, and it has much to do with “immune senescence,” or aging of the immune system itself. A recent Israeli study published in the Rambam Maimonides Medical Journal attributed rapid aging among people with HIV to chronic inflammation of the immune system and the loss of CD4 cells, activated by the immune system to fight infections, rather than the amount of HIV virus—known as “viral load”—in a person’s blood.
Additionally, a research review published in the Journal of NeuroVirology found that the immune systems of HIV-infected individuals resemble those of non-infected people decades older, triggering heart disease, kidney disease, and diabetes much earlier.
In 2009, Jay Jones had a double-bypass after his chest pains and shortness of breath were misdiagnosed as asthma by an emergency room doctor. He was 48 at the time and experienced heart problems much earlier than members of his extended family with its history of heart disease. Living with HIV for 21 years, Jones, 52, tried several drug regimens, which his doctor told him were partially responsible for his coronary blockages.
“I was angry because they didn’t tell me this could be a result of taking medications,” the US Army veteran says. “I wondered if I should continue taking them.”
He continued his HIV therapy, but added blood cholesterol medication and started a more active lifestyle. His ability to surmount challenges posed by HIV, heart disease, and depression motivated him to start a second career as a minister at his son’s church in Washington, DC.
Sex and Stigma
Jones says once he’d overcome his internal stigma—for being HIV positive and same-gender loving—he was able to accept himself and the unconditional love of his former wife and children. Stigma and lack of HIV knowledge among medical staff remain powerful obstacles to HIV testing and care for people over 50.
“We’ve done an abysmal job doing sexual histories on the elderly,” says Frances Jackson, RN, BSN, MA, MSN, PhD, a professor emeritus at the Oakland University School of Nursing in Rochester, Michigan. “There’s still a level of discomfort in discussing sex lives with elderly people.”
Among the elderly, specific cultural and sexual identities must be considered. Mental health should be part of the conversation as seniors are prone to depression and feelings of isolation from their peers—especially if they test positive for HIV, experts say. Jackson says older heterosexual men and women may not use condoms because fertility is no longer a factor. Older gay men may feel rejected by younger gay men as sexual partners, leading them to recreational drug use to overcome their inhibitions, says Dicks.
“We need to do a better job with some of our questions,” he says.
Jackson suggests framing discussions about risk behaviors around what a patient’s personal goals are. “You can’t scare people into healthy behaviors,” says Jackson. “We have to meet people where they are. We have to tie it [to] what the individual wants out of their life.”
Jackson, who has practiced HIV/AIDS care for 30 years, remembers when medical staff hosed down hospital rooms where an AIDS patient had stayed. While such stories are less frequent today, the knowledge level of nurses in non-AIDS specialties feels “almost like we’re in the 1980’s again,” says Marion Smith, RN, BSN, a nurse case manager at Whitman-Walker Health.
In an oncology unit at a major urban hospital where she worked before her current position, Smith often heard nurses caution each other: “Be careful when you’re in that room because that person is positive.”
Smith says what’s needed is to normalize HIV for nurses and other medical staff no matter the context. Since HIV care is “continually evolving and changing,” health care managers need to “figure out how to keep people abreast about what’s happening,” she says.
Assumptions that seniors aren’t sexually interested or active, that they’re monogamous, that they’re heterosexual, and that they understand HIV risk factors are all barriers to testing and care, says Goforth.
“We have all this trauma instilled in us about what is HIV and we keep perpetuating that,” he says. “That keeps people . . . from thinking ‘I have good options about having a healthy life in case I am HIV positive.’”
The incidence of immunosuppressed elderly patients has increased over the past few years. Hospitals and rehabilitation centers are seeing patients with greater complications, which poses many risks. Patients face the dangers of mass infection, greater length of stay, isolation from friends and family, limited resources, and poor patient follow-up. These potential threats combined with Medicare cuts in an ever-changing health care system are putting our elderly in jeopardy.
Improving patient care is essential to this community by increasing education and providing better preventive programs and follow-up. Many elderly patients are discharged into a rehabilitation setting after spending some time in the hospital due to illness or trauma. Complications can be seen very early and vary from weakness and dehydration to cognitive and physical problems. In order for a patient to receive optimal care, problems need to be addressed accordingly.
Patients’ physiological changes can cause a simple illness to present differently and can make treatment difficult. In rehabilitation, patients require detailed assessments from the rehabilitation team, easy-to-follow instructions, a well-lit environment, minimal noise level, and a keen eye to notice changes in the patient. Evidence-based practice must include continuous education for staff, such as interventions for current disease processes, assessments of current medications and side effects, and an evaluation of support systems and community needs.
Elderly patients who suffer from dementia or delirium can also experience a positive rehabilitation experience by simply minimizing triggers that may cause anxiety. Patients need to feel comfortable in their new surrounding. Reorient the patient often and repeat instructions accordingly. Encourage safety and maintain an open dialogue with the patient and his/her family to enhance opportunities for teaching and learning.
Nurses need to be aware of changes that could cause a patient to become increasingly confused: fever, infection, dehydration, a change in room, poor eyesight, poor sleeping habits, or medications such as antidepressants. Confusion can also lead to falls, an increase in length of stay, and/or lawsuits. Within the past few years, the cost of falls has risen to $30 billion dollars. The statistics are shocking:
1 in 3 adults over the age of 65 will be treated for a hospital fall related injury
30% suffer complications such as infection and/or death
By the year 2020, the cost of falls will cost health insurances over $50 billion dollars
Immunocompromised patients may require longer hospitalization and rehabilitation. Premorbid conditions may present differently and can be difficult to treat. Family and caregivers must be taught to watch for signs and symptoms of infection and dehydration. Education is extremely important, particularly current medications and their side effects as well as proper follow-up. Patients can become lost for many different reasons: lack of support, decrease in income, lack of understanding of current disease process, or no means of getting to the doctor. Families must be encouraged in order to have a positive outcome.
Patients who have better access to community services fare better and are more likely to follow-up with doctor visits. They tend to keep a better dialogue with visiting nurses, require less hospitalization, and comply with medications and procedures. These patients gain an understanding of their disease process, identify possible risks, and seek medical help sooner.
Helping seniors remain independent for as long as possible is extremely important to their psyche. Community services range from town to town, availability, and cost. Coordinating care can be tricky, but a case manager is an essential source of information. Caregivers can arrange transportation, meals, social and physical programs, and even group events. Some programs are even specifically geared to gender, needs, race, or religious affiliation.
Staying active and being part of the community plays an important role in health. Daily fears of isolation, poor health, decrease in income, and loss of friends can contribute to an ailing health. In reality, caring for the elderly requires a community—nurses, doctors, family, friends—in order to maximize independence and decrease current challenges.
Rehabilitation can allow patients to regain communication skills, increase mobility and strength training, and gain emotional support. Rehabilitation programs offer patients and families the chance to learn, intervene, and reduce complications. These instructions are proactive in nature to prevent further accidents, injury, and acute hospital care. MN
Since the first identification of AIDS in 1981, and the eventual discovery of HIV two years later, HIV/AIDS has become a dominant global public health priority with a wide range of humanitarian and economic implications.
According to the World Health Organization, nearly 70 million people have been infected with the HIV virus since the beginning of the epidemic, and approximately 35 million people have died of AIDS since the 1980’s. The Centers for Disease Control (CDC) estimates that there are approximately 1.3 million people in the United States who are infected with HIV.
While those statistics are alarming, it is important to acknowledge how far we have come in the fight against HIV/AIDS in the last three decades. “For those of us that have worked in HIV/AIDS over the past 20 years it’s almost impossible to imagine where we are now,” says Liza Solomon, MHS, DrPH, an HIV/AIDS public policy leader and a principal associate at Abt Associates. “Treatments were rudimentary and there seemed to be very little that medicine could offer.”
Since that time, new drugs have become available, medications have improved, side effects have lessened, and death rates have declined. Even more, AVERT, an international HIV and AIDS charity, estimates that in 2008 alone, over $15 billion dollars was spent on HIV and AIDS compared to $300 million dollars spent in 1996. This money from donor governments, low-income and middle-income country governments, the private sector, and individuals has helped fund research and treatments as well as fuel scientific advances in the fight against HIV/AIDS.
Scott Kim, MD, Medical Director for HIV Medicine at AltaMed Health Services, believes that new developments not only attest to the tremendous importance of government-funded basic science research, visionary pharmaceutical leaders, strong public advocates, and a federal government committed to extending care to all HIV-infected patients, but confirms that we have gone from a disease with a life expectancy that was barely a few years to a chronic disease with a long life expectancy.
Simply put, an HIV/AIDS diagnosis is no longer the automatic death sentence it was once considered.
“We can now speak of HIV/AIDS as a chronic disease, and for the first time, researchers and public health practitioners talk about an AIDS-free world,” Solomon says. “It is clearly not here now, but there is the sense that perhaps we can hope to achieve that within the foreseeable future.”
Research and Medications
Medications have changed significantly since combination antiretroviral drugs (ARVs) were first available in 1996. The development of ARVs—medications for the treatment of infection by retroviruses like HIV—has resulted in greater control of the disease and a prolonged, better quality of life for those infected.
Recent clinical studies have proved conclusively that individuals who are on effective antiretroviral treatments are significantly less likely to transmit HIV to an uninfected partner. The clinical trial called HPTN 052 (HIV Prevention Trials Network) showed a 96% reduction in transmission from an individual infected with HIV to their uninfected partner.
JoAnn D. Kuruc, MSN, RN, a program manager in the AIDS Clinical Trials Unit at the University of North Carolina at Chapel Hill, believes research related to HIV and treatments for the disease is responsible for the great strides achieved in the development of medications over the last 30 years.
In the past, HIV drug treatments consisted of a large number of pills taken at multiple points throughout a day. “Not only was it challenging to remember to take the pills, but the sheer volume that you had to swallow was an obstacle to overcome,” says Kuruc.
Additionally, side effects (nausea, vomiting, and diarrhea) associated with early medications were themselves a barrier to adherence and compliance. Kim says toxicities associated with frequent dosing included lipodystrophy, kidney stones, hepatic inflammation, diarrhea, and nausea.
Today, treatments have improved greatly, resulting in minimal side effects and requiring fewer pills—and in some cases—just one pill per day.
“Research in the drug development has led to more options, allowing individuals with severe side effects or drug resistance to switch to different medication regimens,” Kuruc says. “Years ago, there was only one class of drug available to treat a person with HIV infection, but now this has increased to five different mechanisms or classes of drugs.”
Pre-exposure Prophylaxis
Kali Lindsey, Director of Legislative and Public Affairs at National Minority AIDS Council, reports a swarm of new biomedical interventions resulting from investment in research—including scientific advances such as treatment as prevention and pre-exposure prophylaxis—that have provided exciting new tools to combat the spread of HIV.
The CDC defines pre-exposure prophylaxis, or PrEP, as a new HIV prevention method in which people who do not have HIV infection take a pill daily to reduce their risk of becoming infected.
“Pre-exposure prophylaxis is the use of an antiretroviral drug in HIV-negative individuals who engage in behaviors that place them at heightened risk for acquiring HIV,” says Amesh Adalja, MD, FACP, an infectious diseases physician at the University of Pittsburgh Medical Center. “By taking anti-HIV medications prior to exposure, they substantially decrease the risk of acquiring HIV if they are exposed.”
The pill contains medicines that prevent HIV from making a new virus as it enters the body and helps keep the virus from establishing a permanent infection. If used effectively and by persons at high risk, PrEP has been shown to reduce the risk of HIV infection.
According to the CDC, in July 2011, researchers announced the results of the TDF2 study that found a once-daily tablet containing tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) reduced the risk of acquiring HIV infection by roughly 62% overall in the study population of uninfected, heterosexual men and women. The Partners PrEP study also found that daily doses of TDF/FTC or daily doses of tenofovir alone reduced HIV transmission among heterosexual serodiscordant couples (in which one partner is infected with HIV and the other is not) by 73% and 62%, respectively.
CDC is also evaluating PrEP’s effectiveness in preventing HIV infection among individuals exposed to HIV through injecting drugs, but those results are not yet available.
Eradicating HIV Reservoirs
While drug treatment has not provided an actual cure, research is now honing in on ways to eradicate the remaining reservoirs of HIV from infected individuals whose HIV is fully suppressed by therapy. Research focused on eradication is still in the early phases and much of the analysis and data to date has been obtained from ex vivo studies, as well as a few Phase I clinical trials, Kuruc explains.
Highly active antiretroviral therapy (HAART) is capable of suppressing HIV viral replication in the body; however, it is incapable of eradicating the virus. When HAART is stopped, viral replication reemerges. The viral rebound stems from virus that exists in latent reservoirs. There may be distinct sites throughout the body that function as “latent cell reservoirs,” perhaps in the lymphoid tissue, the gastrointestinal tract, or the central nervous system. Virus is also known to persist in CD4 cells (T cells) that are in the resting, or quiescent state, found either in the blood or in tissue.
“One of the first steps in developing a cure involves the identification, activation, and elimination of the resting CD4 cells from the reservoir and getting the virus released,” Kuruc says. “Once expressed from the cells, the patient’s current HAART would inhibit new infection from occurring.”
Kuruc adds that scientists are looking at various ways to express the virus from the latently infected cells. Stimulating key areas of the cell that are known to play integral parts in HIV storage (chromatin) or transcription (P-TEFb, or the NF-kB proteins) have been the focus of much of this research.
One approach proposed to stimulate HIV-1 expression is the use of a histone deacetylase (HDAC) inhibitor. Suberoylanilide hydroxamic acid (SAHA), or Vorinostat, is one HDAC inhibitor that is getting much attention in this field. In 2006, Vorinostat was approved by the Food and Drug Administration for the treatment of cutaneous T-cell lymphoma. A recent ex vivo study confirmed the ability of the drug to disrupt latently infected cells. David Margolis at UNC, in a proof of concept study, demonstrated significant increase in the expression of viral RNA when SAHA was given in a clinical trial.
“Although this was an enormous breakthrough, research still needs to determine: if the reservoirs are depleted; if the cells die after releasing the virus; and if the drug is safe to take for an extended period of time without any adverse effects,” Kuruc says.
Kuruc explains that once the virus is released by the latent cell, eradication of the virus and obliteration of the cells remain a concern. Recent ex vivo research illustrated that viral expression from the latent cell may not lead to cell death. Thus, it may be necessary to combine the activation and expression of the virus from the latent cell (SAHA) with other therapies.
“Few scientific and medical challenges are as daunting and complex as the attempts to develop a cure for HIV infection,” says Kuruc. “The progress made so far in understanding the complex biology of HIV infection and the stunning achievements of HAART should give us hope that we can overcome the recognized and the yet-to-be-discovered challenges of persistent, latent HIV infection.”
Vaccines
Vaccines will lead the upcoming fight against HIV, says Robert McNally, PhD, President and CEO of GeoVax, a biotechnology company developing human vaccines for diseases caused by HIV and AIDS.
So far the results have been encouraging. In 2009, Sanofi Pasteur, the vaccines division of Sanofi-Aventis, participated in a preventive vaccine trial that lowered the rate of HIV infection by 31.2%. The trial, involving more than 16,000 adult volunteers in Thailand, demonstrated that an investigational HIV vaccine regimen was safe and modestly effective in preventing HIV infection.
“Albeit modest, the reduction of risk of HIV infection is statistically significant. This is the first concrete evidence, since the discovery of the virus in 1983, that a vaccine against HIV is eventually feasible,” says Michel DeWilde, R&D Senior Vice President for Sanofi Pasteur, in a 2009 press release.
McNally says GeoVax is also at the forefront of this effort, with a substantial scientific lead for an effective preventive vaccine, thanks to the door opened by the Sanofi Pasteur trial. “This glimmer of hope for an effective vaccine has paved the way for biotech companies like GeoVax to gain traction with the next generation of products.”
Currently, McNally reports that human clinical trials for the preventive use of the GeoVax HIV/AIDS vaccine found that their vaccines were well tolerated with no or mild, local and systemic reactions in the majority of trial participants and that 80% of both low and full dose trial participants responded to the vaccine, which stimulated anti-HIV T cells (white blood cells) and antibody responses.
“The goal is to produce a vaccine like the one for polio where large portions of the at-risk population could be vaccinated; thus, over time, the incidence of HIV will decline to the point where the vaccine will hopefully become unnecessary,” he says.
HIV Testing
Decades ago, HIV testing initially consisted of a series of blood tests that took several weeks for the results. Now HIV testing has become easier and more accessible with rapid testing where the test results are available within 45 minutes.
“Newer blood testing techniques currently being marketed not only allows for quicker turnaround of test results but is sensitive enough to detect HIV prior to the body developing antibodies to the virus, thus having persons diagnosed in the earliest stages of the disease (known as the acute phase); [and] therefore, allowing individuals to be diagnosed and treated prior to the virus doing severe damage to the immune system,” says Kuruc.
Solomon says that researchers at Abt Associates are working on two different projects with the goal of educating individuals about HIV, making HIV testing available, and linking individuals into care. The first project involves working with minority serving institutions (colleges or universities that serve predominantly minority students) to develop HIV prevention programs for their students.
“The nursing school at Florida International University’s program is designed to train nursing students to be peer educators and provide HIV prevention education while at school,” Solomon says. “The students are a resource to their peers while they are students, and will develop skills regarding HIV testing and prevention that they will utilize in their future role as practicing nurses.”
Abt Associates’ other HIV project involves a large effort to provide HIV testing to minority men who have sex with men and do not know their HIV serostatus. The goal is to identify 3,000 previously undiagnosed HIV positive men and link them into care.
“We are working with community-based organizations and academic institutions throughout the country to implement this three-year testing and linkage program. A critical component of this program is to bring HIV testing to non-traditional settings so that individuals who may not routinely interact with the medical care system have access to testing,” says Solomon.
Patient Protection and Affordable Care Act
While the developments in biomedical research over the last few years has been exciting to witness, nothing is as critical to the fight against the HIV/AIDS epidemic than the passage and now implementation of the Patient Protection and Affordable Care Act (ACA), according to Lindsey.
“The single largest barrier to HIV/AIDS services in this country, whether prevention or care, is lack of access to quality, affordable health care,” says Lindsey. “While not perfect, the ACA will go far to providing such access, both through its insurance exchanges and its Medicaid expansion. Its patient’s bill of rights will also help ensure that people living with HIV or AIDS cannot be discriminated against by insurance companies through rescission or denial of coverage based on preexisting conditions.”
Currently, only about 13% of people living with HIV/AIDS have access to private insurance. What’s more, less than 30% have achieved viral suppression through adherence to a treatment regimen. Another 20% of people living with HIV are not even aware that they carry the virus. Minorities not only have higher rates of infection, but also suffer significantly poorer health outcomes, including increased mortality.
With more than 56,000 new HIV infections in the United States each year, the AIDS epidemic is far from over. And despite better treatments, there is still no cure. Lindsey believes that expanding access to health care is the single most important thing our nation can do to both improve health outcomes for those living with HIV/AIDS while also working to bring an end to the epidemic itself.
“For the first time in over thirty years, it is possible to realistically envision an end to HIV/AIDS. But ending this epidemic will not be easy. It will require bold, visionary leadership and the commitment of all of us to successfully translate the promise of this moment into a world without HIV/AIDS. Science and research have given us powerful tools; now we must decide to act.”
According to HealthDay News, two recent studies in Africa have shown antiretroviral drugs are effective in preventing the spread of HIV in heterosexuals. The trials were conducted by the U.S. Centers for Disease Control and Prevention (CDC), with the help of the Botswana Ministry of Health, and the University of Washington’s Partners PrEP study.
HealthDay News says the most recent study done by CDC involved 1,219 HIV-negative men and women who were given either a daily dose of Truvada (a pill that combines tenofovir disoproxil fumarate and emtricitabine) or a placebo pill for 30 days. Additionally, all participants were given HIV prevention resources such as free condoms and risk reduction counseling. Results showed that those taking Truvada had a 62.6% risk reduction rate, increasing to 77.9% if the participant continued taking the pill after the trial.
The Partners PrEP study, conducted by the University of Washington and funded by the Bill & Melinda Gates foundation, was put to a quick rest due to its early indications that the pill prevented the spread of HIV, HealthDay News reports. The study included 4,758 couples with one HIV-positive partner. At random assignment, each couple received Viread (single drug), Truvada (combination drug), or a placebo. Results proved those taking Viread had a risk reduction rate of 62%, while those taking Truvada had a 73% reduction, compared to the placebo.
Kevin Fenton, Director of the CDC’s National Center for HIV/AIDS, says there is strong evidence of this prevention strategy within these two new studies. HealthDay News says the CDC will continue the use of antiretroviral drugs for those at risk for HIV.
A study conducted by the University of Michigan College of Pharmacy found that 28% of low-income pregnant women with HIV are depressed but do not receive adequate treatment. Previous studies have shown that African American women are not only less likely to seek help for their depression, but they very rarely report any symptoms of depression in the first place.
The study involved 431 African American women and 219 white women with depression. Of these women, about 20% reported depressive symptoms, but researchers believe the percentage of depression could be much higher for African American women when compared to whites since the research only found results from women already being treated for depression.
According to earlier studies, African American women are more likely than white women to report physician stereotyping and tend to mistrust the medical community. Studies have shown that African American women do not receive the same quality care as white women; if they were to report signs of depression, they may not be taken seriously. Rajesh Balkrishnan, a coauthor of the study, says physicians have reported feeling unprepared to communicate with minority women regarding depression.
In the future, Balkrishnan believes depression should be screened and treated in pregnant, HIV-positive, minority women. If depression goes untreated in this population, it can sometimes lead to suicide or substance abuse, harming both the mother and baby.
As HIV shifts from being a fatal illness to a manageable one, experts say HIV care will become a routine element of primary health care. Nurses will be on the front lines in the expanded effort to test seniors, educate them about risk factors, and motivate them to stay in treatment if they test positive.
