VOL: 99, ISSUE: 48, PAGE NO: 28
Liz Kawonza, BSc, FETC, CertQuality Management, RN, RM, is head of African Services Development, Terrence Higgins TrustHIV is the biggest health crisis the world has ever faced. Last year, more than three million people with Aids died and a further five million people were infected with HIV (UNAIDS, 2003). It is the fastest growing serious medical condition in the UK - there were around 6,000 new diagnoses of HIV last year and these are rising at a rate of over 25 per cent every year.
HIV is the biggest health crisis the world has ever faced. Last year, more than three million people with Aids died and a further five million people were infected with HIV (UNAIDS, 2003). It is the fastest growing serious medical condition in the UK - there were around 6,000 new diagnoses of HIV last year and these are rising at a rate of over 25 per cent every year.
The Terrence Higgins Trust (THT) estimates that there are over 50,000 people living with HIV in the UK, around a third of whom are unaware of their HIV status. These facts are set against increasingly poor general sexual health. The UK has the highest levels of sexually transmitted infection since the NHS was founded, and has one of the highest rates of unplanned teenage pregnancy in western Europe (THT, 2003).
HIV in the UK today
HIV still primarily affects two groups in the UK - gay men and black African communities. There are indications of a growing Afro-Caribbean HIV epidemic, particularly in London. There are also increasing numbers of people with HIV who have been infected abroad, mostly in countries where HIV prevalence is high. Many in this category are women. Eighty per cent of all heterosexuals diagnosed with HIV in the UK last year were infected in an African country (Health Protection Agency, 2003).
A growing problem
It would be easy to think that antiretroviral treatments (commonly known as combination therapies), which have been widely available in the UK since 1997, mean that HIV is no longer a problem in the UK. However, the numbers of people living with HIV have already exceeded the levels predicted in the government's National Strategy for Sexual Health and HIV (Department of Health, 2001).
Pressure on genitourinary and HIV clinics across the country has increased considerably, as has demand for social care services such as those provided by the THT. Calls to the charity's dedicated helpline, THT Direct, have increased from an average of just fewer than 500 to more than 1,000 a week in the last year.
Misunderstandings and fears about HIV are still widespread in the UK, despite the fact that we are now over 20 years into the epidemic. People living with HIV can still face hostility or rejection from society. A study in 2001 suggested that one in five people with HIV had experienced some form of discrimination in the previous 12 months (THT, 2001).
Antiretroviral treatments, side-effects and HIV-related illnesses
Thanks to advances in treatments many people with HIV are able to lead full and healthy lives. Indeed, for people who are diagnosed early enough, the outlook is promising. However, there are still large numbers of people, mostly heterosexuals, who are only diagnosed when they are already ill as a result of having HIV. A third of people who die with HIV each year do so within just three months of being diagnosed, although the mortality rate from HIV-related illnesses has fallen dramatically since the mid-1990s.
Despite the availability of treatments, people with HIV are still at risk from opportunistic infections such as Pneumocystis carinii pneumonia and Kaposi's sarcoma. Increasingly, candida, bacterial pneumonia, toxoplasmosis of the brain, cytomegalovirus and cryptosporidiosis are now commonly seen in people with advanced HIV disease - the term now frequently used, rather than Aids, to describe an HIV positive person with one or more symptomatic illnesses. Most of these conditions are rare in healthy individuals, or do not pose a serious threat, but can be very serious in immunocompromised people.
People with HIV can also experience other symptoms and complaints including diarrhoea, vivid dreams, facial muscle wasting and the accumulation of visceral fat in the abdomen. Some of these might be associated with the side-effects of antiretroviral medicines.
Taking anti-HIV treatments regularly and sticking to the required doses can be difficult, especially for patients who have to hide their treatments from people near them. Newer drug combinations can now mean that people do not need to take as many tablets as often, and this can improve concordance with treatments. Missing doses or not taking a particular drug, even for a few hours, can have a serious effect on how well a patient's treatment works.
If there is a suboptimal level of a drug in a patient's body, it can allow the virus to replicate in the drug's presence. This may allow the virus to develop resistance to a particular drug or class of drugs.
Living well with HIV
It is important that people with HIV are able to take control of their lives. Nurses can help people with HIV understand that good health is not just about feeling physically well - it is also about emotions, thoughts, relationships, environment and many other aspects of life.
Nurses can play an important role in helping people with HIV to live well and manage aspects of their lives beyond clinical matters such as blood test results and medical treatments. THT's 'living well with HIV' team produces a range of written publications on treatments, diet, disclosure of HIV status, sex and relationships, and stress management. As with other long-term medical conditions, lifestyle changes including diet, rest and avoiding stress play a key role.
Nurses' role in caring for people with HIV
Nurses have an important caring role for patients with HIV, from providing information and support before diagnosis, through to giving advice concerning treatment and general health issues (see Box 1). Nurses often have more time than doctors to discuss issues with individuals and may be better able to explain what the doctor has said in a language the patient will understand.
Patients who call THT for advice are sometimes unaware that nurses can provide this level of help. Generally, patients are very satisfied with support from nurses and report finding it easier to talk to nurses. Nurses are also frequently involved in HIV testing, promoting and facilitating decisions on whether to test, taking blood samples, and providing advice and information for people who test HIV positive.
A study of African people with HIV cited talking with doctors and nurses as the most commonly used treatment information intervention (Weatherburn et al, 2003). Such contact can help reduce numbers of hospital admissions, improve the quality of patients' lives and help them to adhere to their medical treatments.
Nurses also have a key role in maintaining patient confidentiality, and in challenging and reducing HIV prejudice and discrimination within affected communities - for example, by educating people in basic facts about HIV. They may also support patients in deciding whether and how to disclose their HIV status to people in their lives.
Nurses with HIV
The Department of Health is currently revising regulations for clinical staff, and this is likely to include compulsory HIV tests for all new NHS staff whose job involves performing exposure-prone procedures. THT believes that such tests are acceptable, as long as a member of staff who receives a positive result is properly supported, and that a positive result is not used as a barrier to employment in suitable areas - those where exposure-prone procedures are not involved. As with anyone else, if nurses or other members of NHS staff have HIV, the sooner they are diagnosed, the sooner they can be treated and take steps to help ensure that they do not pass the virus on to anyone else.
This article has been double-blind peer-reviewed.