1. Care of HIV Patients – Past, Present, and Future
Nursing Practice History and Evolution
Joshua LaDeau
MSN 6003
Registered Nurse, BSN
21 February 2016

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Introduction
Human immunodeficiency virus (HIV) is a virus that attacks the immune system in
people that are infected and can lead to opportunistic infections. The AIDS Institute (2011)
reports that in 1982, health officials began calling these opportunistic infections “acquired
immunodeficiency syndrome” or AIDS, although HIV was about a year from being discovered.
Research is ongoing to finding a cure for this chronic disease, but many advances in medicine
have already been made. Nursing care for patients with HIV has also evolved over the last few
decades since the virus was first detected. The purpose of this paper is to show that evolution in
nursing care of the HIV patient as research and medicine has also changed.
Identification and Discussion of Health Care Issue
According to Hopwood, Newman, Persson, Watts, de Wit, Reynolds, and Kidd (2014),
nursing has been involved in the care of HIV patients since it was first discovered, although
nursing’s contribution to care of HIV patients has not received as much recognition as medicine
and pharmaceuticals. The condition we call AIDS was first identified in 1981 (Peters & Conway,
2011). The AIDS Institute (2001) reports that scientists discovered the virus that causes AIDS in
1983, which eventually came to be known as human immunodeficiency virus, or HIV. An HIV
patient, Tom Matthews (2011), who was diagnosed in 1986, recalls the earliest days of HIV care
when there was no medications or literature available and was given only two years to live. Rose
(2009), among many others, recalls that people living with HIV were stigmatized and ostracized,
even by nurses and other health care workers. She further explains that while nurses are far more
educated about the condition and generally do not hold the same reservations about caring for
HIV positive patients, these patients are still stigmatized and even held in contempt because they

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are seen as people without health insurance, homeless, and/or drug users. Rose (2009) also
indicates that nurses that work in specific care areas may not be well enough informed about
caring for HIV patients, and they should be better educated as affected patients are now living
longer and longer with the disease. She proposes that to reduce fear and stigma of caring for HIV
positive patients and to generate empathy, nurses of all ages should be better educated and
should have personal experience with these patients.
As indicated before, nursing has been involved in the care of HIV patients since its
discovery. According to Ault (2011), 2011 marked the 30-year anniversary of five homosexual
men being diagnosed with Pneumocystis pneumonia, which eventually led to the discovery of
AIDS and the HIV virus. Since nothing was known about the disease, focus at that time was
placed on support and care of these patients as they were dying. Barré-sinoussi, Ross, and
Delfraissy (2013) report that scientists and physicians urgently began searching for the origin
and cause of this fatal disease, which was now spreading rapidly worldwide. Within a few years
HIV was isolated and work began on drugs to prevent or treat patients. As these drugs were
being developed, nursing care also began to evolve.
Theory, Evidence-Based Practice, and Comparison of Past and Present Nursing Practices
In this author’s research of the literature, only one theory was found in reference to care
and interventions for HIV/AIDS patients. This is the Outcomes Model for Health Care Research
(OMHCR) as relayed by Holzemer, Mendez, Portillo, Padilla, Cuca, and Vargas-Molina (2004),
and is based on work done by Donabedian. This model is being used by the Nursing Research
Center on HIV/AIDS Health Disparities, which developed from a partnership between the
schools of nursing at the University of California San Francisco and the University of Puerto
Rico. According to Holzemer et al. (2004), “It gives researchers a model or heuristic for

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synthesizing concepts and identifying gaps in understanding the relationships and factors among
patient characteristics, self-care behaviors, setting characteristics, provider interventions, and
outcomes. The OMHCR model has been used to study health-related outcomes, such as quality
of care, in primary health care and community-based care” (p. 228). This model has been used to
study the disparities in HIV treatment and outcomes in minority populations, particularly black
and Hispanic populations, which are disproportionally affected. Holzemer et al. (2004) opine that
the groups that are most affected are minorities, women, and the poor, who are also less likely to
have access to health care. Admittedly, the article referred to is a bit dated, and results from the
organization’s research had not been published at the time of publication. However, they do note
that the Nursing Research Center on HIV/AIDS Health Disparities has received funding from
several sources and had begun seven pilot studies.
In a 1990 study of nurses, one third of respondents were considering a career change so
that they would not be exposed to HIV and half stated they did not want to care for infected
patients at all (Rose, 2009). Despite these statistics, many nurses did answer the call to care for
these unfortunate patients. Dobson (2014) recalls that after new medications were developed,
nursing for HIV patients consisted of administering antiretroviral drugs (ARVs) three to six
times per day, as well as multiple prophylactic medications to prevent opportunistic infections.
She reports that many of these drugs were given as clinical trials and reporting on side effects of
the drugs was paramount. She recalls patients in the early days of the HIV epidemic suffering
from frequent diarrhea due to cryptosporidia and having to help with various medical tests due to
refusal of other health care workers to get involved with HIV patients. Bellingham (2011) states
that the beginning of HIV nursing was difficult because it consisted mainly of supporting and
comforting patients and their loved ones and preparing them for the end. She also explains that

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some difficulty was met in early 2000 due to medication resistant strains of the virus, in addition
to nonadherence. Even with new medications and a less strenuous regimen, she states that
adherence continued to be a problem. In Bellingham’s native UK, nurses began several programs
to help HIV patients: a metabolic clinic to aid with medication side effects, an exercise program
in cooperation with a local YMCA, and a mental health clinic run by a mental health nurse and
in cooperation with a psychiatrist. They continuously sought feedback from patients to see what
was working and what was not, in order to ensure the best care. Bennett (2011) states that
nursing care has changed “…from acute to chronic and from inpatient to outpatient/clinic based”
(p. 1). She states that instead of treating opportunistic infections and performing palliative care,
today’s nurses focus on managing side effects of current medications and treating other medical
conditions. Ault (2011) states that with the newest antiretroviral drugs, patients are living longer
and that HIV is no longer a death sentence, but is being treated as a chronic illness. Hopwood et
al. (2014) provide a good comparison of the evolution in nursing care in Australia. Prior to the
advent of antiretroviral therapy in the mid-1990s, HIV nursing was very challenging and
emotionally exhausting. Now nurses are focused on chronic disease management, educating
patients and their loved ones, encourage adherence to the medical regime, and manage patients’
psychosocial and psychosexual status. Hopwood et al. do report, among many other authors, that
there continues to be a stigma relating to HIV patients and discrimination.
This author has only taken care of three or four patients with HIV in a decade of nursing
practice. With such little experience, there is little that can be reported. However, in caring for
these few patients, caution was taken to be empathetic, to treat these patients as any other, and as
always, provide dignity and privacy to these patients and their loved ones. Of greatest
importance, use of personal protective equipment and single-use needles was never forgotten

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whenever dealing with body fluids, particularly blood. All of these patients have been
homosexual non-Latino white males, which although not uncommon, one might expect more
ethnic diversity in the South, especially since minorities are so disproportionately affected.
Conclusion
After over thirty years since HIV/AIDS was discovered, great strides have been made in
research, medicine, therapies, and nursing care. Nursing care has evolved as medical treatments
and therapies have improved. Instead of treating opportunistic infections and preparing HIV
patients and their loved ones for an eventual and usually horrific death, nurses now focus on
education, compliance, prevention, and mental health. Dobson (2014) reports that with the
current medical regime, most hospital admissions are unrelated to HIV and the need for ICU care
and ventilator use is very rare. The stigma of HIV continues to be problematic, but nursing and
other health care disciplines are working to reduce stigmatization, so that people will be more
willing to be tested and treated. Although HIV infection rates continue to increase, research into
finding a vaccine or a cure is continuous (Dobson, 2014). Nursing care of HIV patients will
continue to evolve as scientific and medical knowledge continue to grow. Further education of
nurses and personal experience are needed to increase nurses’ understanding of the disease
process and to promote understanding and empathy when caring for patients suffering from HIV.

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