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Photo of multiple blood sample viles.

 

Ryan White Voices

Uncharted Territory

"As health providers we don’t know a whole lot about how to care for these people as they age. And now there is a boom of patients with both HIV and cancer who are also at greater cardiac risk. This is the first real time we’ve had to deal with it."

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Donna Gallagher: Continued

Donna explains, “With HIV, everything changes so rapidly that it absolutely stimulates your brain on a 24-hour basis. It’s not like when I was in school and everything you needed to know was in a textbook. It seems like information about the HIV epidemic changes everyday so the challenge, like any specialty, is for nurses to stay on top of the latest research and drugs in their field.”

“In Africa,” she says, “the bulk of my time and energy is teaching how to provide comfortable end of life care, which is reminiscent of the beginning of the outbreak. Then, as if moving into the 1990s, I am also teaching health professionals how to get antiretroviral medications to their patients and the side effects of the drugs. In many ways, it’s a repeat performance of what I had done decades earlier in the U.S.”

Donna has worked in Brazil, learning about the country’s cutting-edge approaches to HIV prevention and sharing her expertise in AIDS care. She also participated in the International AIDS Society (IAS) Conference on HIV Pathogenesis and Treatment, coordinated by IAS with the Universidade Federal do Rio de Janeiro and Sociedade Brasileira de Infectologia, in 2005. “I was trying to understand what they’re doing in Brazil that has been successful or unsuccessful. They have been particularly successful in prevention and they are pioneers in their work to get non-commercial drugs to HIV positive patients,” she says.

Partners in This Journey

In the U.S., support for HIV prevention has fluctuated over the years. “It wasn’t until 7 or 8 years into the epidemic that we really understood how it worked and how it could be prevented,” says Donna. “Now we know that this virus is 100 percent preventable. Part of the struggle with educating people on HIV prevention is that you have to talk about issues that people still feel uncomfortable with like sexually transmitted diseases and drugs.”

Donna believes that a major problem in the U.S. is that people believe that the AIDS crisis is over, and can be easily managed with medication. She says, “There’s been a push to convince people that this is a chronic disease, that medication can make this virus more manageable and so people, particularly young people, are less concerned with this being a life threatening illness.”

This conception is inherently problematic according to Donna. “On the one hand it’s wonderful that we have medication that makes a huge difference, and on the other hand we’ve done a disservice as though this is a disease where you can just take a pill and get better. The success of emphasizing how important it is to make good decisions is falling to the wayside,” she explains.

“There is still a major emphasis that abstinence is key, but we have to recognize that we can’t assume that just because someone says, ‘Be abstinent’ that everyone will follow those directions. I have three daughters and I’d be thrilled if they never thought about having sex but people also have to be practical,” she explains. “Young women need to be aware of their risks and of their voice in advocating for safe sex.”

HIV incidence among women in the U.S. has remained relatively stable at 15,000 new infections a year1 though as Donna explains, “Women don’t always have sexual choice or control regarding whether they can use birth control or protection placing them at increased risk.”

Donna not only addresses the impact of HIV on women, but also the rise of HIV incidence among what she calls “the graying population,” people over age 50 who are now HIV positive. “As health providers we don’t know a whole lot about how to care for these people as they age. And now there is a boom of patients with both HIV and cancer who are also at greater cardiac risk. This is the first real time we’ve had to deal with it,” Donna says. Most prominently, patients are aging with HIV but, “there’s a definite misunderstanding that people over 50 aren’t having sex, but the statistics don’t lie—new HIV cases are being diagnosed in people over 50 too,” she explains.

Donna calls this “uncharted territory,” and it’s something that she’s traveled to Washington, D.C. to discuss. “Nurses are critical to the future of HIV, both here and abroad,” she says. “When I was in nursing school I didn’t learn how to go up to a senator’s office and talk about financing drugs in Africa, but every nurse has to be an advocate for their patients and whether people die or live comfortably is really in the hands of nurses. We hold a key to successful care for people with HIV. They need us as partners in this journey.”

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