Elizabeth Crock: HIV Nurse Practitioner, Bolton Clarke HIV Program/Homeless Persons Program, Melbourne 

Sandra Gregson:  CNC Torres Sexual Health/ Men’s and Women’s Health  

Acknowledgments to: 

Yoko Mills, Chenoa Wapau, Marion Assan, Ivy Kaidai Torres Sexual Health/ Men’s and Women’s Health 

Oscar Morata Ramirez: Royal District Nursing Service, Melbourne (first edition) 

Shelley Williams: Victorian Aboriginal Health Service (first edition) 

Summary 

• Introduction to key populations 
• First Nations Australians 
• Health service considerations 
• Nursing considerations 
• Useful resources 
• Asylum seekers, refugees, migrants, and international students 
• Nursing considerations 

• Privacy and confidentiality 
• Men who have sex with men 
• People who inject substances 
• Nursing considerations 
• Women 
• People experiencing homelessness. 
• Violence and key affected populations 
• Self-care for nurses and midwives caring for key populations. 
• Nursing strategies for working with key populations: summary. 
• Resources
  

Introduction 

Globally, members of key populations can be especially vulnerable to contracting human immunodeficiency virus (HIV) infection and, if already diagnosed with HIV, may experience poorer outcomes, mostly related to social determinants of health such as socio-economic circumstances, gender, migration status, or ethnicity (1,2). Typically, members of some groups are more likely to be diagnosed late, less likely to engage with health care, access treatment, adhere to treatment and achieve viral suppression, referred to as the HIV treatment cascade or care continuum (3). Lower rates of linkage and retention in HIV care lead to significantly poorer health outcomes and mortality risk, and ultimately greater healthcare costs (4,5). 

International and national nursing standards of practice, codes of conduct, position statements and ethics research affirm that nurses have a special responsibility to those most vulnerable (6,7).  It is therefore a primary role of nurses, midwives, and community health workers to advocate for, and help members of key populations access HIV and mainstream health services and keep them engaged in health care.   

This section draws from the practical experience of nurses in the Australian setting, and local and international literature. Key populations discussed include First Nations people, refugees and asylum seekers, women, people who inject drugs and men who have sex with men.  All may belong to more than one group.   

It is important to note that key populations differ in different Australian states and territories and this discussion is not exhaustive. Nurses and midwives must focus on those most affected/at risk in their local environment.  However, the principles, strategies, guides, and resources discussed here can be helpful across settings.