Nurses, alongside doctors, allied health professionals and peer workers, working at the forefront of HIV care in Australia in the early years of the epidemic, faced a highly politicised and stigmatising landscape given the nature of the illness and the already marginalised affected population. (1) With no precedents, the HIV nursing models that emerged were shaped by the response the crisis demanded, creating a diverse range of nursing roles and a strong, flexible professional specialty. (2) This challenging working environment has been attributed to the strong alliances formed between health professionals, creating the cohesive and resilient sector that still exists today. (1)(2)    

In this largely collegial working environment, nurses across all areas work collaboratively with HIV specialist general practitioners, infectious disease or immunology physicians, HIV specialist pharmacists, social workers and other allied health professionals and peer workers to provide holistic, equitable HIV care. HIV specialist nurses work across a range of areas including:   

• Community and domiciliary nursing services such as Bolton Clarke, Silver Chain, Sydney District Nursing Service   
• General practice and community health   
• Acute and subacute hospital in-patient and out-patient care; Hospital Admission Risk Programs   
• Youth, maternal and child health   
• Refugee health.   
• Custodial settings   
• Sexual health services   
• Clinical trial research 
  

Given the differing levels of complexity among patients, nursing roles vary considerably between settings. Nurses across the sector can experience differing levels of acuity for the same patient based on the setting from which they are providing care, whether it be seeing that patient at a routine GP follow-up appointment or undertaking a home visit through a community nursing program. A strength in the collegial working environment of the HIV sector is the ability for nurses across the spectrum of roles to support and educate one another to ensure the best patient outcomes. The experiences of nurses in the HIV sector in a well-resourced metropolitan tertiary setting will for example, be entirely different to that of a nurse providing HIV care in a remote or rural setting, however each have much to offer the other in terms of collaboration and collegiate partnerships. This approach can be conferred to other sectors not traditionally involved in HIV care who may now be involved in HIV prevention and subsequent new HIV diagnosis or ongoing management.   

The Pharmaceutical Benefits Scheme (PBS) approval for both nurse practitioner and general medical prescribing of Pre- Exposure Prophylaxis (PrEP) for the purposes of HIV prevention in 2018 resulted in a rapid up-take of the latest tool in the HIV prevention tool kit. (3) This shifted what was once a specialty medication accessed through a clinical trial setting, to any setting appropriate, dramatically upscaling accessibility for patients, as well as opportunities for nurses outside the traditional HIV sector to upskill and expand their HIV knowledge around prevention, new diagnosis, and concepts such as undetectable equals untransmissible. (4)  

The Aged Care sector is a worthy consideration for the expansion of HIV education and collaborative cross-sector partnerships among nurses given the ageing population of People Living with HIV (PLHIV). Many long-term survivors have now lived with HIV for close to forty years, a testament to the success of antiretroviral therapy (ART) among other interventions and are transitioning towards aged care services and residential aged care facilities (RACFs). A local protocol to support nurses and staff in RACFs to deliver considered, appropriate care for PLHIV was developed with this in mind by Murray et al in 2014. (5)    

Since the first edition of this publication in 2016, Australian nurse practitioners were granted approval to prescribe PBS subsidised antiretroviral therapy for HIV management under the s100 program (April 1, 2020).  This greatly expands access and opportunities for patients, and nurse practitioners in this area (6)(7).    

Since HIV in Australia is increasingly being managed as a chronic disease, nurses have a significant role in care delivery, comparable with chronic disease management care for other conditions. The role of nurses in leading chronic disease management approaches has been shown to be feasible and acceptable to both clients and fellow health professionals (8).  Nurses are the largest health profession in Australia and are effective in managing chronic diseases, including HIV. With increasing healthcare costs demanding reform, there is a need to continue to support nurses to care for those affected by HIV across all healthcare settings and all levels of nursing practice to prevent avoidable hospital admissions and improve patient outcomes.