Promoting health is a significant component of HIV nursing. Nursing ‘contributes to almost all of the foundations of well-being’ including the equitable distribution of resources and capacity building (10).  The Australasian Sexual Health and HIV Nurses Association (ASHHNA) identify enabling equitable and culturally appropriate access to health care, acting to eliminate stigma and discrimination, and educating others on the determinants of health as key practice standards (11). Nurses have a professional responsibility to advocate for the elimination of health inequities (10,11).     

Nurses work in a variety of settings including acute and community health care, schools, justice systems and across the lifespan of people, enabling significant opportunity to initiate and participate in health promotion. Nurses are experienced health educators in areas such as healthy lifestyles, chronic conditions and risk behaviours. However, it is imperative to consider the impact of SDH and review the efficacy and evidence for strategies as they relate to different population groups (3). An overemphasis on individual behaviour can further increase inequality by not creating the conditions for individuals to have greater ability to manage their health (3). For example, without change to laws in Australia to allow needle and syringe programs, access to clean injecting equipment, non-judgemental health care and harm reduction and education could not have been enabled. 

Whilst there are other health promotion models, the Ottawa Charter for Health Promotion (3) can be a useful guide due to its emphasis on recognising underlying factors outside of individual behaviour and potential for the use of multiple strategies across multiple action areas to address the SDH (3): 

1. Build healthy public policy:

Healthy public policy is at the core of health promotion (12). Forming health policy involves awareness, advocacy and sometimes activism (5,12). Nurses have strong advocacy skills and should work to put health on the agenda at all levels and across other sectors (10,11). Nurses can achieve this through participation in professional organizations, committees and initiating processes, projects and research. Social and political activism is an extension of professional advocacy with an aim to influence systems, funding and public policy (12). A recent example is nurses’ involvement in advocating for ‘Medicare ineligible’ people to have access the care and treatment through ASHM resulting in a change in policy. 

2. Create supportive environments:

Nurses should monitor the impacts on health of the environments we in which we live and work (1). In a local context, ensuring services are accessible through consultation with impacted communities and developing strategies to overcome structural barriers such as opening hours and financial constraints, developing referral pathways to other services and creating a non-judgmental environment.  Nurses can establish and foster partnerships between individuals, services, peer-based organisations and community groups for accessible health care and health promoting strategies.    

3. Strengthen community action for health

Empowerment of communities is a central process for health outcomes (1). Nurses can raise awareness and develop training within the health sector and community about the SDH (13). For example, nurses can raise public awareness of discrimination and stigma by initiating and participating in community events and social marketing such as World AIDS Day. Nurses can advocate for funding, initiate and support community action in specific settings such as schools, prisons, hospitals to prevent blood borne virus transmission, enable access to blood borne virus treatments, development of referral pathways and to address other SDH relevant to the setting (14). 

4. Develop personal skills

Nurses can support, build capacity and harness community strengths, for example, training volunteers in caring for people with HIV through HIV organisations and peer support networks (15). When providing health education, nurses can act to improve health literacy that avoids lifestyle blame and understands that drivers for behaviour can be complex and arise from social, economic, environment and cultural factors (3).  

Nurses can build capacity within health care to respond to health inequality and social determinants of health through role modelling, sharing skills and knowledge in providing equitable care, developing and disseminating research and implementing training. 

5. Re-orient health services:

To improve health outcomes, health care needs to continue to evolve beyond ‘clinical and curative’ services (1). This can be achieved by strengthening primary health care and accessibility for vulnerable groups (6,12). Taking a holistic view of people and communities is essential including cultural sensitivity and empowerment of culturally diverse and marginalised populations (1). Nurses can instigate and support organisational change and health care models to improve health access to vulnerable groups for example, outreach and the use of peer workers and navigators. For example, nurses can outreach and partner with community and peer-based organizations to facilitate health promotion activities such as addressing food security, harm reduction, education and health literacy (15).