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Inaugural meeting of the National HIV Nurses' Association 8th November 1997 Notes taken and webplaced by Ian Hodgson on 20th April 1998 HIV Nursing in the 90s: New Challenges, New Strategies Session 1 Robert Pratt - Introduction Purpose of National HIV Nurses Association (NHIVNA) – for research, support, education. The association will network with the European Association of Nurses in AIDS Care (EANAC), and the RCN HIV Nursing Society. The significance of such a new society cannot be diminished – within the 20 minutes of the introductory session, 200 more people have been infected with HIV. Session 2 Martin Fisher – Current Treatment Issues 13 years on from what was initially called the ‘gay plague’, there is now an era of new optimism. Combination therapy is producing major changes in the prognosis of people with HIV. Developments have included:
Available treatments have increased – in 1986 only AZT was available, and the purpose of therapy has moved away from ‘just’ improving the general quality of life, to the use of ‘markers’ such as viral load and CD4 count. Maximum effectiveness is now achieved by the standard use of 3 drugs (triple therapy), though the third drug does not necessarily have to be a protease inhibitor. How long is treatment actually effective for ? Unless the viral load is reduced to undetectable levels (< 20), then benefits unlikely to be sustainable. Why do drugs stop working ? – development of resistance, due to mutations, and the best way to reduce resistance is to ‘hammer’ the virus – any window will allow ‘rogue’ viruses to develop. Why do some people not respond to treatment ? – initial (very) high viral load and low CD4 count; previous treatment with similar drugs; alcohol; smoking; recreational drug use; ‘non-compliance’ due to large number of tablets (50+ per day). Resistance can be generic (eg. applying to all PIs). For the future: What is known
What is not known
Issues in treatment:
For the next 12 months:
For nurses and carers, the implications of combination therapy include: providing education about the complex regimes and side effects; management of intolerance; encouragement of compliance; post-exposure ‘prophylaxis’ counselling – including after sexual activity Session 3 Henry Graham-Smith (Training Officer, NAM) – Treatment Activism
‘Treatment activism’ – achieved via:
The ‘mental model’ a person holds can affect perception. For example, a person who thinks the CD4 count relates directly to the amount (as opposed to per mm3), then if s/he has a count of 2, s/he may think they will ‘go’ if blood is taken. When is the best time to start treatment ?
Viral load and CD4 count can predict likelihood of AIDS: a viral load of >11000 and CD4 <200 increases significantly chances of progression to AIDS – BUT, if the viral load <3000 and CD4 >750, then AIDS is unlikely. Summary and issues:
Session 4 Debbie Vowles – Women and HIV 45% of people with HIV in the world are women 4615 of the 24924 people in the UK are women (962 from IDU; 2135 contact abroad, mostly in Sub-Saharan Africa) This focus will shift over the next 2 years towards the Caribbean and Asia. There have been problems in the past with a misperception of transmission in women, and this has led to poor advice being given. Prevention choices:
Issues: women often lack power, but also are less likely to leave a partner who is HIV+ve than vice-versa. Also, women are more likely to tell their partner their HIV status, and more likely to be tested without their consent. Ante-natal testing – various arguments are suggested against mandatory testing, though many women assume they are tested anyway. Individual choice on the part of the woman should be considered. What would be the role of the father in the decision? Session 5 National HIV Nurses Association Aims of the association:
Planned events will include a 2 day conference in 1998, and 3 one day meetings |
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