It is with great anticipation that I look forward to this special issue on HIV and aging. I want to express my appreciation to the editors, authors, ANAC members, and other colleagues researching evidence-based best practices and providing innovative and compassionate care for people living and aging with HIV. Ultimately, I want to acknowledge the incredible resiliency and courage of long-term survivors. People living with HIV (PLWH) who have survived HIV for decades experienced tremendous loss, stigma, and discrimination, including within the health-care system. Yet they have persevered, facing a disease with a previously unknown course, changes in treatment approaches, and sometimes a revolving door of providers, repeatedly having to tell their stories and histories once again. They have advocated for themselves and their communities, forever changing the role of patients in their own health care and have held us accountable when we did not measure up. I am grateful for that. Often outliving their HIV peers, they are now beginning to face myriad challenges: clinical, psychosocial, financial, and logistical. Aging with HIV is a complex mix of long-term treatment effects, early onset of general aging, comorbidities, and other confounding factors including mental health and psychosocial factors such as isolation that affect quality of life.
For aging PLWH, the emergence of multiple comorbidities may necessitate moving away from places where they have traditionally received care to new systems that focus primarily on comorbidities associated with aging, such as cardiology, neurology, physical therapy, and rehabilitation. In most communities and institutions, this care is delivered through an uncoordinated maze of multiple specialists who may be unfamiliar with HIV or the unique challenges experienced by PLWH or lesbian, gay, bisexual, or transgender elders. Without proper support, the risk for isolation, depression, and stigma will be increased. Nurses and nurse practitioners are ideally situated to deliver and manage this complex care.
Nurses who care for PLWH have a long history of coordinating complex patient care, which started before the terms care coordination, case management, and navigation were known. As PLWH are aging and their care becomes more complex, their challenges multilayered, and their resources less robust, the need for compassionate and effective nurse managed care is critical. But it may not be nurses who know about HIV who end up providing this care. Our experience and perspectives must now be translated to new care settings and providers where older people, including PLWH, are served.
And so, we are pleased to announce that in 2019 ANAC is launching a multidimensional, 3-year education program with funding from Gilead Sciences, Inc., to reach nurses and nursing students in gerontology settings and programs. We are partnering with major gerontology nursing organizations and nationally recognized schools of nursing with gerontology programs to develop and deliver education and training across the country. Our partners share ANAC's core principles of patient-centered care, quality of life, respect for diversity, the importance of meaningful involvement of PLWH, and the belief that nurses and nurse practitioners are effective providers and navigators. The organizations we are partnering with are concerned about the special needs of aging PLWH and the potential impact of stigma, homophobia, isolation, and depression on the quality of life of aging PLWH as they enter geriatric care settings.
Our project will center on nursing education and efforts to
* ensure that aging PLWH are provided the best possible care regardless of the setting,
* achieve optimal nurse-led care coordination for aging PLWH by nurses/nurse practitioners in settings where older patients are served,
* support self-care and patient wellness for aging PLWH, and
* maintain optimal quality of life for people who are aging with HIV.
A nursing framework based on holistic, strength-based, and patient-centered approaches that include evidence-based quality of care, compassion, advocacy, and effective care coordination is the cornerstone of HIV care. This is the legacy of nursing involvement in HIV care over the past 30 years, which must now be modified and expanded to support the complex needs of the growing population of people who are aging with HIV. We can do this.
Disclosure
The author is the director on an educational project on HIV and aging awarded to ANAC by Gilead Sciences, Inc. She receives no direct financial benefit. ANAC is solely responsible for the content of the project.