1. Chavez, Jose DNP, RN, ACCNS-AG, CCRN
  2. Worth, Kevin RN, PHN, MS, CNS, CPHQ

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In October 2020, the United States had a total of 8 834 393 COVID-19 cases, with 227 045 total COVID-19-related deaths.1 The COVID-19 pandemic parallels the beginning of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic. The infectious disease experts who are guiding the United States on the COVID-19 response have had expertise in the HIV pandemic. Similar factors of the 2 pandemics include the approach and treatment, where for both COVID-19 and HIV, there was a lack of understanding of the disease, with no clear treatment immediately available and no systematic trials to guide treatment.2 The differences include mode of transmission, incubation, period of infectiousness, and the effects on health.3 The clinical nurse specialist (CNS) can leverage the lessons learned from the HIV response to guide leadership in the COVID-19 response. The Joint United Nations Programme on HIV/AIDS 2020 highlighted opportunities and lessons that benefit an effective response to COVID-19. The Joint United Nations Programme on HIV/AIDS identified 7 primary aims to address in the COVID-19 approach: engage affected communities, combat all forms of stigma and discrimination, access to free affordable screening, removing health access barriers, public health restrictions must be limited duration, countries must work to support each other, and support and protect healthcare workers.4


Communities and Stigma

A systematic review meta-analysis found that in low- and middle-income countries, there was a significant presentation of stigma and late presentation for HIV care.5 This has also been associated with COVID-19; low- and middle-income populations are also the vulnerable communities that present late with acute to critical COVID-19 symptoms. A key factor to address COVID-19 in high-risk communities is addressing the misinformation and stigma. Accurate data are vital in these communities, and decreasing and eliminating stigma will have an impact on transmission, which will lead to the identification of positive cases and early initiation of treatment. The negative effects of stigma that impacted HIV patients parallel those of COVID-19 patients; in communities with higher stigma and discrimination, having the disease led to an associated decreased access to health services and negative health outcomes.3


Access Screening and Public Health

The HIV pandemic identified a lack of access to available and quality care, which was also found in the COVID-19 response, with the vulnerable population finding difficulties in screening locations and access to care.4 A CNS should identify vulnerable populations and work with local public health professionals to decrease the gap in access and care. The CNS can also identify barriers to access to healthcare services and, like the HIV response, initiate a sustainment in policy and identify ways to fund resources for the vulnerable population. Public health professionals and communities must collaborate and share resources in a coordinated COVID-19 response. The HIV response would not have been successful without the sharing of resources and coordination of information on the virus.4 The CNS, as an advanced practice nurse (APRN), has the capability of working collaboratively with other APRNs in different hospital systems or in different states that may have resources that can support the population served. The following narrative demonstrates the work of a CNS during both the HIV and COVID-19 pandemic.



As a registered nurse since 1993, and among the early CNSs certified in California in 1998, I can reflect on the availability and use of personal protective equipment (PPE) in both the HIV epidemic and the COVID-19 pandemic. I was a young gay man living in New York City, and not yet a nurse, when the US Centers for Disease Control and Prevention described the first cases of Pneumocystis carinii pneumonia in 1981. As friends became ill and could no longer work, any number of us who were well would provide care. Masks or gloves were not really thought of, except perhaps for cleaning bodily or pet waste.


I entered a midwestern seminary in 1985 to study for the Roman catholic priesthood. The now familiar "bunny suit" that nurses (and in my case hospital chaplains) wore when providing HIV patient care were originally designed to protect the patient and not the caregiver. Clearly, fear was a part of some of the caring culture at that time. I would later see that fear-based culture reversed in San Francisco AIDS care.


Not quite sure about continuing studies for the priesthood, I came to Oakland, California, in 1987, where I volunteered at a drop-in center for people living with HIV. Not unlike my experience in New York, PPE use was confined to gloves when needed.


I began my nursing studies in 1991 in San Francisco, completing my Master's in Community Health as a CNS in 1995. I worked as an HIV Nurse Case Manager with urban American Indians, as well as a home health/hospice nurse, providing case management care and intravenous therapy to some of the most marginalized patients in our society. Personal protective equipment included gloves, and perhaps eye protection when we thought we might risk splash.


Given the challenging living conditions of some of our patients, the hygienic basic precautions led by Florence Nightingale became part of our practice. In addition to my treasure trove of various sizes of Peripherally inserted central catheter lines and other supplies, clean brown paper bags were basic equipment to provide barrier protection between our nursing bags and a questionable surface.


Almost 30 years later, I find myself in a healthcare leadership role where I have system-wide responsibility for infection prevention, among other programs. Today's international conversation about PPE availability is of far greater-and graver-magnitude than anything I can recall from the HIV epidemic. As I help lead critical decisions that impact patient care and safety, the CNS role components remain guiding touchstones for me.



The HIV response infrastructure served as a guide in the evidence that a CNS can use in the COVID-19 response plan. The CNS should use all evidence from previous pandemics to formulate the best response to approach COVID-19. Analysis of previous data during the HIV pandemic can help guide the APRN on identifying vulnerable populations and begin to work with public health officials to decrease the gaps between knowledge and care. Communication was critical in the HIV pandemic and remains critical in the current COVID-19 pandemic. The CNS should use the HIV response data to prioritize decreasing stigma and discrimination in the COVID-19 response, ensuring that accurate information is being delivered to the high-risk population.


The CNS's function in leadership on a system and national level presents opportunity to relay information to the international healthcare community. There is an urgent need to share knowledge, information, and resources on an international level.4 The use of technology during the COVID-19 pandemic has made communication between health systems across the world feasible and efficient, sharing strategies that can improve outcomes. Innovation in care has accelerated during the COVID-19 response; health systems are currently identifying novel ways to triage patients and streamline workflow on care around the COVID-19 patient. As leaders in healthcare, the CNS may also represent vulnerable populations and provide recommendations toward improving access to care, decreasing stigma, and increasing resources.




1. Centers for Disease Control and Prevention (CDC), (2020). CDC COVID Data Tracker. Accessed October 29, 2020. [Context Link]


2. Kunzman K. (2020). COVID-19 vs HIV: How the epidemics compare. Contagion Live. July 8, 2020. Accessed October 28, 2020. [Context Link]


3. The Joint United Nations Programme on HIV/AIDS (UNAIDS), (2020). COVID-19 and HIV: 1 moment, 2 epidemics, 3 opportunities. Accessed October 30, 2020. [Context Link]


4. The Joint United Nations Programme on HIV/AIDS (UNAIDS). (2020). Rights in the time of COVID-19. Lessons from HIV for an effective, community-led response. Accessed November 1, 2020. [Context Link]


5. Gesesew HA, Tesfay Gebremedhin A, Demissie TD, Kerie MW, Sudhakar M, Mwanri L. Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: a systematic review and meta-analysis. PLoS One. 2017;12(3):e0173928. [Context Link]


6. Centers for Disease Control (CDC). Pneumocystis pneumonia-Los Angeles. MMWR Morb Mortal Wkly Rep. 1981;30(21):250-252.


7. Meyer C. Nursing and AIDS: a decade of caring. Am J Nurs. 1991;91(12):26-31. JSTOR. Accessed November 13, 2020.


8. Fox RC, Aiken LH, Messikomer CM. The culture of caring: AIDS and the nursing profession. Milbank Q. 1990;68(suppl 2):226-256. doi:.