1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

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You're the only nurse on the night shift. Most of your patients are acutely ill or dying of AIDS and should be in an ICU, but there are too few nurses and too many patients for that kind of care. Your caseload for the night is 60 patients.


An unthinkable nightmare for most U.S. nurses, this scenario is routine for nurses in a Malawi hospital, says Stephen Lewis, the United Nations secretary general's special envoy on HIV and AIDS in Africa and the 2005 recipient of the International Council of Nurses (ICN) Health and Human Rights Award. In his address to the 23rd Quadrennial Congress of the ICN in May, Lewis painted a devastating picture of the effects of HIV on people in countries such as Malawi that can afford neither antiretrovirals nor the salaries needed to retain nurses lured by higher wages in other nations.


My complacency about the HIV pandemic was shattered at the ICN congress, where the issue of HIV was passionately discussed. The statistics are startling: there are 25.4 million HIV-infected people in sub-Saharan Africa, 55% of whom are women. In a press conference at the congress, Lewis noted the importance of building greater access to antiretroviral medications through public and private partnerships. President Bush's Emergency Plan for AIDS Relief is helping to make antiretrovirals available with the provision of $15 billion over five years for global AIDS treatment; the Clinton Foundation has negotiated with international companies that make generic antiretrovirals to provide these drugs at $139 per person per year. But countries like ours that have promised funding must deliver the aid they've promised and increase their pledges.


Lewis argued that providing treatment can actually help prevent HIV transmission-in several ways. First, treatment requires HIV testing and counseling, both of which raise awareness of HIV and its modes of transmission. Second, treatment reduces the stigma of HIV infection in African and Asian countries. People there want treatment and will be more open about their HIV status if it means getting access to life-saving drugs. And third, treatment decreases the viral load to undetectable levels, reducing the likelihood of HIV transmission.

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When the availability of antiretrovirals is limited, governments set priorities for who will be treated. According to Lewis, nurses must be a priority. He reported that there has been an alarming increase in the percentage of Zambian nurses who have AIDS. He noted that in one Zambian hospital, 18 out of 30 nurses died in one year from AIDS. They have not been replaced. Lewis challenged nurses worldwide to be vocal leaders in calling for free drug treatment for all infected with HIV.


Outgoing ICN president Christine Hancock told congress attendees about the visits she and ICN staff members made to sub-Saharan Africa during her presidency, where they met the children of nurses who had died of AIDS. She announced that the ICN and the Florence Nightingale International Foundation have started the Girl Child Education Fund for the daughters (between five and 18 years of age) of nurses who have died of AIDS ( The greatest predictor of family health is the education of the mother-not the father-but girls are the last considered for education in many African cultures. Hancock reported that an average of $200 per year is required for a girl in a developing nation to attend school, an unreachable sum for most African AIDS orphans and their extended families.


There is more that we can do about the HIV pandemic. At a minimum, we can accept Lewis's challenge to be vocal about the need for greater access worldwide to antiretrovirals and to support both the Bush and Clinton initiatives. And every reader of this page can make a donation, of any size, to the Girl Child Education Fund and encourage other nurses, nursing organizations, friends, and family to do the same.