1. Kennedy, Maureen Shawn MA, RN,


Gains will be short-lived if health care providers don't continue efforts.


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Many of you are probably wondering what comic book characters are doing on the cover of AJN. I imagine we might also receive some disapproving letters. Rest assured, we chose the cover with good reason.


With its cast of boldly colored superheroes, the cover is startling. Robert Walker, a talented illustrator who uses comics to advocate HIV and AIDS awareness, graciously allowed us to use his artwork to help call attention to this continuing epidemic in the United States. (For more on Walker's work, see On the Cover.) According to the most recent estimates from the Centers for Disease Control and Prevention (CDC), approximately 1.1 million adults and adolescents in the United States were living with diagnosed or undiagnosed HIV infection at the end of 2006, including 56,300 with new infections.


In 1975, while attending graduate school, I worked part time as a chemotherapy nurse for a hematologist-oncologist in New York City. Because of his expertise, he was increasingly being asked to consult on cases involving seemingly healthy young men, most of them gay, who were contracting infections and showing blood profiles usually only seen in patients with immune systems weakened by disease or chemotherapy. I didn't realize it then, but we were seeing the first cases of AIDS. It wasn't until six years later, when reports of Pneumocystis carinii pneumonia, thrush, and Kaposi's sarcoma began appearing in this population, that the CDC realized we were facing something new, virulent, and deadly.


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Since then great strides in HIV prevention and treatment have been made, as articles in this issue attest to. In Every Nurse Is an HIV Nurse, Lucy Bradley-Springer and colleagues point out that, largely because of the success of antiretroviral drugs (ARVs), AIDS need not be a death sentence; many people with HIV are living longer. In Aging with HIV: Clinical Considerations for an Emerging Population, David E. Vance discusses how HIV infection and the aging process might interact and addresses some common concerns. (It must be noted that AIDS continues to kill quickly in countries where people have limited or no access to ARVs. UNAIDS, the Joint United Nations Programme on HIV/AIDS, reported that in 2007, for example, only 30% of the seven million people in sub-Saharan Africa who needed ARVs received them.)


Yet AIDS awareness in this country seems to have diminished-in fact, for some, it hardly seems a concern at all. A recent CDC report on risk behavior in adolescents found that during 2007, 39% of sexually active high school students "had not used a condom during last sexual intercourse." In its 2009 Survey of Americans on HIV/AIDS, the Kaiser Family Foundation notes that "[a]t a time when CDC reports new infections have not declined in at least a decade, and in fact the situation is worse than previously thought, it is notable that personal concern is decreasing." And last August Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, was quoted as saying, "It's imperative that we confront a serious threat to the health of our nation. And that threat is complacency. . . . The fact is that, right here in the United States, every 9? minutes someone's mother, someone's daughter, someone's son, someone's father, or friend, becomes infected with HIV."


As the largest group of health care professionals, nurses are the ones most likely to serve as a primary source of information for the public at large, as well as our neighbors and families. Wherever we work-hospitals, community clinics, schools, even assisted living and senior centers-we're in the best position to raise awareness about the ongoing need for HIV prevention. Be proactive. Don't let people forget: there's an epidemic, and it isn't over yet.