This issue of JANAC was curated to coincide with the 24th International AIDS Conference occurring in Montreal (Canada). As the international conference convenes, it is critical that we pause and reflect on the fact that the HIV pandemic is now in its fifth decade. Over the last 41 years, UNAIDS estimates that 79.3 million people have been infected with HIV, of which 36.3 million have died from AIDS-related illnesses. In 2020, 37.7 million people were living with HIV around the globe (UNAIDS, n.d.).

Although great strides have been made regarding access to antiretroviral therapy since the 2000 International AIDS Conference in Durban, South Africa, we still have much work to do, with only 84% of people with HIV knowing their status, 73% accessing treatment, and 66% being virally suppressed in 2020 (UNAIDS, n.d.). Current epidemiologic evidence in key populations also highlights the critical prevention work that needs to happen in collaboration with these populations. Alarmingly, current epidemiologic evidence indicates that the risk of acquiring HIV is:

• thirty-five times higher in people who inject drugs, • thirty-four times higher for transgender women, • twenty-six times higher for sex workers, and • twenty-five times higher among gay men and other men who have sex with men (UNAIDS, n.d.).

The burden of HIV among adolescents and women is also astounding. In sub-Saharan Africa, six of seven new infections are among adolescent girls between the ages of 15 and 19 years. Globally, 5,000 new HIV infections occur weekly in young women between ages of 15 and 24 years — 4,200 of these new infections are in sub-Saharan Africa (UNAIDS, n.d.).

Alongside the HIV pandemic, we also have the TB and COVID-19 pandemics. Persons with HIV are 18 times more likely to get TB, and TB is the main cause of death among persons with HIV globally (UNAIDS, 2022). Regarding COVID-19, we also know that persons with HIV experience more severe outcomes than people not living with HIV (UNAIDS, n.d.).

As the epidemiologic evidence highlighted above indicates, we have a significant need for innovative models of prevention and scaled up interventions to reduce the burden of HIV in key populations. As the nearly 38 million people with HIV around the globe age with HIV, we need innovative models of care and interventions to promote quality of life, emotional health and well-being, and prevent and manage non-communicable diseases. Issues of health equity and the social determinants of health are significant drivers of poor outcomes related to HIV prevention, care, and treatment. These two factors—health equity and the social determinants of health—combined with a focus on population and community health, prevention and health promotion, and systems and models of care are the “five complementary and synergistic research lenses that best leverage the strengths of nursing research,” as described in the recently released 2022–2026 strategic plan of the National Institute of Nursing Research (NINR) at the National Institutes of Health in the United States (National Institute of Nursing Research, n.d., paragraph 5).

Nursing Models of Care and Nurse-Led Interventions

As the largest cadre of health workers around the globe, nurses have been and remain at the forefront of HIV and TB prevention, care, and treatment. Additionally, scientists are also exploring innovative nursing models of care and nurse-led interventions to address some of the most challenging issues associated with HIV and TB.

Jason Farley, past-president of the Association of Nurses in AIDS Care and Professor of Nursing and Director of The Center for Infectious Disease and Nursing Innovation at Johns Hopkins University School of Nursing (USA), leads a cluster randomized trial testing a tailored nurse case management intervention for persons with drug-resistant TB and HIV co-infection in South Africa. He is also collaborating on a SMART trial evaluating an adaptive nurse-led HIV treatment and retention intervention for female sex workers with HIV, also in South Africa.

Patrick O'Byrne, nurse scientist and Canada Research Chair in Public Health & HIV Prevention at the University of Ottawa Faculty of Nursing (Canada), has been at the forefront of building the body of evidence demonstrating the effectiveness of nurse-led PrEP (O'Byrne et al., 2021; O'Byrne et al., 2019).

Allison Webel, a nurse scientist and Professor of Nursing at the University of Washington School of Nursing (USA), and her team are testing the efficacy of a nurse-led, multicomponent intervention to improve the control of hypertension and hyperlipidemia among persons with HIV. The EXTRA-CVD Study consists of four evidence-based components—nurse-led care coordination, nurse-managed medication protocols and adherence support, home blood pressure monitoring, and electronic medical records support tools (Okeke et al., 2019).

Brandon Knettel, a clinical psychologist and member of the nursing faculty at the Duke University School of Nursing (USA), recognizes the significance of mental health on HIV treatment outcomes. As such, his research is exploring how a nurse screening and referral protocol can be implemented in limited resource settings to address suicidal risk among persons with HIV (Knettel, n.d.). A nurse scientist also committed to mental health and well-being is Crystal Chapman-Lambert from the University of Alabama at Birmingham (USA). Her research examines stressful life events, retention in care, and adherence using mindfulness as an intervention modality (Chapman-Lambert, n.d.).

In a rigorously designed clinical trial in the Netherlands, the Adherence Improving self-Management Strategy (AIMS) intervention, a nurse-delivered intervention, was identified to be acceptable to participants and feasible to deliver in routine care (de Bruin et al., 2017). The clinical outcomes of the AIMS intervention yielded a reduction in viral load, increased quality-adjusted life-years, saved resources, and has reproducible effects on medication adherence. Implementation of AIMS in routine clinical HIV care is therefore recommended.

As the fifth decade of the HIV epidemic unfolds, I am confident that my nursing colleagues around the world and other scientists will continue to develop innovative nursing models of care and nurse-led interventions like those described above. After all, as the largest cadre of health workers globally and the most trusted profession in the United States for 20 consecutive years (Gaines, 2022), it makes perfect sense that nurses, nursing models of care, and nurse-led interventions are key to ending the epidemic and supporting the nearly 38 million persons with HIV in living long and meaningful lives.

Disclosures

The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.

Author Contributions

Michael V. Relf was involved with the conceptualization, writing the original draft, and review and editing.

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