Recently, I shared the first part of my conversation about HIV testing with Dr. Vincent Guilamo-Ramos, a member of the Presidential Advisory Council on HIV/AIDS (PACHA). At the beginning of this month, he started his new position as Dean of the Duke University School of Nursing. Today, I’m pleased to share the rest of my great June conversation with him, which explored two topics that have been central to his work: HIV among youth and the important roles that nurses play in HIV prevention, care, and treatment. The following highlights of our conversation have been lightly edited for length and clarity.
Kaye Hayes: Among your areas of expertise is working with adolescents at risk for and living with HIV. What opportunities do you see to expand access to HIV testing among youth at risk for HIV? What are some innovative approaches that could be implemented more broadly for and with this population?
Vincent Guilamo-Ramos: There is an urgent need to expand access to HIV testing for youth at risk for HIV. Undiagnosed HIV disproportionately affects youth. According to the latest data from CDC, 44% of youth living with HIV aged 13-24 are undiagnosed. That’s a substantially higher proportion than the 13% of all people living with HIV in the United States who are undiagnosed.
One opportunity to expand access to HIV testing among youth at risk for HIV is family-based HIV prevention programming. Parents are particularly well positioned to support their adolescent’s access to STI and HIV testing and adherence to prevention strategies such as correct and consistent condom use and PrEP.
Developmentally-appropriate services are also critical to expanding adolescent access to HIV testing. HIV treatment outcome data shows that adolescents are more likely to achieve HIV care goals within developmentally appropriate HIV care settings. My colleagues and I have proposed that an adolescent- and young adult-centered differentiated care framework adapted to the unique factors shaping engagement, adherence, and retention in HIV services among youth holds promise.
For racial and ethnic minority youth, such as Latino and Black youth, culturally appropriate HIV prevention or treatment services are equally important. Expanding the dissemination of and access to training and continuing education resources that equip providers with specific strategies to deliver culturally appropriate care is a necessary step in improving patient outcomes for youth who are at the greatest risk for falling behind in HIV prevention and care.
Beyond youth-friendly testing programs, HIV prevention and treatment interventions specifically designed for youth should also be developed, evaluated, and disseminated. In addition to the disproportionate impact of undiagnosed HIV on youth, young people ages 13-24 consistently have worse HIV prevention and treatment outcomes than people older than 25, including PrEP uptake, retention in care, and achieving and sustaining viral suppression. Our center, the Center for Latino Adolescent and Family Health, is in the final stages of developing a novel HIV stigma reduction intervention called NO FEARS (Nurturing Ourselves: Family Education and Activities to Reduce Stigma). This family-based intervention leverages animation as a developmentally and culturally appropriate mechanism to guide youth living with HIV and their families on how to support stigma reduction, particularly among Latino and Black gay and bisexual youth. The animated video series, in conjunction with a family workbook that leverages the role of parents, is designed to promote retention in HIV care and adherence to ART.
KH: Finally, you’re about to begin a new job as Dean of the Duke University School of Nursing. Congratulations! Nurses have been vital partners in the response to HIV since the beginning of the epidemic. What are some innovative and effective ways that nurses today are helping to provide HIV testing and connect patients to the HIV services needed based on their results?
VGR: Nurses have made invaluable contributions towards ending the HIV epidemic, since even before effective treatment was available. These contributions range from patient-centered service delivery within communities and clinics to advancing innovations in research and policy, as colleagues and I recently discussed in an article in The Lancet Infectious Diseases that includes an accompanying animated video and infographic.
Partly stemming from nurses’ holistic approach to health care grounded in an understanding of the social determinants of health, extant literature has found that many models of medical care led by advanced practice nurses achieve comparable or better outcomes relative to physician-led care and have the potential to reduce both cost and burdens on the health care system.
Many opportunities exist to leverage nurses, the largest and most trusted segment of the health care workforce, for HIV services. For example, specialized HIV training programs for nurses exist and should be expanded, particularly given shortages in the HIV specialty care workforce. Duke University’s School of Nursing offers an HIV Specialty for nurse practitioners (NPs) that equips the next cadre of NPs with the skills and knowledge to deliver primary care tailored to the psychosocial needs of people living with HIV.
There also exists a need for enhanced HIV leadership development in community-based organizations and coalitions, who have been monumental in advocating for people living with HIV as well as scaling up HIV testing and linkage to prevention and treatment services. The people advancing this work at the local, state, and national levels have the opportunity to increase their impact through strategic leadership training, contributing to a more effective and equitable HIV response inclusive of and driven by the voices of key populations affected by HIV.
For this purpose, the DILES (Tell Them) Institute (Instituto Latinx del Desarrollo Integral de Líderes Empoderados contra el SIDA) housed in the Duke University School of Nursing will develop a pipeline of Latinx leaders equipped to make high-impact contributions towards ending the HIV epidemic. A primary focus of the Institute is developing a nationwide network of HIV leaders equipped with technical knowledge in the HIV treatment continuum and epidemiology, in addition to management and adaptive leadership skills.
KH: Vincent, thank you for sharing these ideas. You’ve highlighted some important issues and promising approaches to address them as well as underscored the vital roles of nurses in our nation’s work to end the HIV epidemic.
VGR: My pleasure. I hope that they be useful and inspiring to some readers engaged in this important work to end the HIV epidemic in their communities.