By Lauren Coelli.

Refugees from DRC

Client Experiences -

Torture and trauma

Many women have been exposed to HIV through rape and may have witnessed the murder or rape of family members.  Many have fled without their children to safety or experienced the trauma of their children being kidnapped.  

Attitudes to HIV

Highly anxious about the diagnosis, fear of death, fear of transmission, fear of disclosure, discrimination, worry of children's futures and difficulty understanding the need for monitoring and management processes.

Living with HIV-

Confidentiality

Anxiety about attending for monitoring and medication especially if other people from their community or culture are also there.  Distrust of phone interpreters.

Pregnancy

Bottle feeding identifies the mother as having HIV.  Fear of disclosure during pregnancy, anxiety about family and case workers finding out during the monitoring processes.  Baby requiring ART and repeated blood tests being potentially identifying.

Strategies

Build trust and rapport, use a flexible walk-in model and spend time upskilling clinical staff.  Work arounds to avoid identifying HIV status - use of immunocompromised on medical files to reduce risk of disclosure. 

Education needs to include health professional, community, WLWHA and the Men from DRC.

Dr Roanna Lobo

There has been significant progress towards the virtual elimination of new HIV transmissions in Australia by 2020.  This is evident by collaboration and community partnerships, combination of prevention strategies such as PrEP, PeP and TasP and the quality of life focus for PLHIV.  

Despite this there are still many challenges with late diagnoses and undiagnosed rates higher in Aboriginal peoples, heterosexuals, SE Asian populations, CaLD communities and other regional communities.  There is both a moral and human rights approach to leave no-one behind.

How can this be achieved -

• Equitable access to new HIV testing, harm reduction services and biomedical intervention for groups at highest risk
• Reduce barriers to accessing treatment and care
• Increase health literacy
• Meaningful involvement with affected communities
• Shared care models
• Improved data and surveillance, research and evaluation
• Continued investment and partnerships

Innovative Models of Nursing Care and the Role of Advance Nursing Practice

Congratuations to all presenters on these inspiring sessions. The diversity demonstrated in these different models of care showed the adaption of nursing into various work settings.  

Leah showed us how being innovative in the way things are done can not only continue to achieve positive outcomes for clients living with HIV but also achieved the desired activity performance markers required by health departments.

Elizabeth reminded us that nurses are the linchpin in the treatment cascade encouraging us to act with a focus on justice, politics and collaborative leadership.

Danielle encouraged us to use creative thinking in our clinical delivery, to analyse the gaps, engage local partners and the local community and have a well defined scope of practice with appropriate governance.  

Joanne showed us how peer educators and community screens have achieved some substantial outcomes in the management of STI's in the Cape York.

Penny works across several jurisdictions to provided comprehensive SRH care to diverse communities in North Queensland. 

Bridget demonstrated the diverse role that nurses play in models of care to individuals with Hepatitis C from community settings, nurse led clinics to community care.

Karen has shown that even with a successful model of care for HIV positive pregnant women, consideration to adaptions in service delivery needs to be factored.  This has been successfully achieved by providing education to rural areas with supporting materials, sharing of CPG'S and shared cared models.

HIV Dried Blood Spot test:  Internet based self-sampling increased access to HIV testing

Anna McNulty

The HIV dried blood spot test is available for individuals living in NSW who are over the age of 16 yrs.  It provides another option for individuals to access HIV testing.  This test is provided free (health dollar cost $12) it is designed to be mailed out, with full instructions in the kit, it is performed in the individuals own time and posted back.  The average turn around time of returning a sample was 18 days.  Test results were given by text if negative and a phone call if positive. At this time it has resulted in 2 positive results that may not otherwise have been diagnosed. This provides a great option to those that face barriers to screening and has been used by some individuals as a means of ongoing screening.  It demonstrates the convenience of testing, the ability to remain anonymous and resulted in the screening of a diverse group of individuals.

https://www.hivtest.health.nsw.gov.au/The-Test

Started in Cairns in 2014-

Prominently young indigenous males, facing social challenges consistng of poor housing situations, employment issues, drug and alcohol use, high mobility and low health literacy.  MSM and sporadic IDU use.  Coinfection with STI's especially syphilis.

Challenges -

Low levels of testing occurring in this group, with individuals not identifying as being at risk, low health literacy and lack of knowledge of HIV.  Knowledge of TasP poor and known sporadic engagement with health services and treatment compliance issues.  Stigma, shame, cultural factors and lack of trust are contributing to challenges in culturally appropriate contact tracing.

The way forward-

Urgent culturally appropriate health promotion activities, increasing point of care testing, access to condoms,TasP, PrEP, NSP's.  Treatment and support needs to be individualised using a multidisciplinary outreach approach.

Integrated service provision is essential in the delivery of consumer-centred care that is accessible, acceptable and affordable.  Through ongoing engagement with the key populations in the community, services can be mapped to ensure that there is ongoing assessment of marginalised communities in particular those living with HIV, multiple co-morbidities and poor social situations.  Access doesn't always equate to acceptable services it therefore is essential to consider what the community identifies they need and considers safe.  Signalling safety is best achieved with a broad approach through the multiple social layers.  Partner organisations play a pivotal role in extending access to prevention strategies aimed at improved consumer outcomes.  This holistic address of multiple needs can only be achieved through enabling service principles that are integrated and promote, equitable, affordable, acceptable services to exist within the communities most in need.