HIV/AIDS Prevention 101: Tackling Tough Conversations

So you want to be a community health nurse?
HIV disease is a good place to start. Prevention education is the cornerstone of public health, and there are some easy tricks that will ensure success. So let’s take HIV as an example. The CDC recommends routine HIV screening at least once for EVERYONE ages 13-64. That means every nurse will at some point need to talk about HIV. It’s a disease with much progress and many remaining challenges. So how do we address stigma while at the same time respond accurately and confidently to questions about a complicated disease–one with no cure? The short answer is, you don’t have to be an expert. No one expects you to know how to explain the anatomy and functions of the HIV virus... BUT...there are a few really important concepts to nail down before striking up conversations around HIV and AIDS that teach us lessons about prevention education. Teaching should be accurate, relevant, and most of all–impactful! There is nothing worse than individuals at risk who don't know they are at risk! This is true for any disease that can be transmitted from person to person. In order to raise awareness and start difficult conversations, nurses must learn a little bit about many facets of a disease from its beginnings to current state. As primary, secondary, and tertiary prevention educators, we want to create a safe space for clients to talk openly, dispel myths, teach clients how to determine their risk, and encourage testing and early treatment. The goal: prevent disease transmission and help HIV positive clients stay healthy for as long as possible.

Tips for Teaching About HIV/AIDS

Dispel Myths
Infectious disease is particularly mythic in nature. Nurses will get a lot of questions from clients–especially adolescent clients and parents of pediatric clients about the origins of any disease. The classic question I hear from teens is “Did HIV come from humans having sex with monkeys?” HIV is believed to be a mutated form of a primate virus from just one species of chimpanzee. The virus entered the human population sometime in the early to mid-20th century. This transmission likely occurred when humans came into contact with blood from these animals. Sex had nothing to do with its origins. Knowing ‘the history’ may seem like a drag, but the truth is, HIV prevention AND treatment has come a long way, while other diseases like Zika are pretty new. Gaining perspective allows us to dispel myths and is very helpful when we teach clients about any epidemic.
Get Terms Right
HIV is the virus that causes AIDS. AIDS is a clinical diagnosis (now called HIV Stage III), and is only made when certain criteria are met–typically when a lab value (CD 4 count) is low enough or when an opportunistic infection meeting the definition of AIDS is diagnosed. Many people with HIV infection may never ‘get’ AIDS. It’s super important that nurses use the appropriate phrasing. Nurses must use non-biased terms pertaining to groups most affected by HIV, including men who have sex with men and those who share needles. A nurse may be counseling a male client with increased risk for HIV due to encounters with men, but who self-identifies as “straight”. Using the term “gay men” when counseling this client sends an inaccurate message. The same is true for clients at risk through sharing needles. Not everyone who shares needles is a “drug user”. Consider those who inject illegal steroids.
Provide Privacy and Maintain Confidentiality
Providing a private space helps clients to feel safe. Confidentiality is a major concern for clients and must be maintained and explained. Because HIV is a reportable disease in some states, and AIDS is always reportable, learning about the process in your state is important.
Be Blunt: Use Factual Terms About Transmission
Don’t say “body fluids”–be specific! Every disease is transmitted in very particular ways. Some we know about, some we don’t. For HIV, we KNOW that there are only 4 fluids that contain HIV and pose a risk for transmission.
4 Body Fluids That Transmit HIV
Breast milk
Vaginal fluid
When nurses are knowledgeable about evidence, clients get the most from prevention education and are able to reduce their risk. It’s OK to be direct when talking about transmission routes using terms the client chooses. When in doubt, ask permission to talk frankly. Keeping it client-centered is important. But nurses must clarify terms used to describe behaviors and fluids for example. Yes, this is where you will show your true nursing colors by using the term vagina instead of “lady bits”. Keep in mind, it’s OK for clients to use whatever terminology they want, in their own words–no need to correct them, but nurses should always try to use correct anatomical terms and clarify any lay terms while teaching. In fact, keeping it about the fluids and transmission is a great way to put clients at ease when talking about intimate subjects. In this way, the nurse and client are on the same page and misinformation is avoided.
Don’t Be Shy
It takes some practice, but clients feel less awkward discussing sexual behavior when you portray comfort with the subject. A good way to work out the kinks is to practice talking with a partner or friend. Some of this begins with knowing the facts so you can be prepared to answer anything–and with sexually transmitted diseases– I mean ANYTHING!
Open-ended Questions
Find out what the client already knows about HIV. I often start the conversation here because it allows the client to be the expert for a moment, shows interest, and encourages the client to share and the nurse to listen. It also allows the nurses to customize education to meet individual needs, correct misinformation, and avoid embarking on a preachy rant. (No one likes to be lectured.) Getting clients to talk about intimate life details is a challenging task and can be accomplished best with open-ended questions and good listening skills. If a nurse finds they are talking more than the client, this signals the nurse to format questions differently.
Know The Basics
What’s most important to clients is are they at increased risk, how to get tested, interpreting results, and what lies ahead–including how to prevent future infection and what HIV positive will mean. Public health changes rapidly and nurses should be aware of the latest advances. Learn about the different tests available–especially the tests a facility uses. Oral tests are available over the counter to allow people to test at home. It's important that clients understand the limitations of these tests, and which test are used to confirm infection. There are tests on saliva for those who are needle-phobic. Learn the difference between exposure and infection. Learn about PrEP and PEP–Pre-Exposure Prophylaxis and Post–Exposure Prophylaxis.
HIV Disease Classifications
Stage I Acute HIV Infection 2-4 weeks after exposure, may note symptoms: fever, malaise
Stage II Latent/Chronic HIV No symptoms
HIV Stage III AIDS diagnosis Opportunistic infections, low CD-4 count
Source: CDC ,
Learn more about testing on the CDC website–like who should get tested and how often. Last, learn about antiretroviral treatment (ART). Remember, nurses don’t have to be experts, but we should know enough to explain what living with HIV looks like today. Above all, be prepared to say,“I don’t know the answer to that, but I will find out.” This is true for anything in nursing and something we hear in school. It’s OK to say we don’t have all the answers. Clients really appreciate honest and sincere communication. Image Attribution: Wiki Commons: [File:Red ribbon, 2001 Wellcome L0030703.jpg|Red ribbon, 2001 Wellcome L0030703]]