San Francisco Chronicle - (Sunday)
Resilience: The San Francisco Model
Thirty years have passed since San Francisco hosted the 6th International AIDS Conference (AIDS 1990). At the time, AIDS was well on its way to becoming the main cause of death for Americans aged 25 to 44, with San Francisco seen as an epicenter. By 1995, the city had the highest percentage of people infected with HIV in the U.S., and by far, most were gay or bisexual men.
The story of the three decades that have passed is one of resilience — with frontline health care workers leading the way. This year, 2020, marks the International Year of Nurses, an opportunity for the HIV community to reflect on their contribution to the ongoing work of ending AIDS.
As the world’s largest health workforce, nurses have long played a unique and critical role in the HIV response. Since the earliest days of the epidemic nurses have provided the skills and care required for those living with HIV in the U.S. and around the world. Case in point: what became known as the “San Francisco Model” evolved out of wards 86 and 5b of San Francisco General Hospital where some of the first HIV patients were treated.
The model was nurseled and avoided the traditional physicianovernurse hierarchy, taking the radical approach of treating patients as human beings. Working in tandem with social workers, nutritionists, psychiatrists, addiction and other specialists, these pioneering providers took an interdisciplinary approach that continues to inform HIV care today. At a time when HIV — and the populations who were affected most by the virus — were deeply stigmatized, nurses played an integral role in tailoring care to patients’ diverse and specific needs.
As the epidemic has changed, the role of nurses has expanded to cover the complete continuum of care that those living with HIV need to navigate and helped shape and deliver the evolving response. This is true outside the U.S. as well. In subSaharan Africa, often faced with a scarcity of physicians, nurses are the linchpin for health care providing not only HIV diagnosis and treatment, but also counseling, encouraging testing and playing a community leadership role.
Yet despite being the largest workforce delivering the HIV response, nurses are too often absent from the policymaking table and underrepresented on decision making bodies. Nurses face a range of challenges — from inadequate investment in training to restrictive licensing and other obstacles preventing them from offering their patients the full extent of their competencies. What’s more, female nurses are less likely to progress and reach levels of autonomy required for policymaking involvement in countries where gender inequality is endemic with hierarchical health systems dominated by male doctors.
With the 23rd International AIDS Conference (AIDS 2020: Virtual) fast approaching, the global community has the opportunity to shine a spotlight on these challenges — and to dismantle them. The HIV response requires deeper investments in nursing worldwide from increased staffing and training to ensuring fair working conditions to tackling policy barriers.
Though we have made incredible progress and changed the face of the epidemic, the need for resilience has not changed.