Jonah Pierce

In the late 1980s, during a personal break from my nursing career, I worked in a rehabilitation program for people with severe, persistent mental illness. This role helped me develop the skills I would later need to care for patients with HIV, many of whom are marginalized and struggle with mental health issues. During this time, I stayed abreast of the ongoing HIV epidemic and led the AIDS ministry team at a church I was attending. When I was ready to reenter the nursing workforce, I asked to be on a unit that provided care for people with HIV and AIDS. I knew I wanted to provide high-quality, compassionate care to this community. When an opening came up at an infectious diseases clinic, I took it.

What we do. HIV nurses provide long-term acute care and preventative treatment and services to patients living with HIV and to at-risk individuals. For me, the most important thing we do is provide welcoming, nonjudgmental trauma-informed care to patients who are often traumatized by the stigma that comes with an HIV diagnosis. Daily tasks may include providing telephone support, arranging lab work, administering medications, and education outreach. At my clinic, where I work as an HIV patient care coordinator, we provide care and medical case management to more than 2,000 patients, many of whom have complex needs and challenges.

Progress in the field. Outcomes have changed drastically since I started in HIV nursing. We now have simple, once-daily oral treatments with minimal adverse effects that allow people with HIV to live long, healthy lives. If taken correctly, these treatments can lower the amount of HIV in a patient's bloodstream to undetectable levels, meaning they can't transmit the virus to others. And recently, a long-acting injectable formulation became available in which two shots are given every two months to achieve and maintain an undetectable viral load. HIV prevention has also greatly improved with the advent of preexposure prophylaxis (PrEP).

Challenges. The biggest challenge the HIV community faces, especially in the South, is the stigma associated with this disease. Barriers to engagement in care at my clinic include food insecurity, multigenerational poverty, unstable housing, and mental health challenges. For patients with food insecurity, we provide a referral to the local food bank, but that's just a temporary fix. Many of my patients live in rural areas, far from the clinic and needed resources. Some days I feel like I'm playing Whack-a-Mole, trying to find solutions that fit my patients' lives. I try to hold a space for them and not judge them—to meet them where they are.

With PrEP available, no one today should be newly infected with HIV. But because of lack of knowledge of and access to PrEP and the stigma and isolation still experienced by patients, particularly young gay men of color in the rural South, patients still come into my clinic who are newly diagnosed with HIV. As a member of the LGBTQ+ community, this disturbs me because it means information on PrEP is not getting to the people who need it most.

Career opportunities. The HIV/AIDS Nursing Certification Board offers several certifications in the field of HIV nursing, including HIV/AIDS Certified LPN/LVN, HIV/AIDS Certified Registered Nurse (ACRN), and Advanced HIV/AIDS Certified Registered Nurse. I am proud to be a board-certified ACRN because it signals that I have achieved a level of knowledge in the field. I try and stay up to date on everything related to HIV, so I can translate that information for my patients.

Connecting with colleagues. I am a member of the Association of Nurses in AIDS Care (ANAC; www.nursesinaidscare.org), where I am on the national board of directors and involved in the policy and advocacy committee. The association offers professional development opportunities, resources, job opportunities, and more. Membership also offers camaraderie. My spirit and sense of purpose are encouraged and refreshed through the connections and shared understanding I have with other members. Through our annual conference, Facebook pages, and other communications, nurses can connect with fellow ANAC members who work in HIV and know what it's like to face these challenges and keep moving forward.