Nowhere in the world has the AIDS/HIV pandemic cut a greater swath of devastation than in sub-Saharan Africa, where two-thirds of all people infected with the virus reside. As Barbara Smith, PhD, RN, FAAN, discovered firsthand, no segment of society there has been left unscathed.
Two years ago, the School of Nursing's Associate Dean of Research was making the rounds in a Nigerian hospital when she met a 7-year-old girl. The young patient, suffering from HIV/AIDS, was failing second- line therapy and facing near-certain death. That didn't come as a surprise to Smith. What did give her pause was that the girl's father, a physician, and her mother, a nurse, had both succumbed to AIDS.
That incident lent an increased sense of urgency to Smith's HIV/AIDS research in Africa, which aims to prevent the occupational transmission of HIV in nurses and other health care professionals. In the eight years that Smith has been pursuing HIV/AIDS research efforts and relief in Africa, she has witnessed progress in some areas. But in others, serious impediments—like the pervasive stigma associated with HIV/AIDS—persist.
Back in 2002, Smith was first invited to travel to Zambia as part of an AIDS research endeavor with the University of Alabama at Birmingham's Center for Infectious Disease Research. Given the widespread presence of AIDS there, the scientists knew they would need to narrow their research focus. They chose to concentrate on the risk of occupational transmission of HIV in midwives, nurses, and other health professionals.
Though the concept was sound, a lack of resources prevented the project from being funded.
At the time, antiretroviral medications were not widely available to patients in sub-Saharan Africa. Therefore, Smith and her research counterpart in Zambia, Margaret Maimbolwa, felt it would be unethical to advocate for HIV testing among the nurses they planned to study. Ironically, the proposed study was denied funding, at least in part, because it failed to include HIV testing of subjects.
Today, Zambians with HIV/AIDS have far greater access to antiretrovirals. But many continue to go without—even those who understand the medicines' benefits. "We have a lot of nurses and other health care workers who become infected and are not treated until late stage. They're afraid of being 'found out,'" Smith says.
While it's impossible for an outsider to stamp out the stigma associated with HIV/AIDS in Africa, Smith has found a way to effectively convey the education piece of the puzzle. Working directly with native nurse educators in Africa, she educates them on early intervention and prevention strategies, such as making sure they don protective apparel like gloves, gowns, and masks. They, in turn, share that knowledge with other nurses.
"There aren't enough physicians in Africa to care for people with HIV/AIDS. The sooner people begin to realize that they are going to have to count on nurses to deliver care, especially in some of the more remote areas, I anticipate [the region] will do quite well," Smith says.
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