2020 FNA Book Of Reports

2020 Florida Nurses Association
with the exception of infectious disease specialties or those involved directly with HIV care, remain unaware
of the threat still posed by HIV. Despite the societal changes in those with HIV, it remains a disease with
much stigma and those who are diagnosed experience depression at twice the rate of those who are not
infected (National Institute of Mental Health, 2017). Research has shown that adolescents and young adults
are impacted at a higher rate by the psychological stressors of living with a chronic disease and face more
isolation and suffer more long term negative social effects (Close, 2010).
Nursing Role / Function
A 2015 systematic review by LeBlanc et al., exploring nurse directed HIV screening supported the relevance
and need for this nurse-based intervention noting that there was an increased rate and acceptance of
testing initiated by nurses compared to other health professionals. It is imperative that our profession leads
the healthcare profession in raising awareness and increasing testing as a critical aspect in controlling this
epidemic. However, it will require all healthcare providers to fully engage in identification of new infections,
preventive care and a less stigmatized approach to testing in order to make a meaningful impact on the
prevention and treatment of this disease.
Legal / Ethical Considerations
The state of Florida remains the number one state in the country for new HIV infections with the highest rates
in the Miami-Dade and Orlando m (Florida Department of Health, 2019). Florida Statute 384.30 allows minors
to consent to be tested and treated for STIs and HIV without parental consent (Florida Senate, 2019). The
law also prohibits a provider from informing a parent. An important tool in the prevention of HIV has come in
the form of pre-exposure prophylaxis (PrEP). Prevention of HIV, through the use of PrEP is trickier in that HIV
prevention, unlike pregnancy prevention is not viewed from the same legal perspective of parental consent and
therefore some practitioners may be reluctant to prescribe PrEP without parental consent. Also complicating
PrEP usage is the need for serial lab monitoring of kidney function. So, while the state of Florida has, in most
cases, been able to provide PrEP free of charge, a pathway for free or low-cost labs has not been established.
Fear of disclosure by means of private insurance explanation of benefits sent to a parent is yet another barrier
to the prevention of HIV.
Consequences to Patient Care
A significant hurdle to adequate HIV preventive measures is the cost factor for our healthcare system.
Currently less than five percent of total health care spending is directed towards public health and prevention.
There is considerable economic value in HIV prevention when compared to the high cost of treatment which
is estimated to cost over 300,000 dollars over the lifetime of someone infected at age 35. For the individual
remaining uninfected, but at risk, the cost of lifetime treatment is less than 100,000 dollars (Schackman,
2015). Ultimately delays in diagnosis lead to sicker patients with lower CD4 Counts and AIDS defining illnesses
which complicate overall quality of life and increase the financial burdens of treatment. Undiagnosed and
untreated patients also increase the likelihood of transmission of the virus to others.
Statement of Position
The Florida Nurses Association supports the widespread, nurse driven, routine testing of HIV in all types
of healthcare encounters, especially among adolescents and young adults. Further, the Florida Nurses
Association supports increased awareness and education among registered nurses regarding HIV including
testing, diagnosis, prevention and scope of the problem. Additionally, the Florida Nurses Association supports
legislative efforts aimed to promote the reduction and elimination of the transmission of the HIV virus.
Recommendations for Action
• The Florida Nurses Association supports a public policy of widespread and routine testing, according to the
CDC guideline, of all persons aged 13 to 64 in all healthcare settings but especially in urgent care centers,
emergency rooms, school-based health clinics, and primary care offices.
• The Florida Nurses Association will direct their lobbying firm to meet with Florida legislators to encourage
legislation aimed at improving access to free testing and preventive measures such as pre exposure
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