Chapters Transcript Video Challenges to HIV Care in a Pandemic: How Black Nurses Can Rise for Those at Risk Challenges to HIV Care in a Pandemic: How Black Nurses Can Rise for Those at RiskOriginally Broadcast: Thursday, June 17 7:00 PM - 8:00 PM ET Hello everyone. Happy thursday, thank you for joining today. I'm very excited to meet all of you. My name is pregnant, Colin. I'm a senior manager at Gilead Sciences on behalf of Gilead, I would like to welcome all of you to our webinar in partnership with National Black nurses Association. Today's program will address the challenges faced by people at risk of HIV or living with HIV as they seek care in the context of ongoing COVID-19 pandemic. This program will also discuss the impact of the challenges from the perspective of nurses who care for them and highlight strategies that nurses can implement to strengthen their resilience. This is the first of a two part series with the second webinar being held in august during the 49th in Vienna Annual Institute and conference. We really look forward to seeing you all again on august 6:12:30 p.m. Eastern Time To briefly go over the agenda for the rest of the hour we have a 15 minute slide presentation Followed by a 20 minute panel discussion and at the end of 15 minute audience Q&A. The presentation will be given by dr Brigitte Brauner and it is titled Us How black nurses can rise for those at risk. The panel discussion will be led by dr Bronner with Panelist Dr sheep, Sheldon Fields and Dr tomorrow Rodney. They will explore the HIV care strategies during the pandemic and the disproportionate impact of the disrupted health services and the pandemic on people who are at risk of HIV and people living with HIV and more importantly, the impact on the black nurses. After the presentation. As I said, we'll have a Q and a session, but at any point during the program, please feel free to submit your question by clicking the button below. But that said, I would like to take a moment to introduce dr braun. Oh uh today's program will be moderated by dr Brigitte Bronner, who will give the presentation and also lead the panel discussion. She is an associate professor of nursing at the University of Pennsylvania School of Nursing and a senior fellow at the Center for Public Health Initiatives and at the Leonard Davis Institute of Health Economics. Dr Bronner is also the chair of the National Advisory committee for the American Nurses Association and the substance abuse and Mental Health Service Administration Minority Scholarship Program. She is a psychiatric mental health advanced practice nurse, focusing much of her research on how living conditions of disadvantaged people negatively impact their health and how short term interventions like planting a community garden can build stronger community ties and support healthy behaviors. DR Bronner collaborates with many other institutions and teachers several interdisciplinary courses. She has received the 2011 Award for Teaching Excellence from Penn Nursing's Family and Community Health Department. Also recently, she received the diversity and Equity Award of the International society of psychiatric mental health nurses. So with that I would like to hand the stage or what did dr Bronner? Thank you. Oh, thank you for that introduction. I am so excited to be here tonight and I look forward to having a dynamic discussion with my two esteemed colleagues. Dr Sheldon Field is the associate dean for Equity Inclusion, as well as a research professor at the Penn State College of Nursing, and he is the first vice president of the National Black Nurses Association and D. N. A. He's an advanced HIV AIDS Board certified registered nurse and is well known for his contribution to behavioral health research in HIV prevention. Dr Tamara Rodney is an assistant professor at the JOHns Hopkins University School of Nursing, as well as a psychiatric mental health nurse practitioner at the Day Springs Treatment Program. Her areas of expertise include PTSD and traumatic brain injury. So let's delve into tonight's presentation. We know the nurses represent about 50% of the global workforce and we are a pivotal to the efforts to help end the HIV epidemic by helping people with testing treatment and prevention. And this is why nurses all over the world have moved to the forefront of global efforts to help achieve the 90, 90 90 treatment for all goals. And since the announcement of these targets by the Joint United Nations Programme on HIV AIDS, the association of nurses and aides care has underscored many ways in which nurses can lead. Uh Anak has developed several policies including areas such as ensuring that patients rights to equitable and accessible health care. Is there providing care along the full spectrum of HIV services and committing to inter professional collaboration? We, as nurses, remain at the front line of service. We have demonstrated incredible courage, selflessness as well as stoicism in these unprecedented times. And what I love when I think about those of us who are involved in HIV. We're applying the lessons that we learned during the early days of the HIV AIDS epidemic, To our response to COVID-19 Yeah, As we think about the COVID-19 pandemic, however, it has absolutely caused disruptions in our health care system and we're seeing this with impacts on both patients and providers. When we think about our status neutral HIV care continuum, we have stigma and other social determinants of health such as racism, transphobia, homelessness, marginalisation, all of these things can influence people's movement and progress along the continuum even before an HIV diagnosis is made. And as we think about testing being the entry point, right, And when we look at that status neutral HIV care continuum as a whole. What that continuum does is outlined the stages that people living with HIV are going through or those who are at risk for HIV um to be able to reduce their risk of transmission as well as acquisition. But for both positive and negative individuals, HIV status is only one aspect or one element of their health. And so with that said, we need comprehensive behavioral as well as biomedical risk reduction strategies to prevent HIV treatment. I'm sorry to prevent HIV as well as to provide treatment for people who are living with HIV. And we need to do that in a way where they are engaged in care. And the steps along the continuum look somewhat similar for people who are at risk as well as those who are diagnosed. But for those who are living with HIV, we really want to emphasize that sustained engagement and care is going to be important for them to achieve and maintain their health. Whereas with HIV negative individuals, um, there may not be that acclimation or there may not be that sense of understanding of the importance of sustained engagement. And so we as nurses really want to make sure that we're doing what we can to make sure that individuals are informed not only about their status, but also what they could do to reduce their risk for HIV. Yeah. COVID 19. However, as this virus has just wreaked havoc on our international community, has significantly impacted people at risk for as well as those living with HIV. And that's coming into play due to the restrictions uh, that people are seeing in testing care and treatment access. And we know that some of the public health measures that have been beneficial in controlling the spread of SARS Kobe to which is the virus that causes covid 19. Um Those restrictions have been helpful in minimizing covid 19 progression, but they have also created limited access to routine non emergent care. In fact, we have research that has shown that telehealth is accessible for those who could benefit from it. However, we know that about 30% of adults with the household income below $30,000 a year, do not own a smartphone. So that's where we start seeing inequities in technology, further perpetuating the inequities that we already see in health. From March of 2020, from March 13 through April 13. There was a 45% reduction in testing when compared to that same time period in 2019. And by June testing volumes have recovered somewhat as the health care system and the rest of the society started to open back up. However, testing volumes were still off by 8% in 2020 when compared with 2019. Another study found that there was about a 26% decline in office visits for people who were living with HIV and a 50% decline in HIV viral load testing in the first six months of 2020. Uh there was an additional study that found people who were living with HIV were 2.1 times more likely to be hospitalized for COVID-19 than people who were not immuno suppressed or immuno compromised. And when we think about that right initially, it makes sense because you will see increased hospitalization risk as a result of those co morbidity. So being immuno suppressed. Um but there's also an association with like a history of cardiopulmonary disease, renal disease where you have an increased risk of hospitalization because of those in particular. However, we still don't have enough data. So it's unclear whether people who are living with HIV have a higher risk of developing severe covid 19. Yeah. Yes. Another thing that we've seen during the pandemic is this convergence of racism, health inequities in COVID-19. And what we're finding is that these factors have merely exasperated issues that were related to HIV access and care Prior to the pandemic coming along. And that was one of the things that I kept saying. Um as COVID-19 began to become more of an international issue was that it was going to use the same playbook that HIV use right that are most marginalized disenfranchised under resourced communities would be the ones most heavily impacted and affected by the pandemic. And now when we have our patients, our population who is at the crossroads of being not only in the pandemic but also being at risk for are living with HIV. We're seeing the convergence of these three factors even more in the U. S. A decrease in new HIV diagnosis overall has been observed and that is great. It's wonderful. It's due to a lot of the progress that we've made in research and practice and education and policy. Right? However when we delve deeper into the numbers we see that the trends vary for different groups of people. And so for example from 2014 to 2018 new HIV diagnoses in the U. S. Declined 7% overall. However, if we look from 2014 to 2015 approximately 41%. Um So four and 10 black men who have sex with men um and approximately 22%. Or almost one and four Latina X. M. S. M. In the U. S. Will be diagnosed with HIV at some point during their lifetime. And when we look at those numbers that's something that should really get all of us up in arms to say what can we do to partner with these demographics and ensure that we can turn the tide because the stake of future generations is at risk with numbers like this. Also if we look at data from 2000 and 9 to 2013, the lifetime risk of HIV diagnosis is approximately 17 times higher in black women and more than three times higher in Latina women than in white women. And again when we think about these racial and ethnic disparities that we see, we want to be crystal clear that it is not anything that is wrong with individuals. Right? So that is not that a Latinas person or a black person is riskier than a white individual. But those same social determinants of health that were mentioned earlier are coming and into play. And so there are systems and structures in place that are causing people to not be able to reach their full health potential and are also increasing their vulnerability to HIV infection. Mhm. This slide gives us a snapshot of the disparities so that we can see the impact that COVID-19 has by race and ethnicity. And what I want to point out is not only our racial and ethnic minorities disproportionately impacted, but when we look at what's going on in our indigenous communities are Pacific islander populations. These are stark disparities, right? Stark Differences. And when you can see a mortality rate of 210 per 100,000 in our native American indigenous communities. Um, those are numbers that should scream, right, that our system is broken. And you will hear people say the system is not broken, it is doing what it was designed to do and working for who it was designed to work for. So, these are all things as nurses that we want to make sure we're keeping in mind as well as advocating for so that the patients we serve have the best opportunities to be healthy. When we think about people who are living with HIV, some have risk factors that are associated with severe covid 19. And there may be this correlation between HIV related lowered immunity and increased risk for SARS Kobe to infection. And that same correlation could then increase one's risk for having more severe covid 19. As an example, people living with HIV could have comorbidities, excuse me. Such as cancer, chronic kidney disease, COPD, you know, cardiovascular disease, obesity. And they could also have um, covid 19 on average, 10 years younger than patients uh, with Covid 19 who are not living with HIV. And so that may be due to the premature aging that we see happen for individuals who are living with HIV, where we have lots of studies that show cardiovascular aging, right? There are different cardio metabolic processes that happen as a result of HIV infection. And so that could be contributing to more severe covid 19 progression In our demographic of individuals who are living with HIV. Now, let's delve into some of the trauma that's experienced by nurses during COVID-19 along with other health care providers. Um, there's risk for personal health every time that nurses attend to patients who have covid 19. And these risk are made worse by potential shortages of personal protective equipment. You remember earlier in the pandemic, we were hearing all of the outcries about PPE and how our nursing and other colleagues weren't adequately protected. And that's on top of being unable to socially distance because they were having to provide care in close quarters. You have the physical and psychological well being of health care providers, which is strained by greater patient loads and colleagues acquiring covid 19. The dangerous work environment contributes to a decline in mental health of nurses, as well as other health care workers And health care workers have to self isolate right, so that they're not passing COVID-19 onto their families. But that self isolation and of itself could also lead to additional guilt or psychological distress. And that fear of passing COVID-19 onto a loved one or on to the general public. And the stress that's associated with it can contribute to post traumatic stress disorder anxiety as well as depression. And when we think about what this has done in our own lives and the lives of our colleagues being thrust into such unfamiliar situations. Um, and that could even just be taking on new skills, right? Learning how to do things through telehealth, being redeployed, making triage plans, reallocating resources, all of these constant rapid fire changes, increased stress. And for those of you who have been on the front lines, you remember those days where you could get report in the morning and then within an hour later the policies procedures, right? Like our standard operating procedures, things were changing so quickly. So all of that constant barrage mint of changing, you know, new information and things being done differently contributed to stress as well. When we think about though, the impact that COVID-19 has had on nurses, there's been a disproportionate impact on health care workers and black nurses in particular. And so in the United States by September of 2020 at least 1,718 healthcare workers had died of Covid 19 and related complications. And that number is just like a gut punch for me because we have almost you know, nearly 2000 people who should still be with us today but are no longer here. Nearly one third of hospital based health care workers who died were registered nurses. And at least 213 registered nurses had died of COVID-19 and related complications. When we delve and look into who the nurses were. However, who lost their lives to this pandemic. Nearly 18% were black. And when we look at the proportion of nurses who are black, black nurses only make up about 12.4% of the registered nurse population in the US. and so there was disproportionate mortality related to the percentage of the workforce that we make up. Yeah. In light of this trauma of the past year. You know we are now at a point where we're more than 12 months into this process. It's important in one of the objectives of tonight's program is to identify strategies for helping both nurses and patients move forward. So let's think through what some of those things are that we could do to address the issues. A key area is going to be resilience and that's going to be very important for both nurses as well as people at risk for or living with HIV. During the covid 19 pandemic we define resilience as the human ability to adapt in the face of a significant life stressor. Or multiple life stressors. Physical resilience is going to determine a person's ability to recover their physical health following a stressor. So when we think about the pandemic, that could be the recovery of their physical health for actually having COVID-19 themselves, taking care of an individual who was diagnosed or sometimes just turning on the television with that constant barrage mint of loss, you know, in change of information and uncertainty. Psychological resilience is based on effective coping and adaptation in response to adversity. And so in this case it could be those same things that are associated with the COVID-19 pandemic. Mhm. When we're looking at resilience as an indicator of health for people who are living with HIV specifically, it can be used to determine their health status um as well as well being. And in an ongoing crisis like this pandemic, what we'll see is that resilience tends to lessen over time. So when things began to really, you know, just steamroll and move ahead in March, Maybe some individuals were doing well. They were still able to take their medication and get their appointments by month 23456. As things just kept going on, it became harder and harder to then be able to cope to adapt to adjust to what was going on and frailty, which is determined by the age-related increase in vulnerability of a patient. And resilience should both resilience excuse me. Should both then be assessed in a patient to determine the urgency of health interventions that are needed. The mental health of health care workers though, as we've talked about all of these things, we absolutely have to prioritize that for nurses and other health care providers during this pandemic, and it should get just as much attention as physical health is getting. Uh we need to have frequent information sessions where we update healthcare workers with the latest knowledge on the virus, um on ways to practice technical decision making. You know, you can think about the days where people have to decide who gets a ventilator and who doesn't um and instructing them on how to use hospital resources most effectively, which can help to lessen that fear and uncertainty. So the more information we can provide individuals to do their job, the less we are putting that burden on them and stressing them out. Um Other strategies to optimize mental health and wellness for nurses and other providers are doing things like ensuring that nurses um and healthcare workers have sufficient breaks in order to take care of themselves, incorporating outside registered nurses into the system, and ensuring that other personnel in the reserve can take over when the existing staff are burned out and exhausting. Or just need to be able to step away and then re employing healthcare workers who have recently retired. And all of these things can be done to relieve the individuals who have become overburdened by the care that they're providing. Um there are schools of nursing as well as professional associations who offer resilience programmes to support nurses. The Nail Hotch and would drove school of nursing at Emory offers a biweekly podcast for nurses and nursing students and it's on topics including resiliency burnout, how to deliver nursing care during the COVID-19 pandemic. The compassionate care initiative at the University of Virginia School of Nursing supports nurses, physicians, allied health care workers and students by teaching resilience and compassion in healthcare through educational as well as experiential growth. Um mm. Vienna offers reset, which is a program to build resilience and provide support for black nurses and it's comprehensive and that it offers counseling podcast as well as webinars. And the american nurses Association offers the wellbeing initiative and that's free to all nurses and it has tools and apps to support the mental health and resilience of nurses. Mhm. While these programs offer support to nurses, um I want to make sure that we also recognize as dr tim Cunningham notes, if we as leaders push nurses to practice resilience but do nothing to address systemic problems. If we tell our colleagues to take more time for self care, but we do not enact meaningful systemic changes, then we are doing nothing more than putting the burden of resilience on the shoulders of the overworked, overtaxed clinical frontline nurses. Um So I hope you enjoyed that presentation. Now I am excited to bring my colleagues doctors Shields and Rodney on for our panel discussion. And I'm looking forward to hearing their thoughts on how to build and maintain resilience among nurses without placing the burden on them. And so, Dr Rodney DR Shields, thank you so much for being with us on this evening. Um Our first topic of discussion is going to be looking at the impact of disruptions to the health care system on people at risk for or living with HIV. And so the first question I'll send to you dr Rodney, what would you say was the immediate impact of increasingly unavailable in person? HIV testing and care during the pandemic on people at risk for living with HIV. Thank you DR Brown. And after the beautiful presentation here I come bearing bad news in a negative light because that was the immediate impact. It was negative. Um and from your statistics cited, we are seeing up to about a 49% reduction in testing events in a short space of time. And so what we did in the pandemic or what happened is that apprehension of knowing one's HIV status was simply refused um replaced with the fear of contracting covid 19. So we're trying to choose between two evils. But in reality what that cause was um lots of engagement, lots of follow up and critically. Lots of support from the providers who are there to support these individuals. And so I think we were left in a negative cascade of delayed treatment and possibly unnecessary exposure to our partners. So taken together, my greatest fear from what this cause was. How much of the great work which was done to progress in HIV care. How much of that was undone And how much will we need to do to get back to where we were Pre pandemic status? Yeah, thank you for that. And doctor feels do you believe that the mitigation strategies that we've used to engage people during the pandemic such as telehealth self testing, virtual counseling, will they continue to be used long term? So you know, they should. But here's the issue if you will, you know, Covid allowed us to finally push forward with some of these initiatives and really prove that they could be effective and they were used even you know, CMS finally started reimbursing providers for surpluses. Which was a good thing. What we know that in certain segments of our populations that we serve, there is still not equal access in terms of there is still a digital divide. You know, certain populations, they either don't live in areas that have good internet connections or they also do not have the devices. You know, we make assumptions that everyone has, you know, a smart phone, a laptop and a tablet. That's not true. And so while the services were able to allow us to still deliver care, we got to be very careful and always ask ourselves, who are we still missing through the use of these technologies. Yeah, thank you for that. And Dr Rodney with your expertise in PTSD and mental health, what do you see as the potential long term mental health effects of the isolation and trauma that the pandemic has imposed on people, either at risk for or living with HIV. Uh and that is a very near and dear um set us to my heart because it's immediately what I started to worry about at the beginning of the pandemic because we have a devastating dichotomy. The same process of isolation, physically distancing herself from individuals is what was recommended to get the pandemic under control. However, those two concepts existed in a negative context. However, for individuals living with or at risk for HIV. So when individuals at their most vulnerable, they're given a need for social connection, um not having that further recreates a traumatic experience for them. So I think initially recognizing that that dilemma does exist with individuals at risk scandals. Living with HIV is critical because I think that recreated or reaffirm what was the process of distrust and stigma and further cause of reluctance engage in care. Um we as nurses need to be vigilant, that Our individual response to this needs to take that into account as well as for patients, but at the bare minimum, I think what really encapsulated for me is a reminder that why not everyone was affected by COVID-19 physically. all of us was affected emotionally and therefore we will carry some of the trauma with us in the future which still needs to be addressed. And what you said something beautifully when we talked about this earlier, when you were looking at the role of that trauma on nurses in particular. And so we looked at that from the patient perspective, what do you think are the long term implications for nurses as they've had to work through this pandemic? So one of the things that nurses have always done is to always approach care and our patients from a place of non judgmental inquiry and accepting them for their individual experience, which this is what, although the pandemic is global, that is what the experience was an individual experience. So we have to know more than ever continuing that role, but also advocate for these individuals for to each member for practice team. And again, I want to emphasize that in many cases it will be a process of rebuilding trust before we deliver care so we can then limit what the long term effects are. If individuals are unwilling or reluctant to engage with us, thank you for that. And doctor feels, what would you say are the implications for nurses in terms of advocating for their patients as they're taking care of people, you know at risk for living with HIV. So the very act of serving as advocates is one of the tenants of our nursing practice. It is in our code of behavior, our ethical code, we are called to advocate. So in that role we need to take it seriously and we we need to give voice to the voiceless. It is part of what we do. And I don't know, a nurse working in this area that has hasn't had to place themselves in that role. But we had to do it in more of an active way. We and we had to be proactive in our advocacy, you know, and we had to utilize our professional nursing organizations and really combine our efforts, you know, the work of the National Black nurses Association and not only advocating um for patients and our specific communities where we're doing a lot of work and where, you know, our membership live, works and plays, but also in partnership with things like the Association of nurses and aides care. And a lot of us belong to both organizations, as you know, but, you know, advocating for for uh, the ability to provide the type of care that we actually know that we could. So here's what I mean by that, you know, Covid hit. And we had all these executive orders that lifted the ban on practice for, uh, nurses that are practicing at the advanced practice level nurse practitioners. So, you know, we were allowed to provide that high level care, the kid that we know that we could. So we were able to, you know, write those scripts and and actually do the telehealth visits that we were talking about earlier And then advocating for, you know, patients to, you know, get a, you know, we needed to do, like a 90 day supply of whatever, you know, they were on or we needed to finally get them some home care services, which in certain areas as an advanced practice nurse, I wasn't able to do. And none of that made sense in terms of getting patients what they actually needed. So in the middle of this crisis we were able to basically perform that advocacy level at a very high level and we really should fight for ourselves in for our patients. So as we do not go back to what was in many ways in inefficient system. I love that the emphasis of not going back, you know, I remember people kept saying can't wait to get back to normal. You know, we just want to get back to the way things were and I would always say for who because you know, clearly was not great for everyone, right? Um and to shift us into our second topic, let's sort of talk through the impact of these disruptions, specifically on black nurses. And so dr fields, you know, in the presentation, I shared the statistics showing that 18% of the nurses who died were black nurses. Yet we only make up 20% of the nurse population. So with that disproportionate impact of the pandemic on black nurses um how would you define resilience for black nurses and how can they maintain resilience in the face of their own trauma? We weren't given a choice. Let's be really clear. We were not given a choice. We were faced with a crisis and we immediately heard from our members of NBN a about the conditions that they were working on in the front lines all across the country. You know, the lack of the P. P. E. The inappropriate assignments, the almost threatening of of workers, you know with their jobs if they didn't do certain things. The way certain institutions were were asking them to do it even though they knew they were putting patients at risk. And it wasn't um an ideal situation. You know, we galvanized and we started to have listening sessions with members and we started to just to have a place for the nurses to vent and to have an outlet. But we organized, we started talking to our elected officials, doing zoom meetings with elected officials. You know, I know that the chapter in new york city that I worked a lot with, you know, we were talking directly with with Senator Schumer's office and you know, those types of representatives, and we actually got him on a zoom call to talk to the nurses, tell us what's going on. Um because if you if you think about it this way, a lot of the black nurses that are working in undeserved communities that were disproportionately already impacted, also live in those communities. So they went to work and dealt and dealt with a great deal of adversity and then they went, they had to go back home to a community that was also suffering disproportionately, There was no break, there was no downtime. So yes, people got stressed, they got overburden. Um and there was a need. And and the question always comes up in those situations who takes care of the caretaker. Uh uh and you know, we're not very good at times and taking care of ourselves. And we don't put it because the inclination is not to put ourselves first, but it really was a double whammy. And while, you know, dr Bronner, you mentioned that statistic for black nurses, I would be remiss if I just simply didn't mention here that the number of our colleagues in uh Filipino Nursing Association that we lost was even larger and more disproportionate given the number of filipino nurses that we have. You know, and and at the end of the day we're all nurses were we are all in this together. But you know, we really um in in in the national of council of Ethnic minority nursing associations where we work all together across the ethnic minority nursing groups and we work closely with the Filipino Nursing Association. Um because you know, we had to help each other. No, that's excellent. And I think you know, we heard the expression a lot. We're all in the same boat, right? And then we would say, well some of us are on yachts and some are floating on cardboard boxes were not in the same boat. Some of us aren't even on boats at all. Right. Um so I thank you for acknowledging what's happening with our Filipino nursing colleagues, you know our indigenous nursing colleagues, it's just been um a hard impact and I love how you put it that for a lot of people they could not escape it. So they weren't just doing it in the hospital, it was at home, it was with their loved ones, it was in their community. So that disproportionate impact was there. And dr Rodney, what would you say then that level of trauma is going to have to affect resilience among nurses? Right. And so what are some warning signs that nurses resilience is being affected? And then what impact does that have on their ability to provide care for people living with and at risk for HIV? Thank you for that. And the the answer is it's a no brainer that it must your human beings regardless of the tigers or the career we chose. But I would like to start first with the expectation nurses are expected to be resilient. Yeah. It's a career choice which we do beautifully and it's a choice to continue. So when resilience is not present or its waning, it's not as easily identified because of that social expectation. And unfortunately the lack of doesn't present the same warning signs as we would say, inaudible cough or a visible wound. And so it's going to be the subtle changes that we're looking at um in order to detect when it's not there. So it's work habits and engagement. You know, last word days avoidance of media unit you used to work on because it does have the traumatic field or unless an emotional connection with either your job or your your career. And that to me I think is detrimental. So it's important to think of resilience and a continual and the problem only becomes problematic when those effects affect the things that we do so patient safety the way we appropriately engaged in care and managing professional conduct. And I always want to remind yourself that on any given day any of us would have some feelings of um, depression. It's a normal reaction to things when it becomes problematic is when it started effectively, we can do a job or love for the jump that we do. And let me just say this, It's the whole trains the trainers who takes care of foreign nurses. That is the ultimate effect because we're going to be affected at every level or educators who are no longer present to train our future nurses or nurses who are no longer present to take care of patients who are in need. And so, um, I would hope that the, at the institutional level, at the organization level, we are being very, very vigilant about when the subtle changes happen, because it might not be voiced, it might just be observed in my new little changes which we have a responsibility to respond to. Okay. And as we get ready to pivot into our third and final topic, just a reminder to the audience, if you have questions for the panelists, you can feel free to put those in the chat because we'll be coming up on our audience Q and A in a few moments. Um, but so for dr fields and Dr Ronnie, when we think about building resilience among black nurses and HIV care, right? Um doctor feels, what would you say could be done to support black nurses who are caring for people at risk for living with HIV because their remaining on the front lines, right? We've acknowledged that they're impacted both personally and professionally. And it's not just the pandemic, but it's the pandemic. It's HIV is systemic racism, right? The conglomerates of all these different things. So how can we better support our black nurses? So, you know, all of the hero worship that was happening that went on. I really love the fact that we reminded those individuals that, well, you would abhorred me as a nerves as a black person in this country. I was still getting harassed and having to deal with issues of systemic racism. So if you're gonna support us, support all of who we are and acknowledge that we were dealing with the dual pandemic, you know, these corporations and um, everyone that had these nice glossy statements about diversity, equity and inclusion, It's time to move to action. So how do you now put your money where your mouth was about really wanting to do something different uh, in supporting, you know, black communities, brown and black communities and the nurses and health care providers that really provide critical access to a lot of people. You know, don't give me lip service. And and you you said it really nicely, you're you alluded to it dr Bronner. Going back to to normal, going back to what what what normal are you talking about? You know, one we we are forever changed. You know? Uh, you see it in the conversations about how people just discovered, you know, some of the historical trauma that that happened to, you know, Brown and black people will let alone medical professionals. You know, you all just learned about the Tulsa massacre. We knew, you know, and yes, you know, you know, our congress just signed into, into law a brand new holiday, you know, juneteenth on, on saturday. But we knew so support us as professionals in however we show up even in our authentic unapologetic blackness, I'll leave it at that. Yeah, I love it. And on that I say we pivot to some audience questions. That's an excellent segue. Uh so let's see what our audience asked. Okay, what are the ongoing needs that people at risk for are living with HIV will have even as the pandemic subsides? And what can nurses do to address those in light of their own trauma over the past year after Rodney, you want to jump in with that one? You're in you. So, I I wanted to say very sincerely that as nurses, we have to first take her ourselves and that's critical and so we know that the problems will be there. We identify them, we know the statistics. But if you're not in a place of good health, emotional and physical health were unable to provide this care. Um I do think we need to also acknowledge that there is a going back, not in that normal but there's a going back to to to recreate some of that work that we have eroded with the pandemic. And so that needs to be rebuilt. Key among that is rebuilding trust, reducing stigma and addressing what I call the tri effect of terrible things that happened. So it's covid it's racism. It's HIV and Accepting that they were always there. They weren't, they didn't arrive in 2020. They really didn't. What we've done is reopened some of those deepest wounds. So I think even before we got to specific is acknowledging to these individuals and then doing it because similar to how the hero worship went and the the noise has stopped. Um It is very easy to forget what these individuals have been living with and if it's not acknowledge and we just simply try to move on, we might not achieve the goals that we're trying to. So that's excellent. And I think the more that we continue to emphasize that nurses have their own trauma, you know, you get on an airplane, you put your mask on first. But we're just, I think we chose this profession, some of us because we desire to care to do and to fix right? And if we um, collectively right meaning, we as nurses, if we forget each other and we forget ourselves, um dr fields, I think you made the comment before. The public will continue to put us on the hero pedestal and the shiro pedestal, right? Um, neglecting the fact that we have had our own trauma and experiences in this process. And so I thank you both for those insights. Um, our next question, What are some creative strategies for building social connectedness that can reconnect people at risk for or living with HIV with the nurses who cared for them in person pre pandemic. So this gets into sort of treatment engagement. Yeah. Well, you know, to the extent that that we are still able to use technology like this to convene groups, um, uh, and drop in and check in on people people. Let's do that. But we have to get back to that community based work as well. Um, you know, we got to take the care back to those people. We got to re engage our testing. We have to embrace, you know, the strategies and the discussion around moving towards ending the epidemic, which at before the pandemic, we were having a really robust conversation and we were very excited about having the tools available to finally end the epidemic. Um, and we were talking about the collective will to do. So, you know, you know, there, there were new things that were coming out and, you know, we're looking at, you know, different, different uh, ways of getting to the population's, getting them in hair, keeping them in care, we have to get back to that. Um, and if there was a connection with a particular provider who may or may not be there anymore, uh, some people might fall through the, you know, fallout of care again. So I think those of us who are left that are on those front lines is gonna have to pick up those balls because we really cannot afford to let anybody, you know, sort of, we can't lose folks because someone's not paying attention. Uh, and, you know, it's a year later and they've never returned to the clinic. Yeah. And Doctor Rodney, are you familiar with any training programs for nurses? Or are their curricula that are available to help individual navigate these things? Right. So like dealing with covid 19 dealing with people who are lost to care as a result of the pandemic, dealing with the racial violence that folks are experiencing. Like what what resources can nurses use to be better equipped to support their patients in light of all of this? You know, thankfully. Um can I just highlight that this conversation tonight is not a tool kit, but this is where it starts and being engaged in conversations like this and leaving hair and being inspired to continue the work and to create those opportunities. And I I will say that you actually did mention quite a few that I'm also familiar with. So the word that's coming out of the american nurses nurses association sam says well, and um, I did want to just touch back on one thing individually groups are doing things, the universities are doing things like the podcast and you're trying to address it at multiple levels, which I think should they approach but engaging the community. So I'm really fortunate to work with an amazing group of community health care health care navigators um, in the getting to Zero project in Baltimore, and that is precisely what we're doing because being hit with the pandemic or like what can we do, what should we be doing? And so we're providing education series. So the community health navigators and the providers about what do we need to reaffirm? Going back into the community and taking a term coined by DR Jason Farley had given full credit to be unapologetically enabling, so remove all barriers that are present for these individuals and lastly, let her patients know that your goal is our goal. We're here to help you get to zero and that, I think is a starting place and acknowledging that it's going to get better, it's going to get more creative and better as we build these new resources and with the support of places like any at a national level to assist us in that process. That's great. I love that concept of reminding them that we're partners in care, right? I think historically the medical or the health care model had been so paternalistic that it was this is what I'm doing, you know, to you and for you versus we are together working towards something that's important to you and to me. So, I love that dr fields, we have a question for you, have you noticed a rise in substance abuse during the pandemic among those who are living with HIV? So there is some data out there that that indicates, you know, people have been using various substances to cope and and and let's be clear, it's coping, you know, everyone has lived through a traumatic experience. Um we're all survivors of the same pandemic, so nurses and patients alike and you know, I I've even started having conversations with individuals. I don't ask people how they're doing anymore. I I asked, you know, so tell me how you're dealing with your trauma, because I assume you have some insight into the fact that you're dealing with some trauma. So, I really want to say this though. We got to make sure that as we bring those patients back into care and we do those assessments and we might find that they're they're using whatever substance it is that we remain in our comparative supportive roles, that we do not judge them because, you know, that will stigmatize it, you know, because if you think, you know, if you can recall not too long ago, you know, marijuana was something that, you know, was illegal. Now, you know what new york state, you know, legalize it and it's being legalized more and more. So, you know, my whole thing has always been in my approach with my patients. I'm not here to judge you. But if you tell me what you're doing, we're gonna work together to figure out how to get to the care that you so and, you know, insert whatever substance it is. And and let's be clear, we're talking about addiction and addictive behavior and during this pandemic. Uh not only, you know, people want to think about drugs dr rana, but people coping a lot of ways, you know, food facts, you know, how are you dealing with the trauma? But we got to make sure we're not being, being um punitive that's not our role. Yeah I like that. The importance of not being judgmental and then normalizing, taking the stigma away from trauma right? Because if I just say how are you dealing with your trauma? It gives you room to not feel like you know, do you have trauma? Yes or no? But it's like hey what's going on? And then they can respond to say oh I don't have any traumas or it opens the door for them to share what's happening. So I like that. Uh looking at our time, we have time for one last question. So whichever one of you, I would like to answer this. Can what can black nurses do to encourage their employers to establish a resilience program? And are there resources for starting a new program you want to take a stab up around the floor? So I am adamant that it is the institution responsibility to take care of our employees. Um Too too often we're finding that that care is taken outside um on a whim in secret in shame that you're not doing as well as you should. So that needs to be baseline. So we're not doing a hard ask. We're doing something, we're asking for something that should already have been in place by the way. And so we can take the approach of assisting. We are here to assist you to tell you what is it that we need and I think that really should be held that conversation starts that it hasn't been done adequately enough. But here I am I can explain to you specifically these are the things that I need to be successful in my role as a nurse to provide the best patient care. Um Uh huh. I think we need to support each other in this process. So it can't be that um five nurses, so they're not coping with covid or the pandemic very well. It needs to be a collective collective effort and ultimately it benefits not just our black nurses, it benefits all our nurses. And that needs to be a part of that conversation. So why we will seek unique care that is relevant to um our status is that nurses experiences that we have. The broad statement needs to be made for two things. It's a responsibility and um it needs to be supported at every level because it's beneficial to all. Absolutely. Um Do you each have final words of wisdom that you would like to leave with our attendees tonight? So I'll say this, you know, and it's a it's an old adage, but I really do believe it. Every nurse is an HIV nurse. We always have been and we got to take that responsibility and get back to doing the work of getting to zero on top of everything else that we must do and that we're called to do, but we are the largest segment of the health care workforce in a profession that is not diverse that does not appreciate at times, what we do is black nurses and again, how we show up as our authentic selves. So to all of my, my fellow black nurses out there, keep the faith keeps showing up as you do. Um if they won't give you a seat at the table, pull up your own because they need us, whether they realize it or not, and we're not going anywhere, and I will just leave you with a quote that I frequently like to use because it reaffirms why I chose this profession in the first place, but service to others is a range we pay on this earth and I am happy to be of service to my fellow citizens and to each other as nurses. Um and ultimately we have to take care of yourself in this process. Um, so be kind to one another and acts that others are kind to you because it's all right that you give to someone else. Yeah. And I would just add to that that no matter what role you play, there's literally nothing too small that we could do, right if each of us takes ownership of our practice, of our care, wherever we find ourselves in the beautiful spectrum of what it means to be a nurse, that there is always something that can be done. And so your lived experience, your academic training, your career experience. They've all positioned you for such a time as this and so take that to use it um for good. You know, take that to do something so that we can make a difference in the lives of those individuals living with and at risk for HIV and then move our our nation, our world forward as we continue to try to survive and thrive through this covid 19 pandemic. Um thank you all so much for being here this evening. I want to thank our distinguished, esteemed panelists. You both have been absolutely amazing. Thank you for the rich expertise that you brought to this discussion. Thank you to the participants are attendees tonight for being with us on a thursday evening. When you could have done five million other things, we're so grateful that you chose to be here. I would like to remind you to complete the post program survey that's going to be arriving to you by email and having that feedback is important for us. Very important because it's going to help to strengthen future programs that will run. I'd also like to say that together as black nurses, let's rise up for those at risk for or living with HIV and work towards ending the HIV epidemic. Right. That goal of getting to zero is achievable and so we don't want to be in a position where Covid 19 coming derails that and it goes to the back burner, but let's keep that at the forefront because the health of our future generations are at stake. I also would like to thank Gilead for sponsoring the program this evening and continuing to do such amazing work in the community so that we get the information out that individuals need to be safe or to live long healthy lives with HIV infection. And with that I would like to hand it back over to Prague MMA who is going to close us out for the evening I and wow, what an amazing program. Thank you to our dynamic speakers and thank you to Prague Nha my colleague for starting this. I'm chauncey Watson and I just on behalf of our company Gilead Scientists would like to thank you for attending today's program. What was very clear to me is that our way back after this pandemic starts with addressing us as providers and that focus is critical to the success of shifting the culture around us. That can further help save the lives of all those we serve. We'd like to continue this conversation with those of you who work every day to support communities impacted by HIV. Please join Gilead Scientist and a panel special guests for a program in honor of national HIV Testing day on june 28 through conversations. This program will elevate issues related to normalizing HIV status awareness, educating individuals about the importance of HIV testing as the entry point to both HIV prevention and the care continuum and also de stigmatizing HIV testing, ultimately helping to empower individuals who are at risk for HIV to get tested. Please look, please be on the lookout for an email invitation with more details and a lean to register with that. Please have a great afternoon in a great evening and thank you for joining. Yeah, a little less. Yeah. Yeah. Created by
