World AIDS Day 2016

Ever since the outbreak of the AIDS epidemic in 1981, many medical professionals, community activists and others have been fighting to prevent new HIV infections, diagnose existing ones and care for people living with HIV/AIDS. On December 1, people around the world will unite in the fight against HIV/AIDS under this year’s theme for World AIDS Day: “Leadership. Commitment. Impact.”

The Duke University School of Nursing (DUSON) is no different in its commitment to leading and impacting the health and wellbeing of people living with or at risk for HIV/AIDS. In particular, James “Les” Harmon, DNP, RN, ANP-BC, AAHIVS, associate professor, Schenita Randolph, PhD, MPH, RN, CNE, assistant professor, and Michael Relf, PhD, RN, ACNS-BC, AACRN, CNE, FAAN, associate professor and associate dean for Global and Community Health Affairs, have a history of working to improve health care for this population through clinical practice, education and research.

Harmon's volunteer experience at an AIDS hospice in San Francisco in the 1980s led him to pursue a career in nursing, and his work as a registered nurse at Davies Hospital in San Francisco in 1991 led him to focus his career on HIV/AIDS. “I was inspired to work in the field of HIV nursing by the many hard-working, dedicated people surrounding me in the early days of the epidemic in San Francisco,” he said, “many of whom were nurses.”

Today Harmon provides primary care for HIV patients at the Northern Outreach Clinic in Henderson, N.C., and leads the Master of Science in Nursing Program's HIV/AIDS specialty concentration at DUSON. Launched in 2013, the HIV/AIDS specialty concentration is designed to fulfill the goals of the National HIV/AIDS Strategy to reduce the number of new infections, help people with HIV stay healthy by increasing their access to care and reduce HIV-related health disparities.

Harmon enjoys leading the HIV/AIDS specialty concentration as it prepares future nursing leaders in a specialized field. “As the current cadre of HIV care providers is aging and many are retiring from practice, there is a great need for more young health care providers to assume the care of those with HIV infection,” he said.

Graduates of the HIV specialty are prepared to enter the workforce and provide the full spectrum of primary care to people living with HIV infection. "I am very proud to have the opportunity to lead this effort at Duke. It is very gratifying to see our graduates go out into the world and improve the quality of life and health outcomes for people living with HIV infection,” he added.

Randolph’s focus on HIV/AIDS started in the late 90s. “In 1998, I worked as a public health nurse working with adolescents in communicable diseases, family planning and school health clinical settings,” she said. “In these settings, I would screen, treat and counsel youth about sexually transmitted infections (STIs) including HIV.”

That experience caused her to wonder about the causes of HIV in this young population. She questioned the personal, social, economic and environmental factors -- determinants of health -- that led to repeat STIs and continued risky sexual behaviors. She also wondered about the factors that contributed to the health disparities experienced by minority adolescents with STIs and HIV. As a result, Randolph continued her education and learned how to assess community health needs and develop innovative policies and programs.

In 2010, Randolph began her HIV/AIDS research focus. She has since obtained funding to test the feasibility of recruiting African-American fathers and their adolescent sons from local barbershops and using barbers as recruiters and educators for future projects. “African-American men have been recruited from barbershops for other health promotion studies; however, no barbershop studies have recruited adolescents, and very few have focused on sexual health for adolescents,” she said.

Her study will inform recruitment, retention and sustainability factors for the development of the first father-son intervention delivered by barbers with a goal to decrease risky sexual behaviors among African-American male youth. “African-American males ages 13 through 24, compared to males of other races, are disproportionately affected by sexually transmitted infections and account for over half of HIV infections among all youth in the United States,” said Randolph. “My research focuses on preventing the risky sexual behaviors of Black male youth that lead to these high rates of STIs and HIV.”

Relf began his nursing career in Washington, D.C., a city whose population has one of the highest lifetime risks of HIV diagnosis according to the Centers for Disease Control and Prevention. “I started my nursing career in critical care but often cared for persons living with HIV while working in the nation’s capital,” he said.

As a health care provider in the early years of the epidemic, Relf witnessed other health care providers being unkind towards individuals living with HIV. “Witnessing this behavior sparked my desire to focus my research on helping to identify the antecedents and outcomes of HIV-related stigma as well as the development of interventions to reduce stigma and promote engagement and retention in HIV-oriented primary medical care,” said Relf.

Relf has led a national taskforce to develop the blueprint for certification in HIV/AIDS advanced practice nursing. Over the years, as his work has become more global in focus, he has also collaborated with nursing leaders in Botswana, Lesotho, Malawi, South Africa, Swaziland and Zimbabwe to establish the essential competencies for nursing related to HIV and AIDS for this region.

DUSON faculty, staff and students are committed to improving the care of individuals living with or at risk for HIV/AIDS. We join millions around the world in challenging people to rethink HIV's outdated stereotypes and myths and to be positive about HIV. Let’s lead, commit and make an impact!

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