School of Nursing Tackles HIV/AIDS in Africa
In Part 1 of a three-part story that originally appeared in the School of Nursing's Science of Caring, Andrew Schwartz reports on how nurses and nurse researchers in sub-Saharan Africa - mostly women - are leaders in the fight against HIV/AIDS in their countries. For over a decade, the UCSF School of Nursing has been part of the effort.
Nonhlanhla Sukati, a nurse educator and researcher at the University of Swaziland, can't forget the face of a now-dead student nurse. It was ravaged not just by a dramatic rash - a herpes zoster caused by HIV/AIDS - but also by the scorn of her fellow students. "They wanted her kicked out of the dormitory and did not want her to go to the dining hall to get her meals because they felt they would contract the disease through sharing utensils," says Sukati.
It's only one of many tragic stories, but for Sukati this young woman's tortured face says much about the effect of HIV/AIDS in her homeland: physical pain, stigmatization caused by ignorance of the disease - and death.
Despite the recent introduction of antiretroviral treatments, HIV/AIDS remains the leading cause of death in sub-Saharan Africa. In some countries, more than one in three adults are infected; no other region of the world has a higher prevalence. As the disease decimates families, friends and neighbors, few people in southern Africa remain untouched.
But, however disturbing the numbers and that young woman's face are, they are only part of the story. Another part, much more encouraging, has to do with people like Sukati herself. For over a decade, she has been part of an alliance of nurse researchers, health workers and people living with AIDS (PLWAs) who are waging a determined battle to push back the pandemic's momentum in southern Africa.
There are many fronts in this battle. Nurses must fight to:
For much of the last 15 years, a growing partnership with the UCSF School of Nursing has aided these efforts. That partnership began with a simple encounter between Sukati and UCSF School of Nursing Associate Dean of International Programs William Holzemer, one of the world's foremost researchers on caring for people living with HIV/AIDS. Among his endeavors, Holzemer is one of three chairpersons of the Institute of Medicine's committee evaluating the President's Emergency Plan for AIDS Relief program. He is the only nurse to hold such a position. In the mid 1980s, Holzemer was working in Swaziland, Nigeria and what was then Zaire on a safe motherhood project for the International Council of Nurses, focusing on primary health care. He met Sukati then. "The project was entitled naku kukhanya, translated 'here is the light,'" says Sukati. "Over the years, Bill and I managed to maintain contact." Through that contact, Sukati eventually became one of a small group of African nurses who, with support from the Kellogg Foundation, have received doctorates from the UCSF School of Nursing. The others are Naomi Mmapelo Seboni and Esther Seloilwe, both at the University of Botswana. None of the three came to UCSF intending to work solely on HIV/AIDS; they were interested in the broader topics of women's and adolescent health. After all, when Sukati and Holzemer first met, the epidemic was still in its infancy. But by the time of Sukati's arrival at UCSF in 1993, HIV/AIDS had killed thousands and had become a major concern for health providers and governments around the world. San Francisco, especially the renowned AIDS ward at San Francisco General Hospital, was the leader in providing care for these patients, most of whom died within 18 months of contracting the virus. "I worked with Bill as part of my research residency," says Sukati. "This sparked an interest in me to explore if the physiological problems prevalent in the USA were similar to those in Swaziland. My interest became symptom relief and management." She would soon find common ground with other nurses and nurse researchers in Africa, especially when, in 1994, the World Health Organization held a meeting in Botswana for collaborating nursing centers. Holzemer was there, as was Seboni. The meeting helped catalyze the pan-African efforts of nurse researchers, as well as their alliance with UCSF School of Nursing. For one thing, it initiated the formation of the UCSF International HIV/AIDS Nursing Research Network (The Network), which had begun as the HIV Nursing Center in San Francisco. Today, The Network conducts collaborative research around the globe focused on care of PLWAs. For another, the meeting led to a fruitful alliance between the UCSF School of Nursing and the University of Botswana. The seeds sown in the 1994 conference bloomed in 1998, when Seboni invited Holzemer to serve as an external examiner for the Department of Nursing at the University of Botswana. "As a seasoned teacher and researcher, he was intrigued by one of the students' projects, which addressed the self-care strategies by persons living with HIV/AIDS in Swaziland," says Seboni. Among the strategies the student had uncovered was that the smell of fresh orange peel does wonders to ease nausea - not a technique that researchers in the United States were likely to happen upon. For his part, Holzemer says, "I became aware of how much Botswana was already focused on HIV/AIDS." He and Seboni worked on a proposal together to look at the various symptom management strategies across four African countries: Botswana, Lesotho, Swaziland and South Africa. With encouragement from all four governments, Bristol-Myers Squibb's Secure the Future Foundation eventually sponsored the study. Seboni was the team leader for Botswana; Sukati, for Swaziland. From there, partnerships between UCSF School of Nursing faculty members and those at universities across sub-Saharan Africa have spread. Projects have generally addressed three overlapping areas: continued work on primary care for people with HIV/AIDS, especially on symptom management; understanding and reducing stigma; and building nursing capacity to help address the crisis. Next: The Rise of Symptom Management
- • Ease the symptoms of those who had received what for all intents and purposes was a death sentence
- • Ensure that the infected get treatment and learn that "living well" with the disease is a real possibility
- • Find and gather scant resources
- • Educate everyone from patients and co-workers to government officials
- • Balance respect for traditional African culture with this brutally modern plague
- • Secure seats at the table of decision makers
For much of the last 15 years, a growing partnership with the UCSF School of Nursing has aided these efforts. That partnership began with a simple encounter between Sukati and UCSF School of Nursing Associate Dean of International Programs William Holzemer, one of the world's foremost researchers on caring for people living with HIV/AIDS. Among his endeavors, Holzemer is one of three chairpersons of the Institute of Medicine's committee evaluating the President's Emergency Plan for AIDS Relief program. He is the only nurse to hold such a position. In the mid 1980s, Holzemer was working in Swaziland, Nigeria and what was then Zaire on a safe motherhood project for the International Council of Nurses, focusing on primary health care. He met Sukati then. "The project was entitled naku kukhanya, translated 'here is the light,'" says Sukati. "Over the years, Bill and I managed to maintain contact." Through that contact, Sukati eventually became one of a small group of African nurses who, with support from the Kellogg Foundation, have received doctorates from the UCSF School of Nursing. The others are Naomi Mmapelo Seboni and Esther Seloilwe, both at the University of Botswana. None of the three came to UCSF intending to work solely on HIV/AIDS; they were interested in the broader topics of women's and adolescent health. After all, when Sukati and Holzemer first met, the epidemic was still in its infancy. But by the time of Sukati's arrival at UCSF in 1993, HIV/AIDS had killed thousands and had become a major concern for health providers and governments around the world. San Francisco, especially the renowned AIDS ward at San Francisco General Hospital, was the leader in providing care for these patients, most of whom died within 18 months of contracting the virus. "I worked with Bill as part of my research residency," says Sukati. "This sparked an interest in me to explore if the physiological problems prevalent in the USA were similar to those in Swaziland. My interest became symptom relief and management." She would soon find common ground with other nurses and nurse researchers in Africa, especially when, in 1994, the World Health Organization held a meeting in Botswana for collaborating nursing centers. Holzemer was there, as was Seboni. The meeting helped catalyze the pan-African efforts of nurse researchers, as well as their alliance with UCSF School of Nursing. For one thing, it initiated the formation of the UCSF International HIV/AIDS Nursing Research Network (The Network), which had begun as the HIV Nursing Center in San Francisco. Today, The Network conducts collaborative research around the globe focused on care of PLWAs. For another, the meeting led to a fruitful alliance between the UCSF School of Nursing and the University of Botswana. The seeds sown in the 1994 conference bloomed in 1998, when Seboni invited Holzemer to serve as an external examiner for the Department of Nursing at the University of Botswana. "As a seasoned teacher and researcher, he was intrigued by one of the students' projects, which addressed the self-care strategies by persons living with HIV/AIDS in Swaziland," says Seboni. Among the strategies the student had uncovered was that the smell of fresh orange peel does wonders to ease nausea - not a technique that researchers in the United States were likely to happen upon. For his part, Holzemer says, "I became aware of how much Botswana was already focused on HIV/AIDS." He and Seboni worked on a proposal together to look at the various symptom management strategies across four African countries: Botswana, Lesotho, Swaziland and South Africa. With encouragement from all four governments, Bristol-Myers Squibb's Secure the Future Foundation eventually sponsored the study. Seboni was the team leader for Botswana; Sukati, for Swaziland. From there, partnerships between UCSF School of Nursing faculty members and those at universities across sub-Saharan Africa have spread. Projects have generally addressed three overlapping areas: continued work on primary care for people with HIV/AIDS, especially on symptom management; understanding and reducing stigma; and building nursing capacity to help address the crisis. Next: The Rise of Symptom Management