More than three decades since the emergence of the HIV/AIDS epidemic in Australia, nurse practitioner Liz Crock believes that advancements in diagnosis, access to effective treatment, and societal acceptance have significantly improved.
“It’s no longer what people would call a ‘death sentence’,” she tells the ANMJ.
“If we can get people on treatment, and it’s quite simple these days, then they can live life well and healthy.”
In 1991, early in her nursing career, Liz began working at the now-closed Fairfield Infectious Diseases Hospital, including on the HIV/AIDS wards. HIV/AIDS first surfaced in Australia in the early 1980s, amid the infection rapidly escalating into a global epidemic.
Overcoming stigma and fear in early HIV care
Back then, stigma was widespread. Sometimes, people were rejected by their families, says Liz. Diagnosis was often kept close to the chest. Sadly, many people, from their early 20s up until older ages, died.
“The peak of deaths occurred around that time,” recalls Liz.
“At Fairfield, because nurses and doctors were trained in that area [infectious diseases] they had a great interest in any new disease, but also all the processes in place to care for people appropriately.
“In the very earliest days there was a lot of fear among nurses, but it didn’t last very long once they understood the way that HIV was transmitted.
“On the wards, at any one time, you could have people that were newly diagnosed and coming to terms with that diagnosis. At the other end of the spectrum, you’d have people that were palliative.”
“Many were ‘outed’ as gay at this time. It was this double stigma of HIV plus their sexuality being revealed, which was often so devastating.”
Despite its challenges, Liz found the job both interesting and rewarding, partly due to the broader involvement of the gay community and advocacy groups like the Victorian AIDS Council (now Thorne Harbour Health), who would visit the wards, and join Royal District Nursing Services (RDNS) nurses out in the community, to provide ongoing support to people at home.
Another drawcard was the newfound collaboration among doctors, nurses, other health professionals, and even patients themselves.
“Because it was a new disease, and the involvement of the high-level of education from the people living with HIV themselves, it sort of dissolved the power dynamic between nurses, doctors and other health professionals,” Liz suggests.
“Because the patient group was very empowered and strong advocates for their own care, it was much more patient-centred than nursing and medicine had been prior.”
Shifting to community care and advocacy
When the hospital closed, Liz, who completed a PhD in nursing ethics and HIV in 2001, chose to remain working clinically, yet pivoted to the community. Her experience with RDNS nurses coming to Fairfield Hospital to help coordinate care for patient at home inspired her to join the organisation as a Clinical Nurse Consultant (CNC).
The HIV program at RDNS became part of the RDNS Homeless Persons Program (HPP) in 2015 (RDNS is now Bolton Clarke), which works with people who are homeless or at risk of homelessness and are experiencing physical, mental and psychosocial health issues.
The increase in referrals for people living with HIV who were also experiencing homelessness motivated Liz to advocate for the addition of a nurse practitioner role to the team. In response to this need, she pursued further education and became an NP herself in 2018.
“I could really see this group finding it very difficult to access clinical care. You could see the benefit of having a nurse practitioner being able to order a pathology test or do some HIV prescribing [which only became possible in 2020].”
In her current role, with Bolton Clarke’s HIV and HPP Program, Liz and a small team of nurses provides primary healthcare outreach to people living with HIV, sometimes in boarding houses, caravan parks or living in crisis accommodation, as well as people living in public housing or their own homes. They care for all people with HIV including asylum seekers and refugees and many long-term survivors. Anyone with HIV can be referred to the program.
Nursing care is centred around keeping people engaged in healthcare and linking them to the services they need so that they can achieve an undetectable viral load – so low that it cannot be detected by a test.
“Basically, we go out to their home, or wherever people are, and we assist them with coordinating their care, helping with their medications, linking them in with other services,” explains Liz.
“I might go out and do a full advanced health assessment on someone. As a nurse practitioner, I can refer them to specialists, order pathology tests. If they need some blood tests and don’t have a GP, I can just start them off with getting some tests done. If they’re running out of their HIV medicines, I can give them a prescription.”
Liz considers “the ability to help change people’s lives” by improving their knowledge about HIV the best part of the job, especially if they are newly diagnosed.
Honouring a career dedicated to change and progress in HIV treatment and care
In November, Liz was named the Nurse Practitioner of the Year at the 2024 Australian College of Nurse Practitioners (ACNP) National Conference in Cairns for her outstanding leadership, clinical expertise and unwavering advocacy for marginalised communities.
“I was extremely shocked,” she says, of receiving the prestigious honour.
“It feels like it’s great reward as a culmination of all these years, nearly 40 years working in HIV. It’s a fantastic opportunity to highlight the areas in which a role like this can benefit marginalised communities, as well as being a fantastic career path for nurses. It’s a very autonomous role and extremely rewarding.”
As barriers preventing nurse practitioners working to their full scope finally begin to break down, Liz believes the specialty can continue to build.
“Nurse practitioners are highly accessible. You can develop an NP role in any setting, really. In primary care, or in my case district/community nursing, there’s just incredible scope for nurse practitioners to add value to the whole system.”
After encountering HIV as a student nurse 1987, Liz has remained forever connected to improving education, treatment and care for people living with the virus.
“There are some really great changes coming, including long-acting injectable medicines. They’ve only recently become more available for people and getting onto the PBS, so they’re properly funded.
“It will mean people, instead of having to have daily medicines, will only need to have an injection every couple of months. At the moment, it’s quite restricted in who can access that, but as time goes on, there’s going to be more and more long-acting injectables, and possibly a yearly injection.
“Research is also moving ahead. There’s no actual cure yet, but in the next decade, that’s what we’re hoping for.”
Nurse Practitioner Week 2024 runs from 9-15 December – Voices for Health – The Future of Healthcare: NPs Leading Change
