USIS Washington File - December 29, 2008
Erika Gebel

Washington - A groundbreaking program called Nurses Strengthening Our AIDS Response, or simply Nurses SOAR, is sending nurses specially trained in HIV/AIDS care from the United States to hospitals and clinics in Africa to act as mentors for increasingly burdened nursing staffs.

In 2007, sub-Saharan Africa accounted for 75 percent of AIDS deaths and 67 percent of people living with HIV, according to the United Nations' biennial report on HIV/AIDS. Much of the burden of caring for the stricken has fallen to nurses.

SOAR funding comes largely through the President's Emergency Plan for AIDS Relief (PEPFAR) and is administered by the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services. Launched in 2003 and renewed in 2008, PEPFAR is "the largest commitment by any nation to combat a single disease in history," according to the PEPFAR Web site.

Nurses SOAR is a partnership among the Georgetown University School of Nursing and Health Studies in Washington, the Association of Nurses in AIDS Care, the Duke University School of Nursing in North Carolina, the Catholic Medical Mission Board in New York and health care organizations throughout Lesotho, South Africa and Swaziland.

The purpose of Nurses SOAR is to strengthen nurses' capacity to deliver HIV/AIDS services. The program does this by building the leadership skills of nurses, building communities of self-care, building HIV/AIDS knowledge and clinical skills, and emphasizing applying the knowledge in clinical nursing care.

Many of the activities are implemented by expert HIV/AIDS nurse volunteers from the United States and faculty from Georgetown and Duke universities.

A COMMITTED CREW

All SOAR participants must be certified in HIV care, be members of the Association of Nurses in AIDS Care and be committed to improving nursing care, said Kevin Mallinson, an assistant professor at the School of Nursing and Health Studies at Georgetown University and the program's principal investigator.

"All members are volunteers," Mallinson said. "They volunteer their own time," and the program provides funds for travel, lodging and meals. Since January 2008, the program has sent some 35 nurses to be mentors in Africa, each for three to five weeks.

Each site receives two or more mentors at a time. After one group goes home, others may come to pick up where they left off.

"The reason I believe in this program is it's not about you. You can't expect to go over there and be the only person to make a difference," said Sandy Sheble-Hall, one of the first mentors deployed. "You have to believe the program will make a difference."

MEETING NEEDS

From his 26 years of experience as an HIV/AIDS nurse, Mallinson says he understands the needs of a nursing staff bombarded by a deadly epidemic. Many programs that send health care workers to Africa focus on intensive classroom training on complicated topics, he said, but SOAR is "teaching people the basics."

In recent years, because of initiatives like PEPFAR, anti-retroviral therapy has become available in some parts of sub-Saharan Africa. Anti-retrovirals can boost the immune system and keep down the level of virus in people with AIDS, a radical shift from the relentless deterioration faced by people with AIDS before such therapy became available.

"Nurses there have experience with AIDS, but they don't have experience in anti-retroviral treatment. It's a big black hole," said Sheble-Hall, who along with other SOAR mentors coaches patients and nurses about side effects of the new drug regimes.

"If they take [anti-retrovirals], they may initially feel sicker. This side effect will go away, but imagine giving someone something and they feel worse," Mallinson said. "Mentors can help with communicating this idea."

BEYOND NURSING

A unique facet of the Nurses SOAR program involves grief counseling.

"People here are overwhelmed by debilitation and death. Orphan numbers are beyond belief," Mallinson said. "One in four nurses where we are now has HIV. They have to deal with their own HIV as well as family members who die."

Because dealing with HIV/AIDS emotionally burdens the nurses, as part of the program, Mallinson takes them away for a weekend of grief counseling and fellowship.

"After a communal intervention to help nurses deal with their loss and grief, they become bonded," Mallinson said. "One of the most successful things the program has achieved is this intervention."

Initial funding for SOAR will end in May 2009. If funding is renewed, the program will extend from three to six the number of countries it serves.

And SOAR organizers are not worried about running out of U.S. nurses willing to participate - of the 33 SOAR nurses who have come home, 31 have asked to return, including Sheble-Hall, who will go back to Africa in March.

"Everyone says it's kind of a life-changing experience. I will attest to that," Sheble-Hall said. "I can't wait to go back. I just loved it."

More information on Nurses SOAR is available on the Association of Nurses in AIDS Care Web site.

More information about PEPFAR is available on the program's Web site.

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