High-profile HIV nurse Jason Warriner talks
to Michael Laffan about prejudice, patient confidentiality
and his work in South Africa.
When
I was diagnosed with HIV it wasn’t health advisers or doctors who helped
me through it. It was a nurse who held my hand and told me it was going to
be ok.
Nurses are the backbone of the NHS, yet so much of their work goes unrecognised.
Senior HIV nurse Jason Warriner wants to change this as newly-elected chair
of the congress of the Royal College of Nursing (RCN).
Jason, a friendly northern lad, is the first out gay man to achieve such an
important position at the college. With 380,000 members, the RCN is the UK’s
largest nurses’ union and one that packs a punch in the corridors of
power.
I met Jason on his lunch break at Guy’s Hospital just before he was
to fly to KwaZulu-Natal, in South Africa, where he volunteers at a children’s
HIV project.
Complacency
Jason has worked as an HIV nurse since the 1990s and has witnessed big changes
in the way the condition is perceived and treated.
“Back then it was all about palliative care, you never really knew a
patient’s life expectancy. Nowadays it’s much more about chronic
disease management.
“What I love about working in HIV medicine are the clients and working
in a partnership with the patient, which is different from any other speciality.
Some patients know more about the treatments or disease process than me. It’s
about learning from that.
“HIV used to primarily affect gay men. Following on the heels of the
gay rights campaign, all those lobbying skills were transferred over to campaigning
for better HIV treatment. So HIV patients were empowered.
“The sad thing is the media still treats HIV as an illness that just
affects marginalised groups, such as asylum seekers. This is why organisations
like UKC and THT are so important.”
However, Jason fears people outside high risk communities are too complacent.
“I’ve always said HIV does not discriminate. I am concerned when
I see lots of people presenting late and only when they have an Aids-defining
illness. People used to be more aware and were much more likely to come forward
for testing.
“I’ve got friends living with HIV. It’s different when you
see it in your personal life. One friend died, and that made me feel really
vulnerable. Sometimes I look back and think it could have been me who became
infected.
“When another friend told me he was positive, my reaction was: ‘Fine,
let’s go for a pint.’ For me, friendship is about people, not
about any virus.”
Support for positive nurses
Many nurses living with HIV tell us stigma and discrimination are rife in
healthcare. They are terrified of telling their employers for fear of being
hounded by the media, sacked or rejected by colleagues.
What is the RCN was doing to tackle HIV discrimination and support positive
nurses?
“The RCN will provide support for HIV positive nurses through our counselling
service, local stewards and health and safety reps. We will not tolerate any
discrimination on the grounds of HIV. We have highlighted the impact of HIV
at congress. But the college and other healthcare organisations have to work
to raise awareness of HIV, not just in nursing but in the wider public arena.
“I am against compulsory testing of health care workers as it would
increase stigma and drive it underground. We should concentrate on getting
staff to disclose their status to occupational health services. If people
follow universal precautions and infection control procedures there is no
risk to patients.
“So what if someone is HIV positive? There’s no reason why that
person can’t be a nurse.”
Facing down ignorance
Does Jason still battle with homophobia in his profession? “Yes, in
nursing and within the RCN. Thankfully it seems to be decreasing. Nursing
is supposed to be a caring profession. If people hold homophobic views what
kind of care do they provide for patients who are lesbian, gay bisexual or
transgender?
“I always believe I can make a difference. Seeing an openly gay man
in a senior position may give confidence to a student nurse who’s just
coming out. For me it’s how you challenge ignorance. I just say ‘I’m
a gay man, I’m good at my job so why don’t you just let me get
on with it?’”
Nurse poaching
I asked Jason about recruiting nurses from countries where they had too few
already.
“There’s some ethical recruitment from abroad, but there are also
questionable practices that have led to a skills drain in some parts of the
world. In my own work in South Africa, I’ve seen with my own two eyes
that they are desperately short of nursing staff.
“Some come attracted by better salaries. They think they can send money
home to support their families. £20,000 looks good to a nurse working
in Africa, but living in London its hard to get by on twenty grand and still
send some money home.
“Sometimes the UK fails to recognise the excellent knowledge, qualifications
experience of some of these nurses. They end up on a low grade, and miss out
on career progression.”
At
the sharp end
“I work on a project set up by the Children’s HIV Association
and the University of KwaZulu-Natal. Antiretrovirals are provided by the government
and we donate our time and expertise. I train nurses, counsellors and even
doctors; it’s important because HAART is so new over there.
“I’ve come to understand the Zulu people’s traditional beliefs
and work alongside Muthi medicine and traditional healers.
“The most important part of what I do is get people started on HIV therapy,
and ongoing CD4 and viral load testing. Then we support people as they start
to get well again.
“You see it on TV but, working in absolute poverty, the devastation
caused by HIV and Aids was really brought home to me. Kids bring themselves
to the project because their parents have already died. Sometimes they’ll
be with grandma or auntie, or even the eldest sibling, who might only be 14
or 15 bringing in younger brothers and sisters for treatment.
“You realise how lucky we are with HIV services in the UK. It winds
me up when people constantly complain about healthcare in this country. Here
you can get resources you need; in Africa you improvise.
“I’ve seen patients die because you can’t start treatment
until you’ve got their CD4 count, but by the time you get it, it’s
too late.”
Short-sighted cuts
In November the RCN joined 17 other healthcare unions to protest against 20,000
job cuts in the NHS and increasing privatisation of services. Is the NHS in
crisis?
“There are definitely problems with funding in the NHS and some cuts
seem short-sighted. It may help balance the books this year, but will these
organisations be able to maintain the same standard of patient care with fewer
nurses?
“The NHS is changing constantly, but I think we should slow down on
change and have period of reflection, so we can look at where we are now and
where we want to be in the future.”
Time to modernise
“New government targets say by 2008 everyone will be seen at a sexual
health clinic in 48 hours. This gives an opportunity to look at the way we
work. We need to modernise.
“We could do much more work in the community; at GPs practices, at family
planning clinics. We have three levels of sexual health treatment, and levels
one and two should definitely be out in the community.
“We also need to break down the stigma surrounding sexual health infections,
to normalise it, so it’s ok to talk about it.
“There’s been a lot of pressure on sexual health services in recent
years. Now it’s the government’s political baby, but we had to
practically reach breaking point first.”
HIV Confidential
What was his view on the growing number of prosecutions for transmitting HIV
and the role of clinics in those cases?
“I’m very concerned about preserving confidentiality because I
would never want to hand a patient’s file to the police.
“When a patient sees a doctor or nurse it’s important they can
talk openly about any issue without fear of repercussions. I also wonder if
clinics are doing enough work around disclosure and risk reduction.
“These cases reinforce stigma around HIV, and may put people off disclosing.
But if people aren’t prepared to disclose their HIV status, they should
be practising safe sex.
“I’ve got really mixed emotions about these cases. I can see it
from the point of view of a healthcare professional, as a gay man, and as
someone who has friends who are HIV positive. If someone I trusted knowingly
infected me with HIV, how would I feel about that? It’s a complex area.
Once a nurse...
“First and foremost I’m a registered nurse. That’s something
very close to my heart and I intend keeping my feet on the ground.
“Nurses have become stronger over the last five years, more politically
aware. There are nurse-led clinics, nurse practitioners and consultant nurses.
“I’d also hope to be a role model for nurses training now. If
someone had told me 17 years ago that I was going to be chair of the RCN,
I’d have thought ‘no way!’
• www.rcn.org.uk
