I was recently thinking about World AIDS day, which is Dec. 1st. An article about an AIDS conference in Florida that was held this fall caught my interest.

As I was reading, I was reflecting on a time about 10 years ago when our community had a very active AIDS organization, and there was a local walk and special events for World AIDS Day.

Now, because of Federal budget cuts and distribution of funds, many programs have had to consolidate their services as - ours has. There is a walk now; it's just not in Lancaster. People are still involved, but it seems to have hit a plateau. Our office is doing free HIV testing and we have about 10 people a week showing up - which is great. Our work in the clinic continues and we have a steady influx of new patients.

But I miss the open activism of those days. I miss seeing movie stars wearing their red ribbons. AIDS still carries a terrible stigma, but nobody's talking about it. Then I read in the article about one of the things they did was have their volunteers in red T-shirts with candles form a ribbon - the red ribbon. It touched me. Then I began to think about the great team I work with, and all that we do for our patients and the testing services we provide and our great volunteers.

The outreach we do in our community as an HIV clinic and how each member of our staff is dedicated to our patients, to the point where I can't stop thinking about them after I get off work; it hit me. We are living ribbons. Each of us. Those of us in our office and every clinic throughout the country. Pouring ourselves into caring and advocating for people living with HIV/AIDS.

To those of you who go to work each day in your HIV centers and care for a population that is discriminated against, misunderstood and marginalized; to those of you who work so hard to fight the stigma in the face of massive federal budget cuts - let your candles burn brightly and may your T-shirts always be red! Keep going red ribbons!

How do you leave your job and not take your patients with you? Of course I don't mean literally. (Even though I'm sure a few would like to follow me home.)

I mean, how do you get them out of your head? How do you leave your patients behind? I am having great difficulty with this. The longer I am here and the more I get to know these people, the harder it is for me not to be thinking about them at home. I e-mail my boss from home with patient questions and concerns.

They are a needy population for sure, and I know I cannot solve their problems. I know I can only do what I can do for them while they are here - but it persists.

This is the best job I've ever had. I work with the greatest people and absolutely love being in the HIV field. I wouldn't change it for anything.

But at the end of the day, how do you think I should try to keep my patients at the office?

Please reply.

We treasure each and every one of these individuals. There is one standout however, Jon, whom without, our office just wouldn't be the same. He's loyal and dedicated to the staff and our patients. He brightens my mornings with his humor and tales of scoring a "good bargain," and will often bring chocolate. Jon is one of our patients as well. He has been very open with his status and, when given the opportunity, shares his story with others. He is truly a witness to the ravages of AIDS and is a champion of survival. 

Jon is a survivor and contributes to the community at large by involving himself in many civic functions. I have always liked him, as he is quite a likeable guy. Jon had recently involved himself with a very sick patient, who, I didn't think, quite frankly, was going to survive.

We have a patient who, at age 40, has been in a nursing home and not doing very well. He wasn't eating and was losing tons of weight to the point where, last I remember it, he had dropped to around 90 pounds. Jon took it upon himself to not only visit the patient, but to bring him food and feed him. He continued to do this, updating the staff on how he was doing. He brought him into the office one day sitting up in a wheelchair with his hair combed. He had put on some weight and looked wonderful.

In healthcare, you can have all of the technology in the world, but sometimes it just takes compassion and a little human contact to give you your faith back to believe in the goodness of people. That's the kind of guy Jon is.

I've come to learn that these people view our clinic as much more than just their doctor's office. For a lot of patients, we are the only stable thing in their lives. We are always here when they call with their issues. We listen and comfort them without making judgments. We find them the resources they need for housing, food and so on. Our social worker continually goes above and beyond to provide for our patients. She bends over backwards to get patients the services they need, often on her own time.

It's about halfway through the year, and I just had my annual review. I'm coming up on my third year at the clinic.

I was just thinking about the great people I work with at the center. You can have all the passion and energy in the world for what you do, but if you don't have people who share that passion and strive to provide the best, most comprehensive care for your patients; your work life will be very draining and you will struggle to realize if what you are doing has any meaning.

I can say this with some authority as I've unfortunately felt unfulfilled in previous nursing roles.

Our team, on the other hand, is a dynamic group of people who are truly dedicated to the care and well-being of people living with HIV/AIDS.

I feel very fortunate to be able to work in an environment where I can live out my vocation and feel supported while doing so.

I hope all of you are able to experience this.

June 27th was National HIV Testing Day and the first day our clinic offered free HIV screening. We weren't really sure how the response would be, but it turned out to be fantastic. We saw 25 people between 1 p.m. and 5 p.m.

We had a real broad range of people walk through our door. Asians, African Americans Latinos, Whites; men and women from as young as their 20s to 50 and older.

It was so satisfying for me as a nurse to be able to sit down and spend time talking with these people while we waited the 20 minutes for each result. Fortunately, all were negative.

Many were very frank about what brought them to us. There were a lot of questions about transmission and prevention. I was so happy to be able to educate these people on the disease: how it's spread, how it's not spread. I don't think the day could've been more fulfilling. It just reinforced the great need for testing, for education and for awareness of HIV/AIDS.

I hope you are encouraging your patients to get tested. This is an equal-opportunity infectious disease. There is no discrimination - you engage in risky behavior, you are vulnerable.

It's important to know your status. Get tested yourselves!

According to the CDC, 25 percent of those in the HIV-positive population are unaware of their status. Scary statistic.

In 2006, the CDC made a recommendation that everyone between the ages of 13 and 64 be tested at least once - more frequently if you are engaging in risky behaviors.

We had a patient who needed a new mattress. My facility works with a medical equipment company that provides this service. After I had sent all the necessary paperwork, I received a rather startling phone call.

The woman at the supply office was upset that we didn't let them know the patient was HIV-positive. I didn't understand the statement and asked her what that had to do with a mattress delivery. She said they had to have their delivery guys take "special precautions" with the delivery.

I was stunned. I was sharing this with my manager, who offered to call her back and talk with her, and I was grateful for this because I don't think I could be as gracious - as I was really upset about it. (I was picturing them walking into this poor woman's house gowned, gloved and masked to switch out a mattress.)  My manager said she offered to come and educate their staff to no avail. (The woman had "no control over their policies.")

Here's what I know: The HIV/AIDS myths continue, and we need to keep educating the public. We've got a long way to go.

I am hoping those of you who read this and my experiences take a little something away and are able to talk about it at work, share it with your colleagues and keep this infectious disease in people's minds - because it is not going away.

There are several reasons I chose to devote my career to HIV/AIDS.

First, HIV is a virus, an infectious disease spread via blood and body fluids. You can't "catch" cancer or diabetes. So there needs to be an element of education here as there are a lot of misunderstandings when it comes to AIDS and the transmission of the disease - not just among patients but healthcare professionals.

Secondly, I don't think there has ever been a disease that has stigmatized its victims more than HIV/AIDS. Those who are HIV positive are judged by their behaviors and moral standards. I often hear people say they feel sorry for those "who got it through no fault of their own"; but have no compassion for anyone else with the disease.

I read the obituary columns that tell stories of those who "fought a brave battle with cancer," and I truly sympathize with that, but I've never seen anyone eulogized as a "brave" person who has lost the battle to AIDS.

Understand that I am not dismissing those who've lost their lives and those who continue to live with cancer. I am just trying to make a point that there are differences between the way HIV/AIDS is perceived in light of other diseases.

I am so glad to have the opportunity to share my thoughts about this in my blog. My goal is to reach as many readers as possible so I can spread the word, initiate awareness and, hopefully, educate people along the way.

Let's talk about HIV. Let's talk about AIDS. Let's get it back into mainstream conversations. This is a disease that destroys lives, families and people we love. It's not a moral failure, it's a disease.

How has HIV/AIDS affected your lives as nurses?

I was doing what I always do in my clinic: talking to my HIV patients, drawing their blood and listening to their stories. But I was struck by one patient who shared a story of her current recovery efforts from drug and alcohol abuse. She has AIDS, is young and has a son. Really bright and personable, but has lived a rough life. She shared her thoughts on her living arrangements in a halfway house and her goal to get her own place for her and her son. She told me that she never thought she'd make it out [of addiction] alive.

She spoke of how grateful she was that God had blessed her with a friend who stayed with her while she went through the beginning of detox and how this friend stays with her now. Her AIDS diagnosis was a hard blow to her recovery process, but she said the strength of her friendship has been life-sustaining.

Now, I'm not one to get terribly emotional with patients, as I prefer my boundaries, but this one had me in tears.

I thought of my own life and the blessings and gifts I've been given. And then she hit me with "I'm so glad you're my nurse. You make me feel so comfortable and I know I can say anything to you and you'll be cool with it."

I guess that's why I went into nursing.

Let me be perfectly clear: HIV/AIDS is still infecting people in this country. The African American community has been disproportionately affected and infection rates continue to climb. Hispanics are seeing a rise in infections as well.

Even though we know AIDS does not discriminate, there has always been a stigma attached to the disease. The "gay" disease. Drug addicts. People who "get it" do so by "their own fault" ... the "victims" are the children and people who contract it by "no fault of their own." I've heard all of that. It's a shame there is still so much small mindedness and ignorance after all these years.

Then I thought about a new "campaign" for AIDS. New public relations of sorts. A new "image" of AIDS, if you will.

I thought about the ads for breast cancer and how the yogurt manufacturers and other companies from jeans to hardware give money and airtime to breast cancer - not that they shouldn't, and do not misunderstand what I am saying here.

The point I am trying to make is that AIDS awareness needs a makeover. I want corporate sponsorships. I want ads with people of all races in all socioeconomic categories getting together at a party talking about getting tested and about HIV in general. I want an "all-American Mom" and her teenaged girls talking about HIV the way they are talking about HPV and the Gardasil vaccine. I want to see rock-climbing and water-skiing HIV-positive people living their lives like everyone else.

I want to put a better "face" on HIV and bring it back into public awareness. Perhaps then we can get more government funding for much-needed programs and help for more people.

Anyone know a big corporate sponsor I can schmooze? Let me know!

I'd like to chat a bit about the symbolic meaning of ribbons today.

In the past few years there has been an explosion of ribbon displays. It seems there is a ribbon for every cause. I do not know the origin of the general ribbon idea itself, as the yellow ribbon has been a symbol of support for U.S. troops at war for decades.

I do know, however, how the AIDS ribbon came about.

The ribbon was conceived in 1991 by a painter named Frank Moore and was quickly adopted by the Visual AIDS Artists Caucus, an organization made up of artists and art professionals.

But it was the entertainment industry that fueled the fire of activism and got the word out about AIDS awareness. The entertainment industry was hit hard at the beginning of the epidemic and lost many talented people to the disease, and the ribbon first started popping up on lapels of actors at the Emmy and Tony awards.

I think we all remember or know of Ryan White, a young boy who acquired HIV (and eventually died of AIDS) after a blood transfusion in the 1980s. He was ostracized by his community but embraced by the entertainment industry, which publicly supported him. Elton John sang at his memorial service.

Much has changed in 27 years in terms of medications and treatments for HIV/AIDS. AIDS is no longer a death sentence.

But do we still wear ribbons? I know I do. I work with HIV/AIDS patients daily, support local AIDS charities, and continue to educate and provide outreach in the community.

I don't want the ribbon to be just a "symbolic" concern. I want it to be a symbol of actively working towards a cure and a symbol of what it means to support those who are affected by the disease and to fight against stigma and prejudice.

I am not exaggerating the following stories:

1) I speak every couple of months at a nursing school. I talk about our program, the LPN's role, and AIDS education and awareness. I had a student ask me if a person who was HIV positive made some cookies and wanted to be vindictive by putting his infected blood into the cookies would she be at risk for infection.

I think I stood there for a minute with a very confused look on my face. I was waiting for a punch line or someone to jump out and tell me I was on Candid Camera or something.

As it turned out, sadly, this was a legitimate question. It took great composure on my part to answer her without choking her. A nursing student!

2) I recently received a call at work from a woman who had just learned her husband was HIV positive. They have three small children, she told me, and she was concerned about her husband having contact with the kids when they horsed around, ate together or shared the bathroom.

I reassured her that these activities do not spread HIV and that she and the kids were perfectly safe going about their normal routines.

These two instances are of great concern to me. First, if nursing school students are asking questions like this, what in the world are they being taught? The second, sadly, probably reflects a large majority of people still thinking HIV is spread casually.

Still, I chose to use both opportunities as one of those "teachable moments" all nurses encounter. I gave the data. I explained the life cycle of the HIV virus and how it is and isn't transmitted. I reassured them that we do know how HIV is transmitted and that we've dispelled many myths.

HIV/AIDS education is woven into every aspect of what I do for my patients, their families and the public at large. I hope my fellow nurses understand and arm themselves with the knowledge that's needed regarding HIV/AIDS. It's scary out there.

People need to know and understand the facts.

But I soon became very anxious, questioning my ability to give this disease, which really needs more exposure in a manner that better educates healthcare providers and the general public alike, the justice it deserves.

Would I be the activist and educator I want to be, I asked myself. Would others want to read and respond to what I have to say? Would I succeed in discussing the complexities of HIV-nursing intelligently? Would I be able to challenge other nurses and support them at the same time?

If this blog is going to be successful, I'll need feedback from other nurses, my peers. I would like you to ask questions and share your stories about your experiences with me and my audience.

AIDS was clinically identified in 1981 and, as I like to call it, the disease of my generation.

I grew up in the 1980s, and AIDS seemed to be isolated to the gay male population at first, but quickly spread throughout the heterosexual community. In my experiences I've seen members of the gay community unite, actively and effectively lobbying for awareness, research and treatment for those dying within their communities.

It's because of these brave activists, who were part of a community that was frequently ignored and discriminated against, that AIDS awareness reached the mainstream. Their efforts led to government-funded money for research, which eventually led to the development of antiretroviral therapy.

Later, laws protecting HIV-positive and PWAs (persons with AIDS) from discrimination would come. Their activism fueled the rapidly evolving science of HIV medicine and boosted education on the subject.

Sadly, we lost many of these pioneers to the disease. But their work goes on. Twenty seven years later, more than 30 HIV medications exist with more in development. These meds have elevated the life span of PWAs, many of my patients, to the point where they are living their lives like anyone with a chronic, manageable disease, such as diabetes.