HIV nursing in Poland
Since the beginning of the HIV epidemic, incidence and prevalence in Poland have remained at stable levels and, so far, HIV has been kept under control. The very first case of HIV infection was seen in Poland in 1985, and the first case of AIDS 1 year later. Up to the end of 2008, HIV has been diagnosed in 12,068 Polish citizens, 2189 cases of AIDS have been noted, and 962 people have died. In addition, at the end of 2008, 3822 patients were receiving antiretroviral treatment, which included 117 children. HIV patients are treated in 18 reference units (hospitals) around the country.
People living with HIV (PLHIV), and admitted to the Warsaw Hospital for Infectious Diseases, are currently dispersed to all wards. HIV-positive patients are not isolated in any way and are treated no differently from those who are HIV-negative. In Poland, medical personnel are responsible for their own and their patients’ safety and are obliged to treat all patients as potentially infected with HIV. This is a far cry from the early days of the epidemic. In 1985, the hospital was asked to prepare a place for the first Polish HIV-positive patient. The woman had come back from her job abroad and was directed to the hospital straight from the international Okecie airport, accompanied by her luggage. The nurses had been asked to turn a ward into a room exclusively for her use. All furniture and equipment was taken out, the ward was disinfected and only the most necessary items were returned. The patient was given new personal belongings, such as cutlery and towels for her use only, and all these items were cleaned and disinfected individually. She had a separate WC and a shower, again for her personal use, and she was not allowed to leave her room or be in contact with any other patients. At the time, everyone, including the medical staff, was frightened of HIV transmission.
These days, a relatively large group of HIV patients are regularly treated at the same Warsaw hospital. Over time, patients have made friends with one another and formed a strong social group. This mutual support has had a very beneficial influence on patients’ psychological states and also on the outcome of the treatment. It also ensures that nobody living with HIV feels lonely or isolated at this hospital.
Unfortunately, there are still sometimes acts of discrimination, usually by HIV-negative patients, which are a sad result of the low level of common knowledge about HIV in Poland. Generally, however, over the last 10 years, problems from stigma and discrimination have been reducing. For example, in the early 1990s, the priest Arkadiusz Nowak was unable to establish hospices for people with AIDS because there was such strong opposition on the part of local populations. Medical and nursing personnel who took care of HIV-positive patients at this time also had to cope with stigma and often preferred not to state accurately where they worked, or in which ward of the hospital. This situation can be contrasted with the events 10 years later, when, in 2000, a hospice for people with AIDS was opened in Otwock, near Warsaw, without comment. This positive shift has been brought about by social campaigns launched by, among others, the National AIDS Centre.
The patient profile is also changing. Initially, most patients had acquired HIV through intravenous drug use, but now the majority of patients are men who have sex with men (MSM). More recently, while some patients have also been infected through contaminated blood products, there are now increasing numbers of people being infected via heterosexual sex, confirming that HIV is a problem for all of us.
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Treating patients with HIV is not always easy, particularly those who have other serious problems such as drug addiction. Drug use can make a patient’s behaviour erratic and nurses can be subjected to abuse. In addition, illegal drug use can lead to serious trouble with the police and judicial system, as well as with criminal associates. Nurses often have to assist patients, especially those in hospices, with these matters, for example, helping patients to answer court summons, and even trying to trace the patient’s estranged family and friends.