Nursing during the 14-year AIDS crisis

It was the early 1980s and a new, mysterious virus had emerged that was a death sentence for thousands of people – many of them previously healthy, young gay men.

By enlisting the gay and IV drug using communities to share HIV prevention strategies among their own, Australia is credited with achieving one of the fastest and most successful responses to the AIDS virus in the world.

But a lesser told story is that health professionals were thrust into a polarising debate about compulsory testing and notification. There was the fear, too, of contracting HIV. And there were the stories of courage and compassion in standing up to prejudice while caring for patients who were dying too young, sometimes rejected by their own families.

In the mid-1990s, new anti-retroviral therapies were introduced that meant death was no longer an inevitable outcome of HIV infection. But in the 14 years between the first Australian HIV diagnosis in 1982 and the introduction of effective anti-retroviral therapy, more than 5100 Australians died of AIDS-related causes. As contrast, 521 Australians died in the Vietnam War.

Monash University history PhD candidate, Geraldine Fela, became intrigued by the invisibility of nurses in accounts of the HIV crisis from the early 1980s to the mid-1990s.

Through her research, including interviews with 30 nurses and unionists, Geraldine discovered that nurses and the ANMF had played ‘a progressive, sometimes radical’ role in the AIDS crisis.

‘Both union officials and rank-and-file members acted in solidarity with HIV/AIDS patients and fought for their rights in medical institutions and the outside world,’ states Geraldine in her article in the November 2018 Labour History journal.

The ANMF pushed for universal precautions to be introduced to manage HIV infection risks for healthcare professionals, opposing the Australian Medical Association’s and Australian Association of Surgeons’ campaigning for compulsory HIV testing of surgical patients.

It didn’t surprise Geraldine that nurses, in the main, took a patient-centred approach to the AIDS crisis.

‘Once I started hearing about the nursing that was being done and the intimate relationships that nurses were forming with patients, it’s very clear that nurses would have a more compassionate and thoughtful approach towards (compulsory) testing,’ Geraldine said.

Nurses caring for HIV-positive patients in Melbourne’s metropolitan HIV specialist hospitals – Fairfield Infectious Diseases Hospital, and later, The Alfred Hospital – were especially connected with the gay community.

‘They had very close relationships with patients; they might even have been their friends. A lot of men nursed their lovers on the ward, so they were really intimately connected,’ Geraldine said.

Nurses conducted outreach work at gay saunas in Melbourne, testing men for sexually transmitted infections, including HIV. A former clinical nurse specialist at an HIV/AIDS clinic recalled it was ‘an incredibly stressful and sad time.’

The former nurse, who is now a psychotherapist and wishes to remain anonymous, said: ‘Young men were dying from this dreadful and not fully known disease in the prime of their lives. As a front-line health professional, it was emotionally challenging and relentless’.

In the early to mid 1980s, gay sex was still illegal in some Australian states and as there was no effective treatment for HIV/AIDS, gay men were reluctant to get tested. There were fears of being exposed to the discrimination that was rife at the time. The NSW and Queensland governments enacted compulsory notification legislation, meaning that doctors in those states were compelled to notify the government of HIV cases.

A nursing student’s experience in Warrnambool demonstrated that gay men’s fears around disclosing their HIV status were warranted.

‘Nurses in defence‘

In 1985 Jill O’Flynn and Karen Daws were completing their third year of nursing training at Warrnambool Base Hospital when they heard a radio station had outed a friend of theirs – a fellow nursing student – as being HIV-positive. The Warrnambool Standard newspaper published an article headlined ‘AIDS suspect’ and a letter to the editor which questioned whether people who were gay should be nurses.

Jill, who was 21 at the time and Karen, who was 23, are still friends. Now working as nurses in Melbourne, the pair wrote a letter to the editor of the Warrnambool Standard addressing the ‘scathing’ letter to the editor about their friend Barry, who was also Jill’s second cousin. Both letters, retrieved from the State Library Victoria records, are printed below.

‘I can’t remember what (the first letter) said but it was pretty homophobic and (said) that people with HIV shouldn’t be nurses… and so we wrote a letter saying no we don’t agree,’ Karen recalled.

‘My sense of it was we said we look after anyone and we’re quite happy to do that, and anyone should be able to be a nurse.’
Jill remembered rebuking the letter writer’s homophobia.

‘It was just outrageous, that you would say that someone can’t do their job because you’re frightened they might give it (HIV) to you. It’s just rubbish,’ Jill said.

Although the newspaper had given Barry the pseudonym ‘Paul’, as one of only two male nurses at a small-town hospital, it was not difficult for the community to identify Barry as the nurse who had contracted HIV.

Barry had earlier told his nursing friends that he was HIV-positive and explained to them that he posed no risk to them or to patients.

‘As nurses we’d heard about HIV but didn’t really have any experience of it,’ Karen recalled. It wasn’t until 1987 that the infamous Grim Reaper ad would appear on television spreading the message that unsafe sex could lead to HIV and death.

‘A couple of charge nurses (nurse unit managers) were very supportive and knew we were good friends (with Barry). One of them sent me off the ward to go and find him on the day it came out on the radio, to make sure he was alright,’ Karen said.

The other charge nurse, recognising the distress for Barry of being diagnosed with a fatal virus then exposed as HIV-positive within his community, invited him to lie low at her house on the Mornington Peninsula.

‘I was quite angry that (Barry) had told someone out of his sense of responsibility and that person had gone to the radio station.

To me that was shocking and they failed in their responsibility towards him,’ Karen said.

Six weeks after their letter was published, the two nurses finished their training and left for Sydney, the epicentre of HIV/AIDS infection, where they would find out a lot more about the virus as they nursed people with AIDS.

Barry died at his Seddon home in 1991, with his nurse friends caring for him until the end. His funeral, held in Warrnambool, was well-attended, Karen recalled. “Baz was a really fun person. He was a really lively, funny person.’

ANMF was successful in its advocacy for the introduction of universal precautions to manage risk of HIV infection to healthcare professionals. This had the side benefit of improving occupational health and safety for nurses against all blood-borne infections, Karen said.

‘We may have given compassionate care but we were put at risk in terms of the way we did things,’ she said.

‘We didn’t use gloves ever, for any practices, and I’m pretty sure if we got a needle stick injury we would have just gone “Oh whatever” and washed our hands.’

It was no accident, Geraldine says, that nurses’ advocacy for universal precautions in the 1980s coincided with a move to university education for nurses and ANMF (Vic Branch) members flexing their industrial muscle in pursuit of better wages and conditions – most notably in the 1986 50-day nurses’ strike.

‘Nurses were so often dismissed as the doctor’s handmaiden…

In this period, nurses are starting to say “No, we’re actually experts and we have a very important role to play – and we’re going to fight for that recognition”,’ Geraldine said.

‘So when you get doctors saying “We want (compulsory) testing”, nurses come back with their own vision of what the appropriate healthcare model should be, and they had the confidence to fight for that because of this industrial context.

‘Now we just take universal precautions for granted but it’s fascinating to read back through the archives and see what doctors were saying about them right into the early 1990s…

“This is ridiculous”, “It’s too expensive”, “How absurd”, “How time-consuming”.’