Reading the address of Stephen Lewis, then the special U.N. envoy for HIV/AIDS in Africa, to the 2005 International Council of Nurses 23rd Quadrennial Congress was heartbreaking, inspiring and thought-provoking.

With the disease reaching pandemic proportions in Africa and spreading to China, Asia and elsewhere, Lewis called on nurses to speak up so that resources (knowledge and drugs) are shared, behaviors change and the status quo is challenged.

"Nurses didn't expect, in the course of their training and their work, to have to mount the barricades, to have to begin using their voices in a way which would rally society or criticize the establishment. But I have to say to you that AIDS has changed absolutely everything," Lewis said.

It got me thinking about the role of nurses in this country at the beginning of the AIDS outbreak 25 years ago — nurses who changed bed sheets five times a night, held young men as they died in their arms and wondered whether they would contract the devastating disease.

"Nurses were always in the direct line of care; they were the unsung heroes," said Andrea Lewis, RN, BSN, MHA, director of the Medical-Surgical Nursing Department for Grady Health System. "They were the connection between patients and the man on the street."

Those nurses — individually and collectively — let people know what was real and what was a rumor in relation to AIDS.

By 1987, nurses in the Northeast had organized the Association of Nurses in AIDS Care (ANAC) to share experiences, develop a knowledge base, initiate a research agenda, fight complacency, advocate for patients and educate the public. A new nursing specialty had been born.

The Atlanta chapter of ANAC, which was founded in 1992, is still working toward those goals.

"Our members accomplished a lot this year," said Donna Chambers, RN, MS, FNP-C, instructor at Kennesaw State University's nursing school and past president of Atlanta ANAC.

Some examples:

• One chapter member heads KHARMA (Keeping Healthy and Active With Risk Reduction and Medication Adherence), a National Institute of Health-funded HIV/AIDS project through Emory University.

• Another edits ANAC's national journal.

• One student member led a group that raised $13,600 for AIDS Walk of Atlanta.

Chambers is proud of the Atlanta chapter's efforts to fight AIDS. "We participated in the National HIV Testing Day and initiated a project to train ER staff on the symptoms of drug interactions in AIDS patients," she said.

The AIDS epidemic is controlled but far from over in the United States. There is no cure, and about 40,000 people a year become infected.

Thanks to new drug therapies, patients live longer, but the high cost creates disparities in who gets treated. AIDS incidence rates have leveled off in the gay community but have climbed steadily among minorities, IV drug users and the indigent. Yet, the Ryan White CARE Act, which funds clinics nationwide, passed in Congress only at the last hour.

While the early stigma of the disease has decreased, AIDS nurses are still fighting ignorance and complacency. Carla Johnson, RN, BSN, ACRN, clinical manager at Grady Health System's Infectious Disease Program clinic, calls it "AIDS fatigue."

"People are tired of hearing about the crisis," she said. "There's a public perception that AIDS is no longer a serious problem in this country."

"Young people tell me that being HIV-positive is no big deal. They'll just take some meds and be fine, like [former basketball superstar] Magic Johnson," said Marie Todd-Turner, RN, BSN, M.Ed., ACRN, clinical manager for Grady's Infectious Disease Program. "It is a big deal, and they have no idea of what it means to have AIDS. We want to remain vigilant, and we need to find a cure. People are dying in Africa, and they're dying here, too. We can't afford to let our guard down.

"It's important to practice safe sex, to know the risk factors, to be tested. That's the message that we preach constantly."

You can read Lewis's full address in the April/May 2006 issue of Imprint or at www.nsna.org.

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