Jeffrey Kwong, DNP, MPH, ANP-BC
Director, Adult-Gerontology Nurse Practitioner Program
Jeffrey Kwong, DNP, joined the CU Nursing faculty this summer as Director of the Adult-Gerontology Nurse Practitioner Program and as an assistant professor. He has more than 16 years of clinical experience in HIV care and has worked with diverse populations including people with addictions, the homeless, and the LGBT community. Kwong has practiced in a variety of settings including university medical centers, community centers, and outpatient clinics. He is a certified HIV specialist by the American Academy of HIV Medicine and is also certified by the Association of Nurses in AIDS Care. He currently serves as secretary for the Greater New York Chapter of the Association of Nurses in AIDS Care.
Q: During the onset of the epidemic in the 1980s, AIDS was an inevitable death sentence. Today, we are able to treat HIV/AIDS as a chronic disease. What are the some of the clinical challenges for nurses when dealing with long-term complications from managing AIDS as a chronic disease?
A: In the beginning of the epidemic, nurses focused mainly on palliative and end of life care. Today, we’re seeing complications of long-term HIV infection as well as the long-term effects of antiretroviral treatment. Although we still see individuals who present with opportunistic infections, the majority of patients in care are experiencing conditions like heart disease, metabolic complications, liver disease, renal disease, and cancer. The focus for nurses is now on cardiovascular risk reduction, nutrition, screening, detection for malignancies, and smoking cessation to help these patients minimize the impact of these co-morbidities. This has made nurses shift to a wellness model from an illness model when we educate and counsel patients.
Helping patients adhere to treatment remains a vital role for nurses despite the advances in treatment such as single tablet regimens. The current HIV guidelines recommend treatment for all individuals, regardless of their level of immune compromise. Previously, patients would only take medications if they had more advanced diseases, but newly-infected people are now encouraged to start treatment even if they have very strong immune systems, to keep them healthy and reduce or minimize the risk of transmitting HIV.
Q: Your focus has been on HIV/AIDS from the very beginning of your career. What inspired you to devote you career to helping people with this disease?
As a young gay man, I saw firsthand the devastation that this disease had on my community, and I wanted to make a difference. I began working in the HIV field in 1986, volunteering for a local HIV community service organization in Northern California, as a “buddy” providing companionship and assistance to persons living with HIV. I knew how isolating and stigmatizing this disease was, and I felt no one should die alone. Once I got involved, my passion for helping people with the disease grew. My commitment never ceased, even though the demographics of the epidemic have shifted. There still is a tremendous amount of stigma and injustice associated with HIV, regardless of who is affected.
I have learned so much from my patients and in the communities I’ve cared for over the years. They inspire me and have touched me in many ways. I continue to devote my career in this field to them.
Q: Two patients in Boston seem to be free of HIV after undergoing bone marrow transplants for cancer. Do you think a cure for HIV infection is on the horizon?
These cases of cures or functional cures are very exciting and promising. We are at a turning point in history where we have most of the tools and evidence we need to end the HIV epidemic. We have effective treatments, biomedical means of prevention, and national policies that support testing, treatment, and access to care.
My dream would be to have a cure in my lifetime. If you asked me five years ago, I would have said that it was impossible. But things may change with these recent advances. If you told me in 1993 that we could one day treat HIV with a single pill taken once a day, I wouldn’t have believed it. And now in 2013, we have three single tablet regimens to treat HIV. I’ve learned to never underestimate the power of science and technology.
Q: You’ve said that as a nurse practitioner, your philosophy of care is focused on promoting wellness. When a patient exhibits symptoms for a particular problem, how do you shift the conversation to prevention and wellness?
I always try to incorporate health promotion and health maintenance into every visit, even if patients come in for an acute complaint. I reserve a few minutes to check-in with them about their lives, by asking about their work, sleep, mood, or hobbies. Their answers usually give me an opportunity to incorporate a health maintenance recommendation or reminder. It can be about stress reduction, exercise, smoking cessation, safer sex, oral health, or nutrition. It’s amazing what you can fit into a couple of minutes. When I have to see 20 patients in a day it can be challenging to fit in, but I believe they appreciate it.
Q: Many of the Adult-Gerontology Nurse Practitioner students will encounter marginalized populations in their careers as advanced practice nurses. What are some of the challenges of teaching students to work with these patients?
It's a big challenge making sure students feel comfortable approaching patients and teaching them how to ask the right questions in order to deliver appropriate care. The majority of our students are aware of the importance of cultural sensitivity and diversity in health care, but some may encounter populations with whom they’ve never interacted. So I emphasize the importance of getting to know the populations they are working with in their clinical rotations not only in terms of their health problems, but also in context of their cultures. It’s also important for students to recognize their own preconceptions and biases of populations and cultures before entering the clinical arena. I try to emphasize that all patients want and deserve the same thing– unconditional care– and it’s our job to provide it to them. By providing our students with exposure to diverse populations, we’re preparing a workforce that will be able to provide the highest quality care to everyone.