There are vast differences between HIV nursing models nationally and internationally due to epidemiological variability, differences in health system infrastructure including the scope of nursing practice and access to resources worldwide.
Models of HIV nursing care are similar in resource rich settings to the models existing in Australia, as demonstrated by the translation of HIV and sexual health guidelines from the United Kingdom into an Australian context. These include similarities in access to care through hospital, outreach and collaborative care models and an emphasis on holistic HIV treatment and prevention.    Nurse practitioners and nurse prescribers are well established in the HIV sector in Canada, the United States of America and the United Kingdom, unlike the Australian context. Barriers to the expansion of nurse practitioners specialising in HIV care in Australia include the restrictions to Schedule 100 medication prescribing which exclude nurse practitioners from the Pharmaceutical Benefits Scheme (PBS) prescribing regulations as well as the wider debate in Australia as to the cost effectiveness of nurse practitioners.   This has changed with the advent of PBS listing of Pre- Exposure Prophylaxis (PrEP) in 2018 to include both nurse practitioner and general practitioner prescribing of an antiretroviral combination for the purpose of HIV prevention.
Just as in a resource-rich setting, resource-poor settings typically work in collaborative care models, although the nuances between the models vary and appear largely driven by workforce shortages and a corresponding focus on task-shifting, and an economic imperative in resource-poor settings. This, coupled with a high degree of patients lost to follow-up, co-infection with malaria or tuberculosis and limited access to HIV treatment and prevention strategies equate to a vastly different and challenging nursing environment. Task shifting, or the up-skilling of non-physician health-care workers, has been identified as an effective and economic way to manage the human resources crisis affecting HIV care in resource-poor countries in sub-Saharan Africa.
This practice extends to up-skilling nurses to nurse practitioner-type roles, and community health workers to undertake some nursing duties in order to increase access to HIV treatment, care and prevention strategies. With the current human resources crisis affecting health care in resource-poor settings predicted to worsen, there may be a role to play for nurses in Australasia to work with and support nurses in resource-poor settings to support the HIV treatment and prevention scale-up efforts already in place. Uniting these differing models of health care is the underlying commitment to reduce the burden of HIV on those affected and continue to scale-up the response. Despite a vastly different landscape in HIV nursing in Australia today compared to when the sector developed almost 40 years ago, the same guiding philosophy and commitment to primary health-care principles exist among a sector that remains as bonded as ever.
As HIV in Australia is increasingly being managed as a chronic disease, nurses have a significant role in care delivery, comparable with chronic disease management care for other conditions. The role of nurses in leading chronic disease management approaches has been shown to be feasible and acceptable to both clients and fellow health professionals. Nurses are the largest health profession in Australia and are effective in managing chronic diseases, including HIV. With increasing health-care costs demanding reform, there is a need to continue to support nurses to care for those affected by HIV across all health care settings to prevent avoidable hospital admissions and improve patient outcomes.